Tổng quan
Nghiên cứu cho thấy mối liên quan nghịch đảo giữa tiêu thụ cà phê vừa phải và nguy cơ phát triển một loạt các bệnh về gan bao gồm ung thư, xơ hóa và xơ gan.
Tiêu thụ cà phê vừa phải thường được xác định là 3-5 cốc mỗi ngày, dựa trên đánh giá của Cơ quan an toàn thực phẩm châu Âu về an toàn caffeine 1.
Cơ quan Nghiên cứu Ung thư Quốc tế (IARC) không tìm thấy mối liên hệ rõ ràng giữa lượng cà phê và ung thư tại bất kỳ vị trí cơ thể nào và cho rằng uống cà phê thực sự có thể giúp giảm nguy cơ mắc một số bệnh ung thư, bao gồm cả ung thư gan .
Các phân tích tổng hợp đã gợi ý rằng tiêu thụ cà phê so với không tiêu thụ cà phê có liên quan đến việc giảm tới 40% nguy cơ ung thư gan (mặc dù đây là mối quan hệ phụ thuộc vào liều) 3.
Nghiên cứu cho thấy rằng uống cà phê có liên quan đến việc giảm nguy cơ xơ gan , xơ hóa , bệnh gan mãn tính và phát triển bệnh gan nhiễm mỡ không do rượu.
Nghiên cứu ở những bệnh nhân mắc bệnh gan liên quan đến viêm gan C tiến triển cũng cho thấy rằng tiêu thụ cà phê thường xuyên, vừa phải có liên quan đến tỷ lệ tiến triển bệnh thấp hơn.
. Nghiên cứu ở những bệnh nhân mắc bệnh gan liên quan đến viêm gan C tiến triển cũng cho thấy rằng tiêu thụ cà phê thường xuyên, vừa phải có liên quan đến tỷ lệ tiến triển bệnh thấp hơn.
Một số cơ chế có thể đang được nghiên cứu để giúp tìm hiểu xem, và ở mức độ nào, caffeine có liên quan đến mối liên hệ nghịch giữa tiêu thụ cà phê và các bệnh gan này.
Ví dụ, chất chuyển hóa caffeine chính, paraxanthine, dường như ngăn chặn sự tổng hợp CTGF ( yếu tố tăng trưởng mô liên kết) thông qua một loạt các chu kỳ kiểm soát, sau đó làm chậm sự tiến triển của xơ gan, xơ gan và ung thư gan.
Các cơ chế được đề xuất khác bao gồm tác dụng chống ung thư của cafestol và kahweol , và tác dụng chống vi rút có thể có của axit chlorogen và axit caffeic.
Thông tin lai lịch
Hiệp hội Nghiên cứu Gan Châu Âu ước tính có khoảng 29 triệu người ở Liên minh Châu Âu bị bệnh gan mãn tính. Bệnh gan mãn tính là nguyên nhân gây tử vong phổ biến thứ năm ở châu Âu.
Dữ liệu cho thấy khoảng 0,1% dân số châu Âu bị ảnh hưởng bởi bệnh xơ gan, tương ứng với ước tính 170.000 ca tử vong mỗi năm.
Có nhiều biến thể trong nội bộ châu Âu, ví dụ khoảng 0,1% nam giới Hungary chết vì xơ gan mỗi năm, so với 0,001% nữ giới Hy Lạp.
Viêm gan, bệnh gan phổ biến nhất, ước tính ảnh hưởng đến hơn 10 triệu người ở Châu Âu.
Ung thư gan là nguyên nhân phổ biến thứ năm gây tử vong liên quan đến ung thư trên toàn cầu và phổ biến thứ 14 ở châu Âu. Nó chiếm 5,4%, tương đương 695.000 ca tử vong trên toàn thế giới (47.000 ca tử vong ở châu Âu).
Ung thư gan là nguyên nhân hàng đầu gây tử vong ở bệnh nhân xơ gan.
Các dự báo dịch tễ học đã gợi ý rằng số người có nguy cơ mắc bệnh gan mạn tính đang tăng
Tiêu thụ cà phê và chức năng gan
Cà phê và nguy cơ ung thư gan
Trong năm 2016, Cơ quan Quốc tế Nghiên cứu về Ung thư (IARC) công bố một sự xem xét cập nhật của các bằng chứng khoa học liên quan đến cà phê và ung thư.
Việc tìm kiếm không có bằng chứng thuyết phục cho một hiệu ứng gây ung thư của cà phê nói chung, và ,kết luận rằng các nghiên cứu cho thấy mối liên quan tỷ lệ nghịch giữa tiêu thụ cà phê và ung thư gan 9 .
Bốn phân tích tổng hợp của cả nghiên cứu đoàn hệ và nghiên cứu trường hợp tương lai, xem xét ung thư gan, kết luận rằng tất cả mười nghiên cứu dịch tễ học được xem xét cho thấy mối liên hệ nghịch đảo giữa tiêu thụ cà phê và ung thư gan 3-6 .
Kết quả của các nghiên cứu đoàn hệ có trong các phân tích tổng hợp chỉ ra mối quan hệ liều đáp ứng giữa tần suất tiêu thụ cà phê và giảm nguy cơ ung thư gan.
Dữ liệu từ nghiên cứu đoàn hệ đa sắc tộc Hoa Kỳ cũng cho thấy rằng tiêu thụ cà phê có liên quan nghịch với tỷ lệ mắc ung thư tế bào gan, cho thấy giảm 38% nguy cơ ở những người uống 2-3 tách cà phê mỗi ngày và 41% ở những người uống nhiều hơn hơn 4 cốc 34 .
Hai nghiên cứu lớn 35,36 cũng cho thấy mối liên hệ tương tự, với mức giảm rủi ro lên tới 72% ở những người uống cà phê cao nhất trong nghiên cứu EPIC 35 và 54% ở những phụ nữ uống hơn 3 tách cà phê mỗi ngày Hiệp hội Hoa Kỳ 36.
Điều thú vị là nghiên cứu của Mỹ cho thấy hiệu quả lớn hơn ở phụ nữ so với nam giới. Dữ liệu từ Phần Lan đã xem xét vai trò của loại cà phê, kết luận rằng lượng cà phê có liên quan nghịch với ung thư gan và tử vong do bệnh gan mãn tính, bất kể cà phê được đun sôi hay lọc 37 .
Mối liên quan nghịch đảo giữa tiêu thụ cà phê và ung thư gan được quan sát cả ở những người tham gia có và không có tiền sử bệnh gan. Ví dụ, các nghiên cứu kiểm soát trường hợp ở bệnh nhân viêm gan cho thấy rằng tiêu thụ cà phê có liên quan đến việc giảm nguy cơ ung thư biểu mô tế bào gan 38,39 , với một trong những nghiên cứu nhấn mạnh vai trò tiềm năng của việc tiêu thụ cà phê trọn đời khoảng 3 tách cà phê mỗi ngày .
Nhìn chung, uống cà phê có liên quan đến việc giảm tới 40% nguy cơ ung thư gan so với những người không uống cà phê 34-39 .
Cà phê và nguy cơ mắc các bệnh gan khác
Uống cà phê cũng có liên quan đến việc giảm nguy cơ mắc các bệnh gan khác. Một đánh giá có hệ thống được công bố vào năm 2014 cho thấy tiêu thụ cà phê có liên quan đến kết quả có lợi ở bệnh nhân mắc bệnh gan mạn tính, xơ gan, ung thư tế bào gan và bệnh gan nhiễm mỡ không do rượu 7 .
Một đánh giá năm 2016 cũng kết luận rằng uống cà phê hơn 2 tách mỗi ngày ở bệnh nhân mắc bệnh gan từ trước có liên quan đến tỷ lệ xơ hóa và xơ gan thấp hơn, tỷ lệ ung thư tế bào gan thấp hơn và giảm tỷ lệ tử vong 9 .
Xơ gan
- Một đánh giá kết luận rằng những bệnh nhân có mức tiêu thụ cà phê cao hơn cho thấy quá trình xơ hóa nhẹ hơn, đặc biệt là trong bệnh gan do rượu 10 .
- Dữ liệu từ các khảo sát kiểm tra dinh dưỡng và sức khỏe quốc gia Hoa Kỳ (NHANES 1999-2010) cho thấy rằng lượng cà phê cao hơn (bao gồm cả cà phê khử caffein) có liên quan đến mức men gan thấp hơn 40 .
- Dữ liệu từ nghiên cứu Rotterdam Nghiên cứu ở những bệnh nhân bị gan nhiễm mỡ không cồn cũng cho thấy rằng tiêu thụ cà phê hàng ngày từ ba tách trở lên sẽ làm giảm độ cứng gan (một dấu hiệu của bệnh xơ gan ) 41 .
Bệnh gan mãn tính
- Một nghiên cứu của Scotland cho thấy uống cà phê có liên quan đến việc giảm tỷ lệ mắc bệnh xơ gan ở bệnh nhân mắc bệnh gan mạn tính 12 .
- Dữ liệu từ Hiệp hội đa sắc tộc Hoa Kỳ kết luận rằng uống cà phê có liên quan đến việc giảm tỷ lệ mắc bệnh gan mãn tính. So với những người không uống cà phê, tiêu thụ 2-3 cốc mỗi ngày có liên quan đến việc giảm 46% nguy cơ tử vong do bệnh gan mãn tính và lớn hơn 4 cốc mỗi ngày với mức giảm 71% 34 .
Bệnh gan nhiễm mỡ không do rượu
- Một nghiên cứu ở Bắc Mỹ để điều tra các tác động của hành vi ăn kiêng ở bệnh nhân mắc bệnh gan nhiễm mỡ không do rượu, sử dụng bốn chu kỳ khảo sát kiểm tra sức khỏe và dinh dưỡng quốc gia (NHANES 2001-2008), cho thấy lượng caffeine có liên quan độc lập với nguy cơ thấp hơn bệnh gan nhiễm mỡ không do rượu, cho thấy tác dụng bảo vệ tiềm năng 14 .
- Một nghiên cứu năm 2012 liên quan đến tiêu thụ caffeine cà phê với tỷ lệ lưu hành và mức độ nghiêm trọng của bệnh gan nhiễm mỡ không do rượu. Tiêu thụ caffeine cà phê có liên quan đến việc giảm đáng kể nguy cơ xơ hóa ở những bệnh nhân bị viêm gan nhiễm mỡ không do rượu 15 .
- Một nghiên cứu kiểm soát trường hợp ở Mexico đã xem xét tác dụng chống oxy hóa của cà phê bằng cách đo các enzyme chống oxy hóa và các dấu hiệu peroxid hóa lipid ở bệnh nhân mắc bệnh gan nhiễm mỡ không do rượu và ở những bệnh nhân không mắc bệnh gan nhiễm mỡ không do rượu. Họ phát hiện ra rằng một lượng cà phê cao có tác dụng bảo vệ chống lại bệnh gan nhiễm mỡ không do rượu; tuy nhiên không có sự khác biệt đáng kể trong các biến số chống oxy hóa được phân tích 16 .
- Dữ liệu từ 728 người trưởng thành trong Mạng nghiên cứu lâm sàng viêm gan không do rượu (NASH-CRN) cho thấy rằng uống cà phê có liên quan nghịch với xơ hóa tiến triển ở bệnh nhân mắc bệnh gan nhiễm mỡ không do rượu 17 .
- Ba đánh giá tiếp theo cho thấy giảm đáng kể nguy cơ mắc bệnh xơ gan ở những bệnh nhân mắc bệnh gan nhiễm mỡ không do rượu đã uống cà phê 18-20 . Một trong những đánh giá này cho thấy thêm rằng tiêu thụ caffeine cà phê thường xuyên, chứ không phải tổng lượng caffeine, có liên quan đến việc giảm nguy cơ 19 .
Viêm gan C
- Một nghiên cứu đoàn hệ tương lai của Hoa Kỳ đã tuyển dụng 766 bệnh nhân nhiễm viêm gan C và theo dõi họ trong gần bốn năm 21 . Tổng cộng có 230 bệnh nhân cho thấy tiến triển bệnh nghiêm trọng, ví dụ như xơ gan hoặc tăng 2 điểm trong số điểm xơ hóa của Ishak (điểm số mô học của tiến triển thành xơ hóa, với điểm số từ 0 đến 6). Tiêu thụ trà không liên quan đến kết quả nghiên cứu. Tuy nhiên, tiêu thụ cà phê thường xuyên có ý nghĩa thống kê liên quan đến tỷ lệ tiến triển bệnh thấp hơn.
- Một nghiên cứu Pháp đã phát triển để đánh giá tác động của tiêu thụ caffeine đối với hoạt động cấp và giai đoạn xơ hóa ở bệnh nhân viêm gan C mãn tính phát hiện ra rằng tiêu thụ caffeine hơn 408 mg / ngày có liên quan đến hoạt động mô học giảm ở những bệnh nhân 22 .
- Một nghiên cứu trên bệnh nhân bị nhiễm virus viêm gan C cho thấy trong số những người bị nhiễm trùng mãn tính, tiêu thụ cà phê được lọc hàng ngày có thể có tác dụng tốt trong việc ổn định huyết thanh men gan alanine aminotransferase (ALT) 23 .
- Dữ liệu từ Nghiên cứu Y tế Trung Quốc Singapore, một nhóm nghiên cứu dựa trên dân số gồm 63275 người trưởng thành, cho rằng có mối liên quan nghịch đảo phụ thuộc liều mạnh giữa lượng cà phê và nguy cơ mắc bệnh xơ gan không liên quan đến viêm gan. So với những người không uống cà phê, những người uống hơn 2 cốc mỗi ngày đã giảm 66% nguy cơ tử vong. Tuy nhiên, không có mối liên hệ giữa tiêu thụ cà phê và viêm gan B liên quan đến xơ gan 8 .
Nếu bệnh nhân thay đổi thói quen hoặc chế độ ăn uống do bệnh của họ hoặc liệu pháp tiêu chuẩn của nó, điều này có thể làm sai lệch nghiên cứu quan sát. Do đó, điều quan trọng là phải đánh giá xem các yếu tố gây nhiễu như vậy có được tính đến đầy đủ hay không.
Các nghiên cứu kiểm soát trường hợp đặc biệt dễ bị sai lệch, đặc biệt khi các bệnh nhân khác được sử dụng làm đối chứng; nghiên cứu đoàn hệ tương lai ít bị ảnh hưởng bởi kiểu sai lệch này.
Cơ chế tiềm năng
Theo các nghiên cứu trên, có một số bằng chứng dịch tễ học cho mối liên quan nghịch đảo giữa tiêu thụ cà phê và ung thư gan. Điều tương tự có thể là trường hợp xơ hóa gan và xơ gan do rượu. Rõ ràng, một cơ chế sinh học hợp lý là cần thiết để giải thích và xác nhận các hiệp hội này.
Vai trò của cafein
Caffeine đã được đề xuất như là một thành phần chính trong các mối liên quan được quan sát giữa tiêu thụ cà phê và giảm nguy cơ mắc bệnh gan 10,25,26,42,43 . Các cơ chế chính xác đằng sau hiệu ứng này là không rõ ràng, tuy nhiên một số cơ chế tiềm năng đã được đề xuất.
Một số bài báo đã đề xuất rằng caffeine, và đặc biệt là chất chuyển hóa chính của nó, paraxanthine, có thể ngăn chặn sự tổng hợp CTGF (yếu tố tăng trưởng mô liên kết) thông qua một loạt các chu kỳ kiểm soát, do đó làm chậm sự phát triển của loại mô này.
Lần lượt làm chậm sự tiến triển của xơ gan, xơ gan do rượu và ung thư gan 9,25,26,42 . Tuy nhiên, một số nghiên cứu dịch tễ học không tìm thấy mối liên hệ với trà, điều này cho thấy cơ chế hoạt động có thể không chỉ phụ thuộc vào caffeine (thông qua paraxanthine).
Người ta cũng đề xuất rằng caffeine có thể hoạt động thông qua việc ngăn chặn các thụ thể adenosine, vì cấu trúc của các chất bắt chước caffeine của adenosine 43 , do đó ức chế kích hoạt các tế bào gan.
Tuy nhiên, cần lưu ý rằng caffeine có thể không phải là thành phần quan trọng nhất, vì các loại đồ uống chứa caffein khác dường như không cung cấp sự bảo vệ tương tự chống lại bệnh gan 41 .
Thành phần cà phê khác
Một bài báo năm 2010 cũng đề cập đến vai trò tiềm năng của các thành phần cà phê kahweol và cafestol trong việc giảm nguy cơ ung thư gan 27 . Có một số bằng chứng cho thấy chúng có thể có đặc tính chống ung thư 27 .
Người ta cũng đề xuất rằng các polyphenol có trong cà phê, chẳng hạn như axit chlorogen, có thể làm giảm căng thẳng oxy hóa ở gan, từ đó làm giảm nguy cơ xơ hóa và phát triển ung thư 43 .
Một bài báo khác xem xét vai trò của axit chlorogen và axit caffeic trong cà phê, được chứng minh là có khả năng ngăn chặn sự nhân lên của virus viêm gan B, cả in vitro và in vivo 41 .
Nguồn : www.coffeeandhealth.org
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