Higher chocolate intake was associated with lower risk for future CV events in a prospective study and meta-analysis, although researchers said residual confounding cannot be excluded.
Researchers conducted a prospective analysis of 20,951 men and women (99.6% white) from the EPIC-Norfolk cohort. All participants were free of CVD at baseline. The researchers quantified habitual chocolate intake based on responses to a baseline food-frequency questionnaire, conducted from 1993 to 1997, and stratified participants into quintiles based on chocolate consumption. The participants were followed for CV endpoints until March 2008. Mean follow-up was 11.3 years. In addition, the researchers conducted a meta-analysis of nine studies covering 157,809 participants on the relationship between chocolate consumption and CV events.
Compared with the lowest quintile of chocolate consumption (0 g/day), participants in the highest quintile of intake (15.6-98.8 g/day) had a lower risk for CHD (9.7% vs. 13.8%; adjusted HR = 0.88; 95% CI, 0.77-1.01), stroke (3.1% vs. 5.4%; adjusted HR = 0.77; 95% CI, 0.62-0.97), CVD (12% vs. 17.4%; adjusted HR = 0.86; 95% CI, 0.76-0.97) and fatal CVD (3.9% vs. 7.3%; adjusted HR = 0.73; 95% CI, 0.6-0.89).
When the researchers analyzed a propensity-score-matched subset of participants, they found similar trends, but the results were not significant due to lower sample sizes.
According to results of the meta-analysis, higher chocolate consumption was associated with lower risk for CHD (five studies; pooled RR = 0.71; 95% CI, 0.56-0.92), stroke (five studies; pooled RR = 0.79; 95% CI, 0.7-0.87), a composite CV adverse outcome (two studies; pooled RR = 0.75; 95% CI, 0.54-1.05) and CV mortality (three studies; pooled RR = 0.55; 95% CI, 0.36-0.83) compared with lower chocolate consumption.
A limitation of the study is that underreporting is known to occur on food-frequency questionnaires, according to the researchers. “It is possible that lower CVD rates among people who report consuming more chocolate might be due to differential underreporting of chocolate intake in those with potentially greater CVD risk such as the obese and the physically inactive,” they wrote.
No conclusions can be drawn about the causality of the association because it may be related to the entire dietary pattern, raising concerns about unmeasured confounding, they wrote.
Another factor could be that compared with the other quintiles, the lowest quintile had the highest BMI, highest levels of C-reactive protein, highest levels of inactivity and lowest fat intake, according to the researchers.
The results, combined with previous research finding high chocolate intake is associated with lower incidence of diabetes and increases in body weight, “may suggest that there is a balance between benefit and risk with chocolate intake, which is dependent on the risk profile of the individual, including baseline weight and dose of chocolate intake.” – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.