1. Moderate consumption of unsweetened and sugar-sweetened coffee was associated with reduced mortality from cancer and cardiovascular disease as compared to coffee abstinence.
2. Reduction in mortality for unsweetened coffee drinkers was sustained in subgroup analysis across lifestyle and sociodemographic factors.
Evidence Rating Level: 2 (Good)
Study Rundown: Previous observational studies have shown associations between coffee consumption and reduced risk of all-cause mortality. However, there is a paucity of data on the comparative mortality benefit of different types of coffee and the inclusion of sweeteners. The present prospective cohort study used data from the United Kingdom Biobank to evaluate the association between mortality and consumption of unsweetened, sugar-sweetened, and artificially sweetened coffee. Participants were followed for seven years after enrollment. Consumption of unsweetened coffee was associated with reduced risk of all-cause, cancer-specific, and cardiovascular-specific mortality after adjusting for lifestyle, sociodemographic, and clinical factors. Consistent associations between unsweetened coffee with reduced mortality were found for instant, ground, and decaffeinated coffee. Sugar-sweetened coffee was also significantly associated with reduced all-cause and cancer-specific mortality. The study was unable to find conclusive associations between artificially sweetened coffee drinkers and mortality due to the low sample size and statistical power of this group. There are several limitations to cohort studies that may impact the generalizability of these findings. These include self-selection bias of the participants, measurement error related to type and frequency of coffee consumption, and relatively short follow-up time.
In-Depth [prospective cohort]: The present study used data from the United Kingdom Biobank to evaluate the association between unsweetened, sugar-sweetened, and artificially sweetened coffee with mortality. Data on coffee consumption was obtained from a questionnaire that was administered to participants five times over one year about their dietary intake, including coffee, over the previous 24 hours. In the study cohort (n=171,616), 75.8% of participants reported drinking coffee at least one timepoint. Most coffee drinkers consumed unsweetened coffee (55%), followed by sugar (14%), and artificially (6%) sweetened coffee. The median follow-up time was seven years (interquartile range, 6.6 to 7.8). There was a significant U-shaped association between unsweetened coffee and sugar-sweetened coffee with all-cause mortality (p<0.001). The most beneficial effects are seen with moderate coffee consumption with increasingly harmful effects with excessive consumption. For unsweetened coffee, consumption of any amount was associated with a reduced risk of all-cause mortality after adjusting for lifestyle, sociodemographic, and clinical factors. Artificially sweetened coffee was not associated with improvements in risk for all-cause mortality. There was also a significant U-shaped association between unsweetened coffee and cancer and cardiovascular mortality (p<0.001). Moderate consumption of sugar and artificially sweetened coffee were weakly associated with lower cancer mortality. In summary, this study suggested potential health benefits associated with consuming unsweetened coffee compared to sugar or artificially sweetened coffee.
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