Coffee, Italian-style

In a study reported in the Journal of Nutrition: Nutritional Epidemiology (2020;0:1-10), the researchers affiliated with the Moli-sani Study (a large-scale, long term prospective study of over 20,000 Italian men and women) estimated the risk of death from all causes, cardiovascular disease, and cancer for increasing levels of coffee intake.

One of the issues with studying coffee intake is that there are so many ways to prepare and consume it: it's difficult, for example, to compare those who drink filtered, drip coffee (the most common type of coffee consumed in the United States) with those who drink espresso, which is usually much more highly caffeinated and is not passed through a filter.

The majority of Italians apparently consume their coffee in the form of espresso or espresso-based drinks that include milk, such as cappuccino or lattes. The food frequency survey administered for the Moli-sani Study bases its measure of coffee intake in the standard Italian 30-milliliter cups - not the 4-8 ounce sizes more common in the US. (For reference, 30 milliliters is about 1 ounce.)

The Moli-sani Study recruited participants from 2005 to 2010, with data collection continuing today. For today's research the authors excluded from their analysis all participants with a history of cardiovascular disease (CVD) or cancer, implausible responses to dietary or medical questionnaires, and those who were lost to follow-up.

Coffee intake was grouped into 4 increasing levels of intake: <1 cup per day,>1 and up to 2 cups per day, >2 and up to 3 cups per day, >3 and up to 4 cups per day, and over 4 cups per day. Again, this was standardized to the Italian 30ml cup.

The authors compared the coffee intake of those who passed away during the study with those who did not, taking into account a number of variables that included age, sex, caloric intake, Mediterranean Diet Score, education, smoking status, and diagnoses such as high blood pressure, poor cholesterol scores, or diabetes.

They found that those who drank at least 3 cups of Italian coffee per day reduced their risk of death from all causes by 28% and the risk of death from heart disease by 42%, while the risk of death from cancer at those levels of consumption only fell by 18%.

Drinking more than 3 cups of coffee per day did not improve their relative risk much further, and in the case of cardiovascular disease, drinking more than 3 cups of Italian coffee per day actually increased the risk of death by 4%.

What this means for you

What we find particularly interesting is that when the authors analyzed the relationship between coffee intake, the participants' Mediterranean Diet Score, and the participants' risk of death, they found that the reduction in risk from coffee intake was independent of the participants' Mediterranean Diet Score: the positive effects applied even when the participant's Mediterranean Diet Score was poor (0-3 points in a 9-point scale) as well as when it was good (7-9 points in a 9-point scale).

Unless your physician specifically tells you otherwise (ask if you are concerned), there is no reason for you to avoid coffee.

First posted: January 13, 2021