Health Professionals Newsletter

Welcome to the twelth newsletter from the United Kingdom Tea Council. This service will keep you up to date with current tea4health activities and events and inform you of the latest published research. We'll keep you updated on a quarterly basis with news and views from across the tea industry.

Research Update

Caffeine is not considered a risk factor for low bone mass in healthy 40-60 year old women
According to a recent review published in Osteoporosis International there is no evidence linking caffeine intake to a low Bone Mineral Density (BMD) in women approaching the menopause or recently menopausal.

Woman drinking tea Low BMD is a characteristic of Osteoporosis, a condition where the bones become thin and weak thereby increasing the risk of fractures. Osteoporosis is a major health problem worldwide with more than 75 million people in Europe, Japan and the United States being affected. Every year it causes 2.3 million fractures in Europe and the United States. In the UK one in two women and one in five men over the age of 50 will fracture a bone, mainly as a result of osteoporosis.

Bone loss occurs when estrogen levels decline and as a result Osteoporosis mainly affects women after the age of menopause. Identifying younger women who are potentially at risk of low BMD will help to determine those who may benefit from early intervention. However current risk assessment for low BMD is mainly based on data of older women (≥ 65 years of age) which may not be relevant to younger women. The aim of this current study was to review the scientific evidence to identify risk factors for low BMD in healthy women aged 40 to 60 years.

A literature search was performed to identify the studies that examined risk factors associated with low BMD in women aged 40 to 60 years. Observational studies, as well as articles that evaluated clinical assessment tools, were included if BMD was measured using dual energy x-ray absorptiometry (DXA). Randomized controlled drug trials, case series, case reports, letters, editorials or reviews were excluded. These studies were then screened to assess their eligibility.

Thirteen studies met all the eligibility criteria and were included in the final review. Thirteen risk factors for low BMD were identified: Calcium; Physical Activity; Smoking; Alcohol Consumption; Caffeine intake; Age at menarche; Reproductive history; History of premenopausal amenorrhea; Menopausal status or years post menopause; Family history of Osteoporosis; Race; Older age (independent of menopausal status); Body Weight.

The strength of the evidence for an association between each risk factor and BMD was then graded as good, fair, inconsistent or insufficient. This was determined by the quality of the study, the number of studies assessing a particular risk factor and the consistency of the results:

Good - good evidence for or against an association between the risk factor and BMD (consistent results across studies; more than 3 studies; at least 1 study graded as 'good quality' using the U.S. Preventive Services Task Force guidelines)
Fair - fair evidence for or against an association between the risk factor and BMD (consistent results across studies but limited by quantity (≤ 3 studies) or quality (no studies graded as 'good'))
Inconsistent - inconsistent evidence for or against an association between the risk factor and BMD (studies had conflicting results)
Insufficient - insufficient evidence for or against an association between the risk factor and BMD (inadequate number of studies - less than 3 studies)

Three studies evaluated the relationship between current caffeine intake and BMD, and one also examined lifetime intake. Sources of caffeine in these studies were from coffee, tea and cola, although no details were provided on the amounts of caffeine. An association between caffeine intake and BMD was not detected in any study. Using the grading criteria, the evidence that current caffeine intake is not associated with BMD was graded as 'fair' while there is insufficient evidence for an association between past intake and BMD.

The researchers concluded by saying while there is good evidence that menopausal status is associated with BMD, out of all the risk factors examined, only low body weight can be considered, with confidence, as an important risk factor for low BMD in healthy 40 to 60 year old women. In terms of caffeine, this review found no evidence of an association between caffeine intake and lower BMD.
Waugh EJ et al (2009) Risk factors for low bone mass in healthy 40-60 year old women: A systematic review of the literature. Osteoporos Int 20:1-21 DOI 10.1007/s00198-008-0643-x

Caffeine Consumption may Benefit Cognitive Function and Mental Health in a Non-Working Population
Results from a recently published study have found that among a non-working population, caffeine consumption is associated with better cognitive functioning and a reduced risk of depression without negative health effects.

Woman drinking tea Much of the research investigating the role of caffeine on performance has been conducted in the laboratory using artificial tasks. There has been far less research on the effects of regular caffeine consumption on real-life activities. One previous study examining this found that caffeine consumption was associated with fewer cognitive failures and accidents at work. The main aim of this present study was to determine whether similar effects were seen in a non-working sample. However recommendations for caffeine have to be based on a cost-benefit analysis i.e. the possible behavioural benefits versus any health problems associated with it. Many health effects of caffeine, both positive and negative, have been reported. A second aim of the study was to determine whether the regular consumption of caffeine was associated with significant health effects.

This study involved a secondary analysis of the Bristol Stress and Health at Work Study and the Cardiff Health and Safety at Work Study. The combined database contained information on the level of caffeine consumption, cognitive failures and health outcomes. Additional demographic and health related behaviours were also available.

A daily caffeine consumption figure was calculated using information on reported intake of caffeine containing drinks, but not other sources (e.g. chocolate or medication).

Cognitive failures were measured by asking, 'How frequently do you have problems of memory (e.g. forgetting where you put things), attention (e.g. failures of concentration) or action (doing the wrong things)'? Responses were made on a five-point scale from 'not at all' to 'very frequently'.

The number of accidents requiring medical attention in the past 12 months and the frequency of minor injuries were also noted. Again responses were made on a five-point scale from 'not at all' to 'very frequently'.

Furthermore, a detailed account of health outcomes was recorded including:

The life-long occurrence of serious conditions diagnosed by a clinician (e.g. angina, high cholesterol levels, hypertension, diabetes, heart attack, stroke, asthma, emphysema, bronchitis, breast cancer and other cancers)
Recurrent health problems over the last 12 months (e.g. bronchitis, back problems, persistent skin trouble, hay fever, stomach troubles, asthma, arthritis, constipation, piles, foot problems, varicose veins, trouble with gums or teeth)
Mental health problems (e.g. anxiety, depression)
Use of health services (e.g. visits to the GP, hospital in-patient stay or out-patient attendance)

Finally, demographic information, smoking status and alcohol consumption was obtained.

3223 non-working people (57% women) with an average age of 49.6 years (ranging between 17-92 years) took part in the study. Average caffeine consumption was 140mg/day (range 0-1800mg).

To examine the association between caffeine consumption and measured outcomes, caffeine intake was split into quartiles (0, 1-140, 141-260, >260 mg day). By controlling for demographic and lifestyle variables, analysis showed that cognitive failures (of memory, attention or action) were significantly reduced in those who consumed caffeine compared to those who didn't. Those who consumed more than 260mg of caffeine a day, were half as likely to report 'quite' or 'very frequent' cognitive failures than non-consumers.

There were no significant effects of caffeine consumption on minor injuries, accidents, GP visits and hospitalisation. However in terms of chronic health problems, a beneficial effect of caffeine was found in the angina analysis. Higher levels of caffeine consumption were associated with a lower frequency of angina. Furthermore, higher caffeine consumption was associated with a reduced risk of depression.

Woman drinking tea Researchers conducted a separate analysis into the sources of caffeine, tea and coffee, and yielded similar results suggesting that caffeine per se is producing the effect. This has yet to be proved and the mechanism of action is unclear.

Although the results from this survey support the findings from laboratory studies of acute effects of caffeine, the authors point out a number of limitations. Firstly health outcomes, cognitive failure and caffeine intake was based on self-reporting. This method of collecting data can produce imprecise results. Secondly because of the cross-sectional nature of the study the data could be interpreted in other ways than currently reported. For example, it could be that the higher incidence of angina and depression seen in the non-consumers is due to these disease influencing caffeine intakes rather than the other way round. In other words cross-sectional studies can not determine cause and effect.

Despite these problems the authors believe that the present findings support the view that regular consumption of caffeinated beverages is associated with fewer cognitive failures.

The results of this analysis suggest that caffeine consumption, either from tea or coffee, may benefit cognitive function and mental health in a non-working population. This association does not appear to be associated with any health costs.
Smith AP (2008) Caffeine, cognitive failures and health in a non-working community sample. Hum. Psychopharmacol Clin Exp. DOI: 10.1002/hup.991







Health Professionals Newsletter Welcome to the twelth newsletter from the United Kingdom Tea Council. This service will keep you up to date with current tea4health activities and events and inform you of the latest published research. We'll keep you updated on a quarterly basis with news and views from across the tea industry. Research Update Caffeine is not considered a risk factor for low bone mass in healthy 40-60 year old women According to a recent review published in Osteoporosis International there is no evidence linking caffeine intake to a low Bone Mineral Density (BMD) in women approaching the menopause or recently menopausal. Low BMD is a characteristic of Osteoporosis, a condition where the bones become thin and weak thereby increasing the risk of fractures. Osteoporosis is a major health problem worldwide with more than 75 million people in Europe, Japan and the United States being affected. Every year it causes 2.3 million fractures in Europe and the United States. In the UK one in two women and one in five men over the age of 50 will fracture a bone, mainly as a result of osteoporosis. Bone loss occurs when estrogen levels decline and as a result Osteoporosis mainly affects women after the age of menopause. Identifying younger women who are potentially at risk of low BMD will help to determine those who may benefit from early intervention. However current risk assessment for low BMD is mainly based on data of older women (≥ 65 years of age) which may not be relevant to younger women. The aim of this current study was to review the scientific evidence to identify risk factors for low BMD in healthy women aged 40 to 60 years. A literature search was performed to identify the studies that examined risk factors associated with low BMD in women aged 40 to 60 years. Observational studies, as well as articles that evaluated clinical assessment tools, were included if BMD was measured using dual energy x-ray absorptiometry (DXA). Randomized controlled drug trials, case series, case reports, letters, editorials or reviews were excluded. These studies were then screened to assess their eligibility. Thirteen studies met all the eligibility criteria and were included in the final review. Thirteen risk factors for low BMD were identified: Calcium; Physical Activity; Smoking; Alcohol Consumption; Caffeine intake; Age at menarche; Reproductive history; History of premenopausal amenorrhea; Menopausal status or years post menopause; Family history of Osteoporosis; Race; Older age (independent of menopausal status); Body Weight. The strength of the evidence for an association between each risk factor and BMD was then graded as good, fair, inconsistent or insufficient. This was determined by the quality of the study, the number of studies assessing a particular risk factor and the consistency of the results: Good - good evidence for or against an association between the risk factor and BMD (consistent results across studies; more than 3 studies; at least 1 study graded as 'good quality' using the U.S. Preventive Services Task Force guidelines) Fair - fair evidence for or against an association between the risk factor and BMD (consistent results across studies but limited by quantity (≤ 3 studies) or quality (no studies graded as 'good')) Inconsistent - inconsistent evidence for or against an association between the risk factor and BMD (studies had conflicting results) Insufficient - insufficient evidence for or against an association between the risk factor and BMD (inadequate number of studies - less than 3 studies) Three studies evaluated the relationship between current caffeine intake and BMD, and one also examined lifetime intake. Sources of caffeine in these studies were from coffee, tea and cola, although no details were provided on the amounts of caffeine. An association between caffeine intake and BMD was not detected in any study. Using the grading criteria, the evidence that current caffeine intake is not associated with BMD was graded as 'fair' while there is insufficient evidence for an association between past intake and BMD. The researchers concluded by saying while there is good evidence that menopausal status is associated with BMD, out of all the risk factors examined, only low body weight can be considered, with confidence, as an important risk factor for low BMD in healthy 40 to 60 year old women. In terms of caffeine, this review found no evidence of an association between caffeine intake and lower BMD. Waugh EJ et al (2009) Risk factors for low bone mass in healthy 40-60 year old women: A systematic review of the literature. Osteoporos Int 20:1-21 DOI 10.1007/s00198-008-0643-x Caffeine Consumption may Benefit Cognitive Function and Mental Health in a Non-Working Population Results from a recently published study have found that among a non-working population, caffeine consumption is associated with better cognitive functioning and a reduced risk of depression without negative health effects. Much of the research investigating the role of caffeine on performance has been conducted in the laboratory using artificial tasks. There has been far less research on the effects of regular caffeine consumption on real-life activities. One previous study examining this found that caffeine consumption was associated with fewer cognitive failures and accidents at work. The main aim of this present study was to determine whether similar effects were seen in a non-working sample. However recommendations for caffeine have to be based on a cost-benefit analysis i.e. the possible behavioural benefits versus any health problems associated with it. Many health effects of caffeine, both positive and negative, have been reported. A second aim of the study was to determine whether the regular consumption of caffeine was associated with significant health effects. This study involved a secondary analysis of the Bristol Stress and Health at Work Study and the Cardiff Health and Safety at Work Study. The combined database contained information on the level of caffeine consumption, cognitive failures and health outcomes. Additional demographic and health related behaviours were also available. A daily caffeine consumption figure was calculated using information on reported intake of caffeine containing drinks, but not other sources (e.g. chocolate or medication). Cognitive failures were measured by asking, 'How frequently do you have problems of memory (e.g. forgetting where you put things), attention (e.g. failures of concentration) or action (doing the wrong things)'? Responses were made on a five-point scale from 'not at all' to 'very frequently'. The number of accidents requiring medical attention in the past 12 months and the frequency of minor injuries were also noted. Again responses were made on a five-point scale from 'not at all' to 'very frequently'. Furthermore, a detailed account of health outcomes was recorded including: The life-long occurrence of serious conditions diagnosed by a clinician (e.g. angina, high cholesterol levels, hypertension, diabetes, heart attack, stroke, asthma, emphysema, bronchitis, breast cancer and other cancers) Recurrent health problems over the last 12 months (e.g. bronchitis, back problems, persistent skin trouble, hay fever, stomach troubles, asthma, arthritis, constipation, piles, foot problems, varicose veins, trouble with gums or teeth) Mental health problems (e.g. anxiety, depression) Use of health services (e.g. visits to the GP, hospital in-patient stay or out-patient attendance) Finally, demographic information, smoking status and alcohol consumption was obtained. 3223 non-working people (57% women) with an average age of 49.6 years (ranging between 17-92 years) took part in the study. Average caffeine consumption was 140mg/day (range 0-1800mg). To examine the association between caffeine consumption and measured outcomes, caffeine intake was split into quartiles (0, 1-140, 141-260, >260 mg day). By controlling for demographic and lifestyle variables, analysis showed that cognitive failures (of memory, attention or action) were significantly reduced in those who consumed caffeine compared to those who didn't. Those who consumed more than 260mg of caffeine a day, were half as likely to report 'quite' or 'very frequent' cognitive failures than non-consumers. There were no significant effects of caffeine consumption on minor injuries, accidents, GP visits and hospitalisation. However in terms of chronic health problems, a beneficial effect of caffeine was found in the angina analysis. Higher levels of caffeine consumption were associated with a lower frequency of angina. Furthermore, higher caffeine consumption was associated with a reduced risk of depression. Researchers conducted a separate analysis into the sources of caffeine, tea and coffee, and yielded similar results suggesting that caffeine per se is producing the effect. This has yet to be proved and the mechanism of action is unclear. Although the results from this survey support the findings from laboratory studies of acute effects of caffeine, the authors point out a number of limitations. Firstly health outcomes, cognitive failure and caffeine intake was based on self-reporting. This method of collecting data can produce imprecise results. Secondly because of the cross-sectional nature of the study the data could be interpreted in other ways than currently reported. For example, it could be that the higher incidence of angina and depression seen in the non-consumers is due to these disease influencing caffeine intakes rather than the other way round. In other words cross-sectional studies can not determine cause and effect. Despite these problems the authors believe that the present findings support the view that regular consumption of caffeinated beverages is associated with fewer cognitive failures. The results of this analysis suggest that caffeine consumption, either from tea or coffee, may benefit cognitive function and mental health in a non-working population. This association does not appear to be associated with any health costs. Smith AP (2008) Caffeine, cognitive failures and health in a non-working community sample. Hum. Psychopharmacol Clin Exp. DOI: 10.1002/hup.991
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