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Association Between Coffee Consumption and Pain: A Cross-sectional Study Based on American National Health and Nutrition Examination Survey
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摘要:
目的 基于公开数据库中的大样本信息，探究日常咖啡摄入与不同类型疼痛之间的相关性。 方法 提取美国国家卫生和营养检查调查(National Health and Nutrition Examination Survey，NHANES)数据库中1999—2000年、2001—2002年、2003—2004年3个周期受试者的咖啡摄入、疼痛及11个协变量(包括年龄、性别、种族、受教育程度等)数据，采用无序多分类Logistic回归法构建3种模型评估日常咖啡摄入与疼痛之间的相关性。 结果 共入选符合纳入与排除标准的受试者13 428名，其平均年龄为(49.79±19.06)岁，男女比例为0.9∶1。每日咖啡摄入情况：无咖啡摄入7794名(58.0%)，＞0~2杯咖啡摄入2077名(15.5%)，＞2杯咖啡摄入3557名(26.5%)；每日咖啡因摄入情况：无咖啡因摄入7794名(58.0%)，＞0~200 mg咖啡因摄入3152名(23.5%)，＞200 mg咖啡因摄入2482名(18.5%)。疼痛情况：无疼痛或疼痛持续时间＜24 h 10 202名(76.0%)，急性疼痛910名(6.8%)，亚急性疼痛369名(2.7%)，慢性疼痛1947名(14.5%)。经权重估算，13 428名受试者预计可代表 1.9亿(190 709 157名)年龄≥20岁的美国公民，该期间美国人群急性疼痛、亚急性疼痛、慢性疼痛总体患病率分别为8%、3%、16%。Logistic回归分析显示，在未对任何协变量进行校正时，相较于每日无咖啡/咖啡因摄入者，每日咖啡摄入＞2杯(OR=1.354, 95% CI：1.187~1.544)或咖啡因摄入＞200 mg(OR=1.372, 95% CI：1.185~1.587)人群出现慢性疼痛的风险增加；当校正年龄、性别、种族的影响后，可得到相近结果，OR值分别为1.243(95% CI：1.083~1.427)和1.249(95% CI：1.072~1.456)；当对11个协变量均进行校正时，未发现每日咖啡摄入杯数及咖啡因摄入量与慢性疼痛具有明显相关性。3种模型均未发现每日咖啡摄入杯数、咖啡因摄入量与急性疼痛、亚急性疼痛存在相关性。 结论 与不摄入咖啡者相比，每日大量摄入咖啡者出现慢性疼痛的风险增高，但此种相关性受多种因素的影响；尚未发现日常咖啡摄入与急性疼痛、亚急性疼痛存在明显相关性。仍需开展基础研究和前瞻性临床试验进一步明确咖啡摄入与慢性疼痛之间的因果关系及其确切作用机制。 Abstract:Objective To elucidate whether coffee consumption and caffeine intake was associated with various subtypes of pain based on extensive data from publicly accessible databases. Methods The information was extracted from three cycles of the American National Health and Nutrition Examination Survey (1999—2000, 2001—2002, 2003—2004), encompassing data on coffee consumption, pain information, and 11 covariates (including age, gender, race, etc.). Multinomial logistic regression in three models were utilized for analysis. Results A total of 13 428 participants were included in this study, with a mean age of (49.79±19.06)years and a male-to-female ratio of 0.9∶1. Daily coffee intake: non-drinker 7794(58.0%), > 0-2 cups 2077(15.5%), > 2 cups 3557(26.5%); daily caffeine intake: without intake 7794(58.0%), > 0-200 mg 3152(23.5%), > 200 mg 2482(18.5%); pain situation: no pain or pain duration < 24 h 10 202(76.0%), acute pain 910(6.8%), subacute pain 369(2.7%), chronic pain 1947(14.5%). After weighting, 13 428 participants were expected to represent 190 million(190 709 157) U.S. citizens aged ≥20 years, and the overall prevalence of acute, subacute, and chronic pain in the U.S. population during that period was estimated to be 8%, 3%, and 16%, respectively. Without adjusting for covariates, individuals who consumed more than 2 cups of coffee or 200 mg of caffeine per day exhibited an elevated risk of chronic pain compared to non-coffee/caffeine drinkers, with an odds ratio of 1.354(95% CI: 1.187-1.544) and 1.372(95% CI: 1.185-1.587), respectively. After adjusting for partial covariates including age, sex, and race, individuals who consumed more than 2 cups of coffee or more than 200 mg of caffeine per day still demonstrated an increased risk of chronic pain with an odds ratio of 1.243(95% CI: 1.083-1.427) and 1.249 (95% CI: 1.072-1.456), respectively. However, after all covariates were adjusted, there was no significant association between coffee/caffeine consumption and chronic pain. Furthermore, the number of cups of coffee consumed or caffeine intake showed no significant correlation with acute and subacute pain. Conclusions Compared with nondrinkers, heavy daily coffee drinkers may be more likely to have chronic pain, but it is affected by multiple factors. Basic research and prospective clinical studies are needed to further determine the causality in this association. -
Key words:
- acute pain /
- subacute pain /
- chronic pain /
- coffee /
- caffeine /
- cross-sectional study
作者贡献：闻蓓负责研究设计、数据处理、论文撰写；朱贺负责数据提取、图表绘制；许力、黄宇光负责研究设计、论文修订与审核。利益冲突：所有作者均声明不存在利益冲突 -
表 1 13 428名受试者一般临床资料
Table 1. General characteristics of 13 428 participants
指标 纳入人群数量
[n(%)]权重估算人群数量(n) 权重估算人群百分比
[%(95% CI)]年龄(岁) 20~＜45 5943(44.3) 95 354 579 50(49~51) 45~＜60 2764(20.6) 51 491 472 27(26~28) ≥60 4721(35.2) 43 863 106 23(22~23) 性别 男 6366(47.4) 91 540 395 48(47~49) 女 7062(52.6) 99 168 762 52(51~53) 种族 墨裔美籍人 3023(22.5) 13 349 641 7(7~8) 其他西班牙裔 613(4.6) 11 442 550 6(5~6) 非西班牙裔白人 6774(50.4) 137 310 593 72(71~73) 非西班牙裔黑人 2552(19.0) 20 978 007 11(10~11) 其他 466(3.5) 7 628 366 4(4~5) 受教育程度 高中以下 4341(32.3) 38 713 959 20(20~21) 高中 3179(23.7) 49 775 090 26(25~27) 高中以上 5882(43.8) 102 029 399 54(52~55) 缺失 26(0.2) - - 婚姻状态 已婚 7310(54.4) 106 797 128 56(55~57) 丧偶 1325(9.9) 11 442 549 6(6~7) 离异 1144(8.5) 17 163 824 9(9~10) 分居 426(3.2) 5 721 275 3(2~3) 单身 2047(15.2) 30 513 465 16(16~17) 同居 708(5.3) 11 442 549 6(5~6) 缺失 468(3.5) - - PIR ＜1.3 3502(26.1) 38 141 831 20 (19~21) 1.3~＜1.8 1468(10.9) 17 163 824 9(8~10) ≥1.8 7309(54.4) 122 053 860 64(63~65) 缺失 1149(8.6) - - 每天饮酒情况(杯) 0 4146(30.9) 51 491 472 27(26~28) 1~2 5755(42.9) 85 819 121 45(44~46) ＞2 2867(21.4) 45 770 198 24(23~25) 缺失 660(4.9) - - 体质量指数(kg/m2) ＜20 628(4.7) 9 535 458 5(5~6) 20~＜25 3523(26.2) 53 398 564 28(28~30) 25~＜30 4697(35.0) 64 841 113 34(33~35) ≥30 4212(31.4) 57 212 747 30(29~31) 缺失 368(2.7) - - 日常体力活动 久坐 3445(25.7) 47 677 289 25(24~26) 轻度体力活动 7076(52.7) 95 354 579 50(49~52) 中度体力活动 2032(15.1) 32 420 557 17(16~18) 重度体力活动 859(6.4) 13 349 641 7(7~8) 缺失 16(0.1) - - 吸烟 6506(48.5) 95 354 579 50 (49~51) 糖尿病 1646(12.3) 17 163 824 9(8~9) 每日咖啡因摄入(mg) 0 7794(58.0) 106 797 128 56(55~57) ＞0~200 3152(23.5) 40 048 923 21 (20~22) ＞200 2482(18.5) 43 863 106 23 (22~24) 每日咖啡摄入(杯) 0 7794(58.0) 106 797 128 56(55~57) ＞0~2 2077(15.5) 26 699 282 14 (13~14) ＞2 3557(26.5) 57 212 747 30 (29~31) 疼痛 无疼痛或疼痛持续时间＜24 h 10 202(76.0) 139 217 685 73(72~74) 急性疼痛 910(6.8) 15 256 732 8(8~9) 亚急性疼痛 369(2.7) 5 721 275 3(3~4) 慢性疼痛 1947(14.5) 30 513 465 16(15~17) -：不适用；PIR(poverty-income ratio)：贫穷比率 
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表 2 咖啡摄入与疼痛关系的无序多分类Logistic回归分析结果
Table 2. Results of multinomial Logistic analysis on the associations between coffee consumption and pain
疼痛类型 模型* 咖啡摄入杯数与疼痛的关系(以不摄入咖啡为参照) 咖啡因摄入与疼痛的关系(以不摄入咖啡因为参照) ≤2杯/d ＞2杯/d ≤200 mg/d ＞200 mg/d OR(95% CI) P值 OR(95% CI) P值 OR(95% CI) P值 OR(95% CI) P值 急性疼痛 模型1 0.941(0.735~1.206) 0.631 0.936(0.775~1.132) 0.497 0.925(0.751~1.140) 0.465 0.951(0.770~1.175) 0.643 模型2 1.090(0.846~1.405) 0.503 0.942(0.774~1.147) 0.550 1.038(0.838~1.287) 0.731 0.939(0.754~1.169) 0.572 模型3 1.079(0.833~13.96) 0.566 0.909(0.743~1.112) 0.355 1.031(0.829~1.282) 0.784 0.896(0.716~1.121) 0.336 亚急性疼痛 模型1 0.812(0.526~1.255) 0.3499 0.986(0.741~1.312) 0.923 0.801(0.562~1.420) 0.220 1.058(0.774~1.446) 0.723 模型2 0.840(0.545~1.294) 0.428 0.943(0.697~1.276) 0.705 0.808(0.565~1.154) 0.241 1.011(0.724~1.412) 0.949 模型3 0.870(0.572~1.327) 0.518 0.963(0.706~1.312) 0.810 0.845(0.593, 1.205) 0.353 1.018(0.724~1.433) 0.917 慢性疼痛 模型1 0.968(0.809~1.158) 0.720 1.354(1.187~1.544) ＜0.001 1.088(0.938~1.261) 0.266 1.372(1.185~1.587) ＜0.001 模型2 0.948(0.789~1.139) 0.568 1.243(1.083~1.427) 0.002 1.049(0.902~1.220) 0.537 1.249(1.072~1.456) 0.004 模型3 0.891(0.738~1.075) 0.228 1.125(0.975~1.297) 0.106 0.996(0.852~1.164) 0.960 1.103(0.941~1.293) 0.227 *模型1未对任何协变量进行校正，模型2仅对年龄、性别、种族进行校正，模型3对11个协变量均进行校正
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表 3 咖啡摄入与慢性疼痛关系的无序多分类Logistic回归分析结果
Table 3. Results of multinomial Logistic analysis on the associations between coffee consumption and chronic pain
指标 以每日咖啡因摄入量为主变量 以每日咖啡摄入杯数为主变量 OR(95% CI) P值 OR(95% CI) P值 年龄(以20~＜45岁为参照) 45~＜60岁 1.291(1.096~1.520) 0.002 1.287(1.093~1.516) 0.003 ≥60岁 0.882(0.740~1.052) 0.161 0.887(0.744~1.058) 0.183 性别(以男性为参照) 1.384(1.209~1.584) ＜0.001 1.387(1.212~1.587) ＜0.001 种族(以墨裔美籍人为参照) 其他西班牙裔 1.737(1.241~2.432) 0.001 1.769(1.263~2.478) ＜0.001 非西班牙裔白人 2.528(2.079~3.073) ＜0.001 2.516(2.071~3.056) ＜0.001 非西班牙裔黑人 1.773(1.436~2.190) ＜0.001 1.776(1.438~2.194) ＜0.001 其他 2.009(1.423~2.836) ＜0.001 2.023(1.432~2.857) ＜0.001 受教育程度(以高中以下为参照) 高中 0.916(0.771~1.087) 0.314 0.914(0.77~1.084) 0.302 高中以上 0.787(0.666~0.928) 0.005 0.785(0.665~0.927) 0.004 婚姻状态(以已婚为参照) 丧偶 0.792(0.632~0.992) 0.042 0.791(0.632~0.991) 0.042 离异 1.154(0.944~1.410) 0.162 1.149(0.940~1.404) 0.176 分居 0.866(0.610~1.230) 0.421 0.869(0.612~1.235) 0.434 单身 0.627(0.506~0.777) ＜0.001 0.627(0.506~0.778) ＜0.001 同居 1.154(0.883~1.508) 0.293 1.153(0.883~1.506) 0.296 PIR(以＜1.3为参照) 1.3~＜1.8 0.914(0.738~1.132) 0.409 0.917(0.741~1.135) 0.427 ≥1.8 0.636(0.544~0.743) ＜0.001 0.633(0.541~0.739) ＜0.001 饮酒(以0杯/d为参照) 1~2杯/d 1.010(0.866~1.177) 0.902 1.009(0.865~1.176) 0.911 ＞2杯/d 0.916(0.750~1.118) 0.387 0.914(0.749~1.116) 0.377 体质量指数(以＜20 kg/m2为参照) 20~＜25 kg/m2 1.000(0.734~1.364) 0.998 1.001(0.734~1.364) 0.997 25~＜30 kg/m2 1.261(0.927~1.714) 0.139 1.263(0.929~1.716) 0.137 ≥30 kg/m2 1.642(1.21~2.229) 0.002 1.644(1.212~2.231) 0.001 日常体力活动(以久坐为参照) 轻度体力活动 0.787(0.683~0.908) 0.001 0.786(0.682~0.906) ＜0.001 中度体力活动 0.839(0.692~1.018) 0.075 0.839(0.692~1.017) 0.074 重度体力活动 0.953(0.726~1.253) 0.732 0.950(0.723~1.249) 0.715 吸烟 1.707(1.494~1.950) ＜0.001 1.700(1.488~1.942) ＜0.001 糖尿病 1.443(1.199~1.735) ＜0.001 1.442(1.198~1.734) ＜0.001 每日咖啡因摄入量(以不摄入咖啡因为参照) ＞0~200 mg 0.996(0.852~1.164) 0.960 - - ＞200 mg 1.103(0.941~1.293) 0.227 - - 每日咖啡摄入杯数(以不摄入咖啡为参照) ＞0~2杯 - - 0.891(0.738~1.075) 0.228 ＞2杯 - - 1.125(0.975~1.297) 0.106 PRP：同表 1；-：不适用
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