Lifestyle Diseases and Their Association with Coffee Consumption at Ipoh, Malaysia

ISSN 0974-3618 (Print) www.rjptonline.org 0974-360X (Online) RESEARCH ARTICLE Lifestyle Diseases and Their Association with Coffee Consumption at Ipoh, Malaysia ATM Emdadul Haque 1 *, Nurdiyana Binti Mohammed Hashim 1, Nurfatin Athira Binti Ruslan 1, Mainul Haque 2 1 Faculty of Medicine, University Kuala Lumpur Royal College of Medicine Perak, No. 3, Jalan Greentown, 30450 Ipoh, Malaysia. 2 Professor, Head of the Unit of Pharmacology, Faculty of Medicine, Universiti Sultan Zainal Abidin, 20400 Kuala Terengganu, Terengganu, Malaysia. *Corresponding Author E-mail: emdad0103@gmail.com ABSTRACT: Coffee consumption may reduce the risk of type 2 diabetes mellitus and hypertension, as well as other conditions associated with cardiovascular risk such as obesity and depression; but it may adversely affect lipid profiles depending on how the beverage is prepared. Thus, the aim of this study was to determine the prevalence of lifestyle diseases and their association with coffee consumption among people aged 40 years and above. A questionnaire was prepared and distributed among 300 random respondents in Greentown, Ipoh. Results showed that 85% of participants consumed coffee and majority usually drank 2 cups of coffee per day for more than 20 years. Only few got hypertension, ischemic heart disease, hypertension and obesity but that might be due to genetics or taking too much of coffee with sugar. Caffeine, in moderate daily doses of ~300 mg, or ~3 cups of coffee, appeared to be safe and harmless for healthy adults. However, most of the data on health effects due to coffee consumption were based on observation only and association did not prove causation. KEYWORDS: Lifestyle, Diseases, Coffee, Consumption, Malaysia INTRODUCTION: Lifestyle diseases are more in technologically advanced countries as people live longer. Alzheimer's disease, dementia, atherosclerosis, Type 2 diabetes, osteoporosis, depression and obesity are the most common perpetrator. Coffee has a long history of being blamed for many troubles from stunting growth to heart disease and cancer. Recent studies have found no connection between coffee and an increased risk of cancer or heart disease. In fact, most studies find an association between coffee consumption and decreased cardiovascular mortality especially with coronary heart disease, hypertension and lipid profile. [1 6] Received on 12.02.2015 Modified on 20.02.2015 Accepted on 08.03.2015 RJPT All right reserved Research J. Pharm. and Tech. 8(3): Mar., 2015; Page 285-291 DOI: 10.5958/0974-360X.2015.00048.7 Coffee is a complex beverage widely consumed throughout the world contains more than 1,000 of biologically active compounds [7]. Important biologically active compounds of coffee are caffeine (a potent stimulant and bronchodilator), diterpene alcohols (which can increase serum cholesterol), and chlorogenic acid (one of many types of antioxidant and anti-inflammatory compounds found in coffee) [7]. Extensive research has been conducted on caffeine as a compound in coffee which is the most notorious compound for the inherently habit-forming nature [8]. Coffee is the main resource of caffeine of American children and adolescents [9-10]. The amount of caffeine in coffee is very unpredictable issue. Caffeine content may vary even in same outlet and brand [8,11]. Nowadays, people like to drink very big size mug coffee thus amount of caffeine increases because size of the cup. Therefore caffeine amount varies from ~95 to 200 mg of caffeine [8,11]. 285 Malaysian people like and love coffee as like the west which was reported from a readers poll in 2013 [12]. Therefore coffee is also habit forming drink for Malaysians as like other countries [13]. This poll made us curious to

know if there was any association between lifestyle diseases and coffee consumption. A study showed that coffee consumption may reduce the risk of type 2 diabetes mellitus (DM) and hypertension, as well as other conditions associated with cardiovascular risk such as obesity and depression but it depends on how much they consume and how the beverage is prepared [14]. Drinking coffee increases blood pressure in non-habitual drinkers but not in the habitual coffee drinkers, despite comparable increases of muscle sympathetic activity and plasma caffeine levels in the 2 groups after coffee ingestion [15]. This study was therefore to explore the prevalence of lifestyle diseases and their association with coffee consumption. MATERIALS AND METHODS: This was a cross-sectional descriptive study using stratified random sampling. The study was carried out randomly among the people aged 40 years and above in Greentown, Ipoh. The population size was 300 based on 90% confidence interval using Epi Info. A questionnaire was prepared that included demographic data, health information, and some questions regarding coffee consumption such as number of cups of coffee intake per day, duration of coffee consumption and ways of drinking coffee. The questionnaire was pre-tested on 10 respondents aged 40 years and above who were selected randomly. The study was conducted for 7 weeks starting from 19 th May 2014 until 4 th July 2014. After collection, the data were keyed in into Microsoft Excel for verifications and checking. The data were then processed and analyzed by using the SPSS 20. Descriptive analytical test, Chi-square test was used to see whether the observed proportions for a categorical variable differ from hypothesized proportions. There were no major ethical concerns in this study. The confidentiality of data was strictly maintained. The participation was voluntary, informed consent was obtained, and the respondents were briefed thoroughly about the research. The study was approved by the academic committee of research of faculty of medicine, University Kuala Lumpur Royal College of Medicine Perak, Malaysia. RESULTS: The responses of 300 participants aged 40 years and above from Greentown, Ipoh were collected. 116 of them were female and 184 were male. The overall socio-demographic data has been detailed in Table 1 and Figure 1 and 2. 69% of the respondents knew coffee as a popular drink, but 26% preferred tea and rest 74% liked to drink coffee. Figure 2 refers to the study group drinking coffee from less than 6 months to 20 years and from 1 to 4 mugs daily. The coffee consumption style also varied from with or without milk and sugar (Table 2). Table 1: Showing Demographic of Study Population Age Categories Sex Total Female Male 40-49 60 84 144 50-59 47 78 125 60-69 6 19 25 70-79 3 3 6 Total 116 184 300 Race Frequency Percent Valid Percent Cumulative Percent Valid Chinese 42 14.0 14.0 14.0 Indian 57 19.0 19.0 33.0 Malay 199 66.3 66.3 99.3 others 2.7.7 100.0 Total 300 100.0 100.0 Figure 1: Shows percentage of samples according to occupation. 286

Table 2: Showing Study Population opinion Regarding Coffee and Tea Coffee Or Tea Preferred Frequency Percent Valid Percent Cumulative Percent Valid Coffee 222 74.0 74.0 74.0 Tea 78 26.0 26.0 100.0 Total 300 100.0 100.0 Coffee Drinking is Popular Drink Frequency Percent Valid Percent Cumulative Percent Valid No 94 31.3 31.3 31.3 Yes 206 68.7 68.7 100.0 Total 300 100.0 100.0 Duration of Cups of coffee per day Total drinking coffee >4 1. 2. 3. 4. None <6mth 0 2 4 0 0 0 6 >20yrs 6 21 53 58 5 0 143 0 0 0 0 0 0 45 45 1-10yrs 0 17 16 14 0 0 47 1-5yrs 0 6 9 0 0 0 15 10-20yrs 0 9 19 14 2 0 44 Total 6 55 101 86 7 45 300 Ways of Quantity of sugar per coffee/teaspoon Total drinking coffee 0 1 2 3 4 None 44 1 0 0 0 45 with milk only 52 2 0 1 0 55 with milk/sugar 5 22 31 34 12 104 with no 35 2 0 1 1 39 milk/sugar with sugar only 0 11 36 8 2 57 Total 136 38 67 44 15 300 Figure 2: Showing duration of drinking coffee and number of cups of coffee per day distribution of samples. Table 3: Showing Respondents Known Disease Pattern Disease Family History Total Percentage (%) None Yes Hypertension Yes 11 47 58 19.33 None 200 42 242 Total 211 89 300 Diabetes Mellitus Yes 6 50 56 18.66 None 217 27 244 Total 223 77 300 Ischemic Heart None 270 9 279 7 Disease Yes 6 15 21 Total 276 24 300 Obesity None 272 0 272 9.33 Yes 8 20 28 Total 280 20 300 287

Among 19% of the respondents, either they have or the family history of hypertension. Similarly, 19% either have or the family history of DM. But only 9% either have or family history of obesity (Table 3). In this study, hypertension had statistically significant correlation (p=.000) between cups of coffee consumption per day and durations of drinking coffee with the diseases (Table 4). Similarly, there was a statistically significant correlation (p=.000) between cups of coffee per day and durations of drinking coffee with DM (Table 5). Regarding ischaemic heart diseases, this study population showed significant (p=.000) correlation with number of cups consumption but no (p=.659) significant correlation with duration of coffee drinking (Table 6]. Eventually, this study failed to detect any significant correlation between obesity and the number of cups (p=.079) and duration (p=.313) of drinking coffee (Table 7). Table 4: Showing the relation between number of cups and duration with Hypertension Cups of Coffee Per Hypertension Total Day Yes None >4 0 6 6 1 12 43 55 2 15 86 101 3 5 81 86 4 2 5 7 None 24 21 45 Total 58 242 300 Pearson Chi-Square 46.774 a 5.000 Likelihood Ratio 43.330 5.000 a 3 cells (25.0%) have expected count less than 5. The minimum expected count is 1.16 Pearson Chi-Square 44.907 a 5.000 Likelihood Ratio 41.350 5.000 a 3 cells (25.0%) have expected count less than 5. The minimum expected count is 1.16 Table 5: Showing the relation between number of cups and duration with Diabetes Mellitus Cups of coffee per day Diabetes Mellitus Total Yes None >4 4 2 4 1 10 45 10 2 14 87 14 3 4 82 4 4 2 5 2 None 22 23 22 Total 56 244 56 Pearson Chi-Square 49.302 a 5.000 Likelihood Ratio 44.634 5.000 a 3 cells (25.0%) have expected count less than 5. The minimum expected count is 1.12 Pearson Chi-Square 35.234 a 5.000 Likelihood Ratio 31.253 5.000 a 3 cells (25.0%) have expected count less than 5. The minimum expected count is 1.12 288

Table 6: Showing the relation between number of cups and duration with Ischaemic Heart Diseases Cups of coffee per day Ischemic Heart Disease Total None Yes >4 2 4 2 1 51 4 51 2 94 7 94 3 86 0 86 4 6 1 6 None 40 5 40 Total 279 21 279 Pearson Chi-Square 41.031 a 5.000 Likelihood Ratio 27.866 5.000 a 4 cells (33.3%) have expected count less than 5. The minimum expected count is.42 Pearson Chi-Square 3.266 a 5.659 Likelihood Ratio 4.021 5.546 a 5 cells (41.7%) have expected count less than 5. The minimum expected count is.42 Table 7: Showing the relation between number of cups and duration with Obesity Cups of coffee per day Obesity Total None Yes >4 5 1 5 1 45 10 45 2 96 5 96 3 80 6 80 4 7 0 7 None 39 6 39 Total 272 28 272 Pearson Chi-Square 9.899 a 5.078 Likelihood Ratio 9.879 5.079 a 3 cells (25.0%) have expected count less than 5. The minimum expected count is.56 Pearson Chi-Square 5.932 a 5.313 Likelihood Ratio 7.810 5.167 a 5 cells (41.7%) have expected count less than 5. The minimum expected count is.56 DISCUSSION: About 74% of the participants were regularly drinking coffee. Among them, males are more than female and this might be due to the male participants are more than female participants in this study. The highest numbers of participants were in 40-49 age groups, and the lowest numbers of samples were from 70-79 age group. The majority of the participants (66.3%) were Malay that perhaps reflects Malays as the as the predominant ethnic group in Malaysia [16]. Among the female participants, 15% were housewives which perhaps an incidental findings whereas only 2% were lorry driver among the male participants. It was also found that a total number of 58, 56, 21, and 28 respondents were suffering from or have the family history of hypertension, DM, IHD and obesity respectively. Similar findings for hypertension, DM were reported by a national study [17,18]. Multiple risk of IHD among Malaysian population is quite high [19,20]. Our study also detected quite high IHD prevalence among the respondents. National statistics regarding obesity is 5.8% but our finding is much higher [21]. 289 Current study found that coffee was a popular drink among the people in Ipoh which is quite similar to the global picture [22]. One of the reasons could be the availability of too many coffee shops in and around. Most of the

participants drank coffee for more than 20 years and usually they drank 2 cups of coffee per day. A recent study reported that consuming 2-3 or as much as 4 cups a day of coffee considered reasonable. Caffeine, in moderate daily doses of ~300 mg, or ~3 cups of coffee, appears to be safe and harmless for healthy adults. Conversely, ingesting 10 times that amount of caffeine in a short period could be lethal [23]. In this study, about 39% of participants thought that it was beneficial for their health but the rest did not know about it or knew as not beneficial to health. Some participants explained coffee consumption as the provider of energy, alertness and make people look younger, but others explained as the cause of palpitation, anxiety and sleep disturbance which is supported by a study done elsewhere [24]. There was a correlation between lifestyle diseases and coffee consumption. A strong correlation was found between cups of coffee per day and durations of drinking coffee with hypertension. Based on the results, 58 of the participants had hypertension and among them, most of them drank 2 cups of coffee per day and 24 people did not consume coffee. Most of them drank coffee for more than 20 years. Recent studies stated that the acute effects of coffee are transient, and, with regular intake, tolerance develops to the haemodynamic and humoral effects of caffeine [7]. A recent meta-analysis of 10 randomized controlled trials (RCTs) and 5 cohort studies assessed BP and the incidence of HTN in coffee consumers. Nonsignificant mean changes in systolic BP of 0.55 mm Hg (95% confidence interval [CI]: 2.46 to 1.36) and diastolic BP 0.45 mm Hg (95% CI: 1.52 to 0.61) were noted in coffee drinkers compared with the control group. Evidence analyzed from this large study showed no clinically important effects of long-term coffee consumption on BP or risk of hypertension [25]. Studies and reviews done previously have also come to similar conclusions [26]. The Nurses' Health Study, with 1.4 million person-years of follow-up, demonstrated that daily intake of up to 6 cups of coffee was not associated with an increased risk of hypertension [27]. As for DM, most of the participants drank 2 cups of coffee per day and drank more than 20 years and among them 14 people had DM while another 87 did not have DM. P value is 0.000 and thus showed statistically significant. It can be concluded that there was a correlation between cups of coffee per day and durations of drinking coffee with DM. but drinking coffee did not mean to develop DM. In this research, some participants got DM which might be due to genetic influence and/or plenty of sugar in their coffee. A recently published randomized study found that consumption of 5 cups of coffee per day increased adiponectin levels and decreased insulin resistance [28]. A systematic review compared minimal to low coffee consumption (<2 cups/day) with that of heavy coffee consumption ( 6 cups/day) for the risk of the development of type 2 DM (T2DM). These researchers concluded that the risk of the development of T2DM was lowest in subjects who drank >6 cups daily [29]. 290 As for IHD, most of the participants drank 2 cups of coffee per day and among them only 7 people had IHD while another 94 did not have IHD. P value is 0.000 and thus it was statistically significant. From this, we can conclude that there was a correlation between cups of coffee per day with the occurrence of IHD. In this research, some of them got IHD that might be due to genetic influence as well. Many epidemiological studies have evaluated the potential effects of coffee on IHD, and these individual studies have generally shown neutral effects. However, a meta-analysis of 21 independent prospective cohort studies from January 1966 to January 2008 suggested that moderate coffee consumption may decrease the long-term risk of CHD [1]. Regarding obesity, most of the participants drank 2 cups of coffee per day and among them only 5 people had obesity while another 96 did not have obesity. Most of the participants drank coffee for more than 20 years and among them only 13 of them had obesity while rest 130 was not obese. P value for both cups of coffee per day and durations of drinking coffee with obesity was more than 0.05 and thus was not statistically significant. Hence, there were no correlation between cups of coffee consumption per day and duration of drinking coffee with obesity. This might be due to random selection of participants and the dietary habit and lifestyle of the individuals. Drinking more coffee does not necessarily mean to cause obesity. Maintaining healthy lifestyle with good dietary habit is the foremost issue to control obesity in any population. Some of this study population was obese which might be due to their genetic influence or other bad lifestyle, although it is reported that coffee reduces weight [30,31]. CONCLUSION Based on this research, we found that consumption of coffee was statistically significant with some of the lifestyle diseases like hypertension, ischemic heart disease, DM. Besides that, duration of drinking coffee and the amount of cups of coffee per day also showed some effects. Moderate consumption of coffee is reasonably suggested as studies also showed that it might help to reduce weight, decrease risk of having hypertension, ischemic heart disease and DM. Nevertheless, family history, dietary habit and lifestyle which were not looked in this study actually play important roles to cause lifestyle diseases. The finding of this study can definitely provide a baseline data for monitoring the further studies which need to be done to assess the main factors associated with lifestyle disease. LIMITATIONS: Some of the respondent was reluctant due to their hectic schedule and did not give quality time to fill questionnaire. Some respondents did not even understand all questions and was afraid if their information were disclosed. ACKNOWLEDGEMENT: We are much grateful to study respondents and also Dean, Faculty of Medicine, University of Kuala Lumpur, Malaysia for their kind cooperation in this study. Authors

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