Sickle Cell Disease (SCD) is old, more than a century old, yet we don’t have a widely available cure for this genetically inherent disease. SCD refers to a group of hemoglobinopathies in which at least one sickle (S) beta-globin gene is inherited together with another type of abnormal hemoglobin. SCD is an umbrella term that includes diseases such as sickle cell anemia (HbSS), hemoglobin SC disease (HbSC) and hemoglobin Sβ thalassemia (HbSβthal) major and minor. Sickle cell anemia is the most dangerous type primarily affecting people of African descent though its geographically spread all around the world. It has also been estimated most children with SCD are born in developing countries-almost 2,00,000 HbSS cases occur annually in sub-Saharan Africa, 2% newborns in Ghana are born with SCD while almost 25% of the Ghanaian population are carriers of the sickle cell gene. Despite such high prevalence in the African continent we don’t have much information about SCD here and surprisingly there is a significant amount of information available in countries such as Jamaica, India and US. Despite this, SCD remains as one of the most underappreciated and least referred sources of childhood mortality and morbidity.
SCD normally paves way to vaso-occlusive events that might lead to tissue, bone and organ damage and increased hemolysis that might result in anemia. Other side effects include pain, stroke and anorexia that have a huge impact on dietary intake of kids leading to impaired growth, poor nutritional status and delayed skeletal and sexual maturation. In order to provide such kids with a better growing experience there have been constant efforts made to minimize severity of clinical problems foremost of which includes frequent hospital admission for pain but undernutrition was not included in the list of serious side effects until 1980s. SCD causes a huge blow on physical growth during childhood and adolescent years and these kids are often leaner and shorter than their healthy counterparts. Researchers blame hematologic and cardiovascular status, endocrine and metabolic functions and nutritional status as the critical causes for growth failure while these patients also suffer from several micronutrient deficiencies such as vitamin A, B2, B6, B12, C, D and E, folic acid, iron, calcium, magnesium and zinc. Improving the nutrient intake of these patients might improve their body composition and decrease morbidity and mortality rates due to SCD. Despite numerous cases on growth retardation and under-nutrition the exact part played by intrinsic and extrinsic factors remains unknown which might include insufficient consumption of food or increase in food demands due to higher energy expenditure. The study below clearly helps us understand whether impaired growth and nutritional intake has a take on SCD severity in kids.
Observational Study on Kids with SCD
The study included individuals who were between 6 months and 18 years of age with SCD problem but devoid of any comorbidities. 14 males (48.3%) and 15 females whose mean age was 9.95 years, mean weight was 32.93 kg, height 135 cm and BMI 17.11 were involved in the study. Their nutritional intake was assessed with a 24-hr food recall which also included details about the weekly consumption of major food groups such as meats, fish, eggs, fruits, vegetables, cheese, grains, legumes and sugary beverages. The total calorie, macronutrient, micronutrient and daily intakes were calculated for each child and this was matched against the required nutrient intakes for the child.
Disease severity was assessed through total hemoglobin (Hb) and fetal hemoglobin (HbF) and lactic dehydrogenase (LDH) levels, through total number of days of hospitalization and through lifetime episodes of acute chest syndrome (ACS). Hospital admission rate was inversely related to protein, lipid, phosphorus, vitamin B1 and PP intakes while HbF levels were inversely correlated to carbohydrate, lipid, iron, phosphorus, vitamin B1 and B2 levels. Protein, vitamin PP and A intakes were well above daily requirements while total calorie intake, carbohydrate, lipid, mineral (except phosphorus) and other vitamin intakes were well below daily requirements. Total calorie intake was not significantly correlated to any of the severity indices including vitamin A and C intake. Lifetime episodes of ACS, total Hb and LDH levels were not related to calorie-, macro- and micronutrient intakes. The study clearly shows that various macro- and micronutrient intakes were inadequate the result of which was increased number and days of hospitalization.
Kids with SCD have a basal metabolic rate and resting rate expenditure higher than healthy peers and this causes an increase in their metabolic, energy and protein demands. Calcium and phosphorus intake were inversely related to the number of hospitalizations initially and then to both, number and days of hospitalizations. Iron and phosphorus intake showed a negative correlation to HbF levels seeming to be protective in SCD. A research team evaluating nutrient intakes in Children in America found that low intake of vitamin D, E, folic acid, calcium, phosphorus, magnesium and zinc contributed to a poorer diet with increase in age. Iron deficiency was also commonly seen in these kids but this could be beneficial for patients with SCD as it reduces red blood cells sickling by decreasing mean corpuscular hemoglobin concentration with reduction of hemolysis. But lack of iron impairs physical and intellectual growth and these kids are at a risk of growth and neurocognitive delay. Hence, inadequate nutrient intake, body weight and BMI clearly affect SCD severity but it was also seen that low intake of micro- and macronutrients has a beneficial effect on HbF levels.
Are We Giving Enough Attention to Macronutrient Levels in Patients with SCD?
There has been quite a lot of research happening on micronutrients and what we need now are dietary recommendations for SCD involving more macronutrients. There has been a study in 1985 done on macronutrients intervention that shows measurable improvements in clinical conditions and reduced hospitalizations. There have been various studies done showing the importance of various macronutrients needed by patients with SCD:
Arginine: This is an amino acid whose metabolism is impaired in SCD contributing towards endothelial dysfunction and hypertension. Research shows that low dose supplementation of L-arginine improves liver function, increases plasma arginine concentration and nitric acid levels in patients with SCD. Eating beets, spinach, radish, celery and mustard greens improves nitrate and nitrite contents and also including foods rich in vitamin E, C and A is helpful.
Glutamine: This is a non-essential amino acid whose synthesis is ATP-dependent and lack of it can lead to stress, increased resting energy expenditure (REE), muscle wasting and decreased immune function. Supplementing patients with L-glutamine is useful in decreasing the incidence of SCD-related vaso-occlusive (VOC) pain events.
Vitamin D: Vital for calcium homeostasis and bone mineralization SCD patients often lack in this nutrient due to dark skin pigmentation, limited sun exposure, increased catabolism and decreased nutrient and energy intake. Vitamin D deficiency leads to osteopenia and osteoporosis in 80% of SCD patients. Studies show that supplementing SCD kids with Vitamin D protects them against respiratory infections that commonly attack such kids.
Hydration: Hydration is essential in patients with SCD in the absence of which cells become sickled and poorly hydrated erythrocytes lead to increased viscosity and vaso-occlusive crisis in SCD. SCD patients must drink enough water and fluids, avoid physical activity and extreme weather that can cause sweating and limit sodium intake to keep themselves hydrated.
Maintaining a healthy gut microbiota by consuming enough fruits, vegetables, whole grains, legumes and fermented foods might help SCD patients to optimize immune system functioning.
Calculating dietary needs of patients with SCD can fulfill their macronutrient requirements, fulfilling elevated metabolism of individuals with SCD improves growth and development, promotes weight maintenance, conserves muscle mass and reduces inflammation of these patients. Increasing intake of foods rich in polyphenolic phytochemicals, flavanols, gut microbial required prebiotics, vitamins, minerals and omega-3 fatty acids helps in improving quality of life, sustainable health and longevity of the SCD-affected patient.
Nutrition Impact on SCD Patients in Ghana
The cross-sectional study conducted in Ghana included 120 children aged 3-12 years diagnosed with SCD but free from chronic medical conditions such as HIV, tuberculosis, cleft palate and sores in mouth and throat. Dietary intake was noted by means of a 24-hour recall and a food frequency questionnaire and the kids’ weight and height measurements were also taken. The child was categorized as malnourished or well-nourished depending on the presence or absence of nutritional deficiencies.
Mean energy and protein intake of kids were around 1350 Kcal and when the children’s nutrient consumption was compared to RDA it was found that almost all kids met protein requirements but none of them met vitamin E and calcium requirements. Less than 50% of the participants met requirements of vitamin B12 (46.7%), vitamins A and C (45%), zinc (30.8%), energy (28.3%), folate (9.2%) and magnesium (1.7%). As the kids grew their ability to meet nutrient requirements decreased. While kids aged three met almost five nutrients assessed older children met less than 4. Almost 53.3% met energy recommendations and at least 4 of the 10 nutrients investigated. But, in the 4-8 years and 9-12 years age group not even 25% of kids met recommendations for at least five nutrients. Stunting, underweight, wasting and thinness was present in 25.8, 20.0, 6.8 and 15.8% kids respectively. 38% kids were classified as malnourished, 98% children were anemic, mean hemoglobin was 7.8 and most of them (94%) were suffering from moderate to severe forms of anemia. Thus, this study clearly shows that SCD-affected kids have lower intake of energy and micronutrients (specifically calcium and antioxidant nutrients, vitamin C and E) whose levels further decreased with increasing age.
Effects of Nutritional Intake on Disease Severity in Children with Sickle Cell Disease: https://nutritionj.biomedcentral.com/articles/10.1186/s12937-016-0159-8
Nutrition in Sickle Cell Disease: https://www.dovepress.com/nutrition-in-sickle-cell-disease-recent-insights-peer-reviewed-fulltext-article-NDS
The Role of Nutrition in Sickle Cell Disease: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085005/
Dietary Intakes & Nutritional Status of Children with Sickle Cell Disease: https://bmcnutr.biomedcentral.com/articles/10.1186/s40795-018-0241-z
Variety might be the spice of life but there is also the fact that too much of anything is good for nothing. We need choices but having our hands full on these choices also paves way for a state of confusion. This is applicable to food choices too. Previously, one would have never thought of experiencing different cuisines at the snap of our finger but now we get to enjoy Italian, Mexican and Thai food sitting in the comforts of our house. Likewise, right after childbirth a newborn’s only source of food was breastmilk and there was no discussion beyond it. But now, we have come up with different alternatives for nature’s gift to our lovely babies quoting different reasons. The world has insisted on exclusive breast milk feeding right until the infant’s sixth month owing to aplenty benefits such as increased immunity, nutrients and reduced risk of obesity/overweight still there are many who ignore all these benefits and continue feeding the infant with formula milk or likewise. There might be valid reasons for switching over to formula milk but it is also essential that we understand the downsides of the same.
Obesity and overweight issues don’t exist only among the adult population but is well-established in the child and infant population as well. Obesity during early years is a crucial health issue that’s of immense importance as they have a number of adverse health consequences that’s associated with increased mortality and morbidity risk in early adulthood. There is rapid weight gain and growth during early stages of infancy and those kids who gain more weight during infancy are at an increased risk of becoming obese during early childhood years or even later in life. There are those of you who now wonder how on Earth can an infant become obese when his/her only source of food is milk. You are right but the risk of obesity crops up from the very fact whether the source is breast milk or formula milk as such feeding patterns are the ones that affect growth and development in infancy. During the last decade or so researchers have vigorously studied different feeding patterns, their impact and have also learnt how different infant feeding practices impact health in childhood and beyond. The most important of them is the relationship between early infant feeding and obesity risk. We do have studies showing that formula milk leads to more weight gain than breast milk but we don’t have many that focus on the differences in the growth and risk of overweight in infants fed with different types and volume of milk during early infancy.
Formula Milk & its High Energy Density
A systemic review concluded that formula-fed infants have a 1.2 to 9.5-fold higher energy intake and a 1.2 to 4.8-fold higher protein intake that breastfed infants in the first week of life. The reason being the higher energy and protein content of formula milk and higher volume of consumption all of which contribute to greater weight gain in formula-fed infants compared to breast-fed infants during early infancy. The main difference in early weight gain between formula-fed and breast-fed infants is due to the differences between formula and breast milk in both composition and volume of intake of colostrum. The study elaborated below investigates the association between volume of formula milk consumed at 3 months of age and changes in body weight and length at 3 time points during the first year and also compares the risk of obesity due to differences in volume of milk consumption.
Chinese Systemic Study
1093 healthy neonates were selected for the study and information on maternal characteristics such as age, education, pre-pregnancy weight and height, occupation, health condition, delivery and infant characteristics including sex, gestational age, mode of delivery and birth weight and length were noted down. All the 1093 infants were healthy, singleton, full-term infants of which 587 were boys and 512 were girls. Data was collected at 3, 6 and 12 months of age of the infant. Feeding practices were categorized based on the volume of formula milk consumed at 3 months of age based on the answers to 2 questions: “How many times was your child fed infant formula?” and “How much formula milk does your child usually intake at each feeding?” The research took place in China and according to the Chinese infant feeding recommendations the volume of formula milk consumed was segregated as higher (840 ml or more) or lower (less than 840ml) consumption as the 3-month-old infant consumed 140 ml of formula milk 6 times/day for a total of 840 ml/d. Three types of feeding groups were identified: breast milk feeding (BM, no formula milk) which included 610 infants, lower-volume formula milk feeding (LFM, <840 ml formula milk/d) that included 363 infants and higher-volume formula milk feeding (HFM, ≥840 ml formula milk/day) that included 120 infants. Breast milk feeding included exclusive feeding of breast milk without other liquids or solids with the exception of vitamin and mineral supplements or medicines. Formula milk feeding included feeding of any formula milk with or without breast milk and was categorized into LFM and HFM depending on the quantity of milk consumed per day.
Solids were introduced to nearly 63.7% infants before 6 months of age, almost 51% breast-fed infants were females and the numbers were more than that of the LFM infants (42.4%) or HFM infants (38.3%). Weight-for-length z score (WLZ) and BMI-for-age z score (BAZ) were calculated and was classified as greater body weight (1SD<WLZ<2SD) and overweight (WLZ>2SD) respectively. Results showed that:
Longitudinal Study on Bottle Milk Consumption
A longitudinal study researched not only on the type of milk consumed by infants but also on the mode of consumption on 3000 infants who were followed right from birth up to 1 year of age with 10 postnatal questionnaires mailed at monthly intervals. Weight measurements were reported on the 3-, 5-, 7- and 12-month surveys. In every questionnaire provided to mothers they were asked how often they fed breastmilk, pumped breastmilk, formula milk or other types of milk in the past 7 days and based on the answers infants were classified into six milk feeding categories: breastfed only, breastfed and human milk by bottle, breastfed and nonhuman milk by bottle, human milk by bottle only, human and nonhuman milk by bottle only and nonhuman milk by bottle only.
Results showed that compared to infants who were only breastfed those infants fed by bottle gained 71 or 89 g more per month when fed nonhuman milk only or expressed human milk only but gained only 37 g more per month when fed both expressed breast milk and nonhuman milk. Infants fed both breastmilk and formula milk using a bottle gained 45g more per month. For every 10% increase in bottle feeding infants gained 8 g more per month among those who received at least two-thirds of their feedings with breastmilk. This study clearly shows that the type of milk and also the mode of milk delivery strongly affects the weight changes in infants.
In an ideal scenario, the energy content of formula milk should be equal to the energy content of breast milk but most of the commercially available formulas have an energy density of around 67 kcal/100 mL that’s evidently more energy than contents of early breast milk (at 5 weeks it is 57.4 kcal/100ml and at 11 weeks it is 59.8 kcal/100 ml). Apart from being a rich source of macronutrients and energy-dense formula milk is also consumed more in quantities. While breast-fed infants receive limited breastmilk (as supply is restricted) during the first two days of life mothers who feed formula milk encourage the child to finish the bottle despite signs of fullness expressed by the newborn. Also, while protein content of colostrum is extremely high the nutrient decreases as weeks pass by. Whereas, formula milk has 5-times more protein and these infants consume 5-fold high protein quantities during their first two weeks of life compared to breast-fed infants and this leads to faster weight gain in formula-fed compared to breast-fed infants. Breastfeeding is definitely the best approach for optimal nutrition in infants. Formula milk can never match the goodness of natural breast milk but it is necessary to continue researching to replicate the benefits and composition of breast milk as much as possible in formula milk too.
Early Feeding of Larger Volumes of Formula Milk is Associated with Greater Body Weight or Overweight in Later Infancy: https://nutritionj.biomedcentral.com/articles/10.1186/s12937-018-0322-5
Risk of Bottle Feeding for Rapid Weight Gain During First Year of Life: https://jamanetwork.com/journals/jamapediatrics/fullarticle/1151630
Is the Macronutrient Intake of Formula-fed infants Greater than Breast-fed Infants in Early Infancy? https://www.hindawi.com/journals/jnme/2012/891201/
Cancer is taking over the reins of command in almost every country worldwide with the startling changes in the environment and eating patterns. Earlier, we came across cancer as a rarity in people and treatment course offered was also not advanced enough to help people survive and extend their lifespan. But now, it has become a well-established disease with advancements in treatments, care and extension of life. There are people across the world suffering from various forms of cancer with certain types dominating the male and female populations respectively. Women are often victims of breast, cervical, ovarian and skin cancer with breast cancer being the leading cause of death in women accounting for almost 23% of cancer cases worldwide. The disease can affect any woman but the risk increases as the individual grows old and there are certain other factors too that puts some women at a greater risk than others. We have numerous studies showing that a healthy diet and lifestyle are critical for the prevention of breast cancer, the absence of which has also increased the risk of this cancer form in many women.
Food as a Factor Against Cancer Risk
The studies that quote dietary factors as a weapon against cancer also show that dietary fat is one of the closely studied dietary factors related to breast cancer risk. Among all the dietary factors, n-3 polyunsaturated fatty acids (n-3 PUFA) is appreciated for its inherent property to curtain carcinogenesis and reduce cancer risk as seen in rodent models and in vitro cell studies. We do have the Singapore Chinese Health Study and the Japan Collaborative Cohort Study that show an inverse link between dietary fat (PUFA) intake and breast cancer risk but certain other observational studies are also inconclusive. Fish, the favorite seafood of many, is an excellent source of PUFA but studies show an inverse or positive association with cancer risk. This brings us to a very important juncture here whether fish intake, PUFA’s major dietary source, affects breast cancer risk in any way.
Fish: A Fulfilling Source of Nutrition
Fish is one of the healthiest foods available to mankind on this planet and is an integral part of a healthy diet. Eating fish replenishes one with abundance of omega-3 fats apart from other nutrients such as vitamin D, selenium and protein. We have quite a few studies displaying the authentic advantages of consuming fish which include protecting the heart from diseases, improving blood vessels functioning and easing inflammation. Physicians and health experts suggest eating fish at least twice a week but not all individuals follow this quoting different reasons-a dislike in taste, not knowing how to prepare or fearing toxin presence such as mercury and pesticide residues.
Effect of Fish Intake on Postmenopausal Women
A report by the World Cancer Research Fund in 1997 portrayed that eating fish reduced the risk of colon, breast, rectum and ovary cancer. But we have different studies reporting different conclusions and given below is a study on postmenopausal women and the effect of fish consumption on their breast cancer risk. The study included 29,875 women aged between 50 and 64 years residing in Denmark who were asked to report on their dietary intake through a 192-item food frequency questionnaire (FFQ) through mail. The participants were asked to answer choosing any of the 12 different options given for each question ranging from never to 8 or more times a day. While foods such as fruits, beverages and breads were calculated in pieces, glasses or slices portion sizes of other foods were calculated by multiplying frequencies with portion sizes. OF the 192 foods mentioned 24 of them pertained to different types of fish. A lifestyle questionnaire was also given with questions on parity, age of birth of first child, history of benign breast tumor surgery and so on. Many participants were excluded based on different criteria such as cancer diagnosis right before study, experienced menstruation or did not provide complete information which left the research team with 23,693 women.
The study team analyzed fish intake according to fat content differentiating them as lean (≤8 g fat/100 g fish) and fatty (>8 g fat/100 g fish) and method of preparation (fried (8 questions), boiled (5 questions) and processed (11 questions)). Processed fish were taken as a separate group as the preparation method differs here which includes pickling, salting and smoking. All the participants ate between 11 and 86 g of fish with lean fish consumed more than fat fish. The method of preparation was mostly fried or processed and consumption of boiled fish was low. The study showed that total fish intake was associated with a significant increase in breast cancer incidence rate per 25g daily intake. The team divided total fish intake into quartiles and on comparison of the upper quartile group with the lower quartile group there was an increase of 47% in the incidence rate of breast cancer. Also, to analyze whether incident rate ratio (IRR) was associated with fat content the research team divided fish intake according to fat content. Results showed IRR values of 1.11 and 1.13 for fatty fish and lean fish. Finally, the research team concluded that high total fat intake rather than fat content and preparation method was associated with increased incidence of breast cancer.
European Prospective Investigation
European prospective investigation into cancer and nutrition (EPIC) study is a vast study on diet, lifestyle and environmental factors conducted across 10 European countries on 5,19, 978 participants. Collection of data on dietary habits and lifestyles were via questionnaires on all the participants who were between 35 and 70 years of age. Of them, 366,521 were women of whom many of them were excluded due to various reasons such as prevalence of cancer at the time of recruitment, failure to fill questionnaire or provide complete information. This left the study team with 2,77,834 women.
The study team analyzed total fish consumption (whole fish and molluscs), total lean fish consumption and total fatty fish consumption. Any fish that had less than 4% fat is classified as lean fish (such as cod, haddock) and one that has more than 4% fat is considered as fatty fish (salmon, trout and herring). Results showed that fish consumption was associated with a slight increase in breast cancer risk in some countries, France, the country with the longest follow-up and most breast cancer cases did not show any protective effect nor any increase in risk between fish consumption and breast cancer risk. Women in the top quintile of fatty fish showed a positive association with breast cancer risk but when analysis for both lean and fatty fish consumption was conducted there was no association with breast cancer risk. There are other epidemiological studies that analyzed the association between n-6/n-3 ratio and breast cancer risk but results are contradictory. Three studies that analyzed fatty acids in serum phospholipids or erythrocyte membrane found no association while three other studies that analyzed n-3 and n-6 in adipose tissue showed inverse association with breast cancer.
Meta-analyses of Cohort Studies
A meta-analysis of observational studies was done to understand where exactly fish consumption stands in cancer risk and a search was conducted in the PubMed and Embase database using a set of keywords to extract the relevant studies. Search came up with 215 different publications of which 26 of them were found to be eligible. 11 studies from eleven independent cohorts showed a positive link between fish intake and risk of breast cancer with 13,323 cases of breast cancer and 6,87,770 participants but dose-response analysis did not show a positive link for breast cancer risk for 15 g/day increment in fish intake. 17 articles from 16 independent cohort studies showed an association between n-3 PUFA and breast cancer risk that involved 16,178 breast cancer events and 5,27,392 participants. PUFA intake was inversely associated with breast cancer risk. 8 of the 17 articles were eligible for dose-response analysis whose results showed that a 0.1 g/day increase in n-3 PUFA was associated with a 5% lower risk of breast cancer. 12 articles that involved 14,284 cases of breast cancer and 4,05,592 participants were involved in analyzing the association between ALA exposure and breast cancer risk. There was no association found between ALA intake and breast cancer risk and this was true even in the case of dose-response analysis.
PUFA intake was inversely associated with breast cancer risk in both Asian and Western with the results more predominantly seen in the Asian population. Hence, this meta-analysis shows that high intake of n-3 polyunsaturated fatty acids is linked with 14% reduction in breast cancer risk and with 0.1 g/day increment of intake there was a 5% reduction in risk. This encouraging news is a platform for researchers to take up the research to the next level on finding more information about fish intake and reduction in breast cancer risk.
Fish Intake is Positively Associated with Breast Cancer Incidence Rate: https://academic.oup.com/jn/article/133/11/3664/4817947
Fish Consumption and Breast Cancer Risk. The European Prospective Investigation into Cancer and Nutrition: https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.21819
Intake of Fish and Marine N-3 Polyunsaturated Fatty Acids & Risk of Breast Cancer: meta-analysis of Data from 21 Independent Prospective Cohort Studies: https://www.bmj.com/content/346/bmj.f3706
My day does not start until I have a steaming cup of coffee as soon as I wake up in the morning. That’s true for most people as we all need an energizing factor to get out of bed, wake us from our sleepiness and kickstart the day in a reasonable way. For me, the consumption stops here but there are others in this world who go about drinking 5,6 or even 7 cups of coffee daily especially those working in shifts and staying awake for hours together. Until now we don’t have a clarity on the effects of coffee/caffeine consumption as researches crop up every once a while surprising us with benefits or overloading us with its side effects. Caffeine, the most important chemical found in beverages such as coffee, tea and soft drinks has the characteristic to be easily absorbed by humans, has 100% bioavailability when consumed orally, attains its peak within 15-45 minutes of consumption distributing itself throughout the body and has a number of effects on health. Limited consumption of caffeine has been linked to beneficial effects such as protection against cardiovascular diseases and lipid and carbohydrate metabolism while increased consumption can have disastrous effects on the body. One such effect is on the male reproductive system that can ruin the quality of life of the individual due to the inability to reproduce.
Infertility problems have been an issue for the past couple of decades and it is seen that almost 13% of the reproductive population suffers from these problems with male infertility factors contributing to more than 30% of them. Health experts and physicians blame our lifestyle habits, dietary intakes and inactivity as a cause for increase in infertility rates. The world has witnessed a decline in human sperm quality over the last few decades and even studies report a significant decrease in sperm quality in men residing worldwide including countries such as New Zealand, Australia, Europe and North America. Different lifestyle factors include alcohol consumption, smoking, drugs, obesity, paternal age and coffee consumption stay on top of the list and we are now going to look into various studies that have focused on the effect of coffee consumption on male fertility rates. Male coffee/caffeine consumption has been linked with high levels of testosterone and sex hormone binding globulin (SHBG). Apart from affecting semen quality coffee consumption also influences sperm DNA integrity. A systematic review from observational studies on the relation between coffee consumption and male fertility parameters such as semen quality, sperm ploidy, sperm DNA integrity and time to pregnancy was performed.
Systematic Review on Coffee Consumption & Infertility Rates in Males
Databases such as MEDLINE and EMBASE were searched with specific keywords such as ‘caffeine’, ‘coffee’, ‘semen quality’, ‘sperm quality’, ‘male infertility’ and likewise. The data was extracted independently by two investigators and the results reviewed critically. Initial search came up with 340 articles that could be eligible for review but finally after different elimination criteria only 28 papers were selected for the study.
Coffee and caffeine consumption in men belonging to various studies were collected in different ways. In a cross-sectional analysis by Talamanca et al. who studied 201 taxi drivers there was no relationship found between coffee consumption and sperm count or motility. In terms of sperm morphology, increased prevalence of atypical forms was found among men drinking 1-3 cups of coffee/day but the same was not found in those drinking more than three cups per day. A cohort study by Klonoff-Cohen et al. reported caffeine intake of both men and women during their lifetime up to a year prior to conception attempt. The link between their intake of beverages and various factors such as fertilization rate, multiple gestations, miscarriage rate and live births were reviewed and again, no relation was found between male caffeine intake and sperm count, motility and morphology. Some studies did suggest that those men with the highest levels of caffeine consumption had lowest semen volume when compared to those with little or no consumption but the results were not consistent even among these studies. There was even a study by Yang et al. that showed even just the opposite result. One result that did remain constant was the effect of cola consumption on semen volume-higher the rate of cola consumption lower were the semen volume levels. There was no positive data available on the association between coffee consumption and total sperm count. While two other studies too showed that an increase in cola consumption lowered sperm count there was no relationship observed between coffee/caffeine consumption and total sperm count. Total sperm concentration too had the same result as total count. An exception to this was the study by Marshburn et al. which found that men with highest intake of coffee had highest concentration of sperm count in comparison to those men who did not drink coffee at all but was also lower in comparison to men drinking 1-3 cups of coffee per day.
Sperm morphology was reported as percentage of normal or abnormal forms. Only one study by Marshburn et al. reported abnormal sperm morphology in men drinking 4 or more cups of coffee per day. A couple of studies found that drinking coffee was not related to sperm DNA damage and DNA stainability. A study by Schmid et al. on the association between coffee intake and DNA damage on 80 healthy non-smokers found that men with increased daily caffeine consumption have increased sperm DNA damage linked with double-strand DNA breaks. Two case-control studies compared coffee intake between men with impaired fertility rates. A study by Parazzini et al. explored the cases of men with unexplained dyspermia and found that risk of the disease increased with the number of coffee cups drank per day.
A study by Florack et al. found that men with low or moderate caffeine intake did not differ but those with higher levels of caffeine intake experienced a reduction in fecundability. A study by Curtis et al. found a slight decline in fecundability when caffeine drinkers were compared with those who never drank coffee. While there was no overall association with fecundability for male coffee, tea and cola drinkers consuming more than three cups of tea per day was linked with decreased fecundability. A study in North America by Wesselink et al. found that male soda intake had an inverse link with fecundability, male energy drink intake was also associated with reduced fecundability but caffeinated coffee, black tea and green tea were not. Decaffeinated coffee and tea were linked with slightly lower fecundability but soda had no such links. Studies on the success of ART among coffee drinkers found that male caffeine consumption had no effect on fertilization, pregnancy or live birth delivery. But increased caffeine intake was a risk factor for causing multiple pregnancies. For every 100mg/day increase in caffeine consumption there was an increase in risk of multiple gestations by 2.2 times during normal days and by 3 times for intake during the week of the initial clinic visit. The review shows that caffeine intake might negatively affect male reproductive function but epidemiological studies on infertility rates and semen parameters remains inconclusive.
Semen Quality Changes due to Caffeine Intake in Danish Men
A cross-sectional study among Danish young men from the general population analyzed semen samples for the effect of caffeine on fertility rates. Spermatozoa morphology was assessed in 284 men consuming more than 1 bottle of cola per day, in 97 men consuming no cola and 98 men consuming less than 1 bottle of cola per day. All the men were questioned on the various quantity of beverages consumed which included wine, beer, alcoholic drinks, cola, soft drinks, coffee, tea and chocolate-containing beverages. Their dietary habits were also questioned upon which included details about consumption of butter, cheese, vegetables, fruits, burgers and fish.
A total of 2,554 men participated in the study of which 141 fathered a pregnancy and 15 were examined for infertility. It was seen that more than 50% caffeine intake was derived from coffee and only 20% from cola as one cup of coffee contains about 117 mg of caffeine compared to 70 mg in 0.5L of cola. Results showed that:
Coffee & Caffeine Intake & Male Infertility: https://nutritionj.biomedcentral.com/articles/10.1186/s12937-017-0257-2
Caffeine Intake & Semen Quality in a Population of 2,554 Young Danish Men: https://academic.oup.com/aje/article/171/8/883/82236
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