Caffeine has long been known to lower the risk of developing liver disease and reduce fibrosis in patients with chronic liver disease. Recently, a new study was published in the American Association for the Study of Liver Diseases’ Journal of Hepatology, which demonstrated that the caffeine in coffee reduces the risk of early fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). Therefore, increasing coffee intake could potentially enable patients with non-alcoholic fatty liver disease (NAFLD) to avoid early fibrosis. Over the past two decades, there has been a steady increase in the prevalence of diabetes, obesity, and metabolic syndrome, which has led to an increase in the incidence of NAFLD. In fact, in the United States, experts consider NAFLD to be the leading cause of chronic liver disease, surpassing hepatitis B and C in the number of patients. The majority of patients have only fatty liver disease and are very unlikely to develop more serious liver disease. However, a minority of patients will develop NASH, which is characterized by inflammation of the liver, necrosis of liver cells, and possible scarring of the liver. 15 years later, about 10-11% of NASH patients will develop liver cancer (early scarring of the liver). To further investigate the relationship between coffee intake and the incidence and extent of NAFLD, Dr. Stephen Harrison of Brooke Army Medical Center, Sam Houston Base, Texas, surveyed participants in previous NAFLD studies and patients treated in the center’s outpatient liver clinic about coffee intake among the 306 participants and divided them into four groups : patients with no signs of fibrosis on ultrasound (control group), patients with steatosis, patients with NASH stages 0-1, and patients with NASH stages 2-4. The researchers found that the four groups consumed an average of 307, 229, 351, and 252 milligrams of total caffeine per day, and an average of 228, 160, 255, and 152 milligrams of coffee per day, respectively, and that there was a significant difference in caffeine intake between the steatosis group and the NASH0-1 group, and that the NASH0-1 group had a significantly higher coffee consumption than the NASH2-4 group. Fifty-eight percent of the caffeine in the NASH0-1 group came from regular coffee intake, compared with only 36% in the NASH2-4 group. Multivariate analyses showed a negative association between coffee intake and the risk of liver fibrosis, and Harrison concluded, “Our study demonstrates, for the first time, a histopathologic relationship between fatty liver and coffee intake, and moderate coffee intake in patients with NASH may reduce the risk of early liver fibrosis. Future studies will further examine the intake of coffee with clinical efficacy.”