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Page 2 of 9 Calabrò et al. Hepatoma Res 2020;6:69 I http://dx.doi.org/10.20517/2394-5079.2020.63

A B C

Figure 1. 2D chemical structures of caffeine (A), chlorogenic acid (B), ferulic acid (C)

(NASH), and finally in cirrhosis. Today liver diseases and in particular NAFLD, affects about 25% of the
[1-4]
population worldwide, representing the main cause of chronic liver disease in industrialized countries .
Lifestyle modifications such as maintaining a healthy diet and regular physical activityare key in reducing
the onset of NAFLD [5-9] . In particular, it is most important to remove all dietary compounds that can
promote NAFLD, for example fructose, saturated fatty acids, carbohydrates with a high glycemic index,
[2,3]
and foods with a high sodium content . Promotion of a balanced diet and loss of excess weight are also
important in the context of this clinical condition. The reduction of at least 5% body weight is effective in
reducing hepatic fat accumulation [10,11] .

In recent years, the Mediterranean diet has also been accredited as a therapeutic standard in the treatment
of NAFLD [12-17] . Different studies have showed how functional foods can positively influence our
health [5,18-22] .

Among the functional foods, we find coffee the most promising; a drink appreciated and consumed all over
[23]
the world . Different beneficial effects have been related to moderate and regular consumption of coffee.
In particular, the intake of this drink has proven effective in reducing the risk of type IIdiabetes mellitus,
gastrointestinal disorders, Parkinson disease, cardiovascular problems, and gallbladder stones [24-28] .

The present review aims to describe the beneficial effects of coffee consumption in patients with NAFLD.

CHEMICAL COMPONENTS OF COFFEE
Coffee, one of the most consumed beverages in the world, is composed of a large number of substances
and polyphenols that contribute to making coffee a real functional food thanks to their beneficial activities.
Among the main polyphenols in coffee, chlorogenic acid and ferulic acid [Figure 1] have shown promising
antioxidative properties.

The most representative and known compound of coffee is undoubtedly caffeine [Figure 1], an alkaloid
naturally present in leaves, seeds, and fruits of coffee, tea, cocoa, cola, and guarana plants. Caffeineis
absorbed in the stomach and first portion of the intestine within 10 min after ingestion, reaching a
maximum concentration in the bloodstream after 45-60 min. Once absorbed by the body, caffeine is
metabolized in the liver where it is converted into three dimethylxanthines: paraxanthine, theobromine,
[29]
theophylline which contribute to enhancing its effects .
In recent years, natural compounds have been the subject of several studies in order to identify their
beneficial activities, and in this regard promising antifibrotic effects have been attributed to caffeine [Figure 2].

In particular, caffeine showed promising antifibrotic effect resulting from a series of biochemical processes
initiated by liver cell stimulation causing induction of intracellular F-actin and cAMP expression, inhibition