title: Effects of caffeine consumption in patients with chronic hepatitis C: A systematic review and meta-analysis.
abstract: BACKGROUND
  Increased caffeine consumption has been associated with a decreased risk of liver enzyme elevation, cirrhosis, and hepatocellular carcinoma. However, few studies have assessed these effects in patients with chronic hepatitis C; therefore, we conducted a systematic review and meta-analysis to investigate the impact of caffeine consumption in patients with chronic hepatitis C infection.
  
  
  METHODS
  We performed a comprehensive search of the databases of the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE from inception through November 2015. The inclusion criterion was observational studies' assessment of the impact of caffeine consumption in adult patients with chronic hepatitis C.
  
  
  RESULTS
  Eleven studies were included for full article review, and data was extracted from five observational studies for meta-analysis. The pooled odds ratio of advanced hepatic fibrosis in patients who had higher caffeine intake was 0.39 (95% confidence interval 0.21-0.72, P=0.003) compared with lower caffeine intake group. The statistical between-study heterogeneity was moderate with an I2of 70%.
  
  
  CONCLUSIONS
  Our meta-analysis demonstrated that caffeine intake is significantly associated with decreased odds of advanced hepatic fibrosis in patients with chronic hepatitis C. Future prospective studies assessing the optimal dose and preparation of caffeinated beverages for prevention of hepatic fibrosis are needed.
authors.affiliation: Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA; Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Electronic address: veeravich_j@hotmail.com.
authors.forename: Veeravich
authors.initials: V
authors.lastname: Jaruvongvanich
authors.affiliation: Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, NY, USA; Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: anawin.sanguankeo@bassett.org.
authors.forename: Anawin
authors.initials: A
authors.lastname: Sanguankeo
authors.affiliation: Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA. Electronic address: nattawat@hawaii.edu.
authors.forename: Nattawat
authors.initials: N
authors.lastname: Klomjit
authors.affiliation: Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, NY, USA; Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: sikarin.upala@bassett.org.
authors.forename: Sikarin
authors.initials: S
authors.lastname: Upala
mesh_terms: D000284:Administration, Oral; D001628:Beverages; D002110:Caffeine / Q000008:administration & dosage*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008103:Liver Cirrhosis / Q000517:prevention & control*; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000697:Central Nervous System Stimulants; D002110:Caffeine