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Open Access 01-02-2020 | Coronary Heart Disease | Original Contribution

Chocolate and risk of chronic disease: a systematic review and dose-response meta-analysis

Authors: Jakub Morze, Carolina Schwedhelm, Aleksander Bencic, Georg Hoffmann, Heiner Boeing, Katarzyna Przybylowicz, Lukas Schwingshackl

Published in: European Journal of Nutrition | Issue 1/2020

Abstract

Purpose

Evidence for the association between chocolate intake and risk of chronic diseases is inconclusive. Therefore, we aimed to synthesize and evaluate the credibility of evidence on the dose-response association between chocolate consumption with risk of all-cause mortality, coronary heart disease (CHD), stroke, heart failure (HF), type 2 diabetes (T2D), colorectal cancer (CRC), and hypertension.

Methods

Prospective studies were searched until July 2018 in PubMed, Embase, and Web of Science. Random-effects meta-analyses comparing highest versus lowest intake categories, linear, and non-linear dose-response analyses were conducted. The credibility of evidence was evaluated with the NutriGrade scoring-system.

Results

Overall, 27 investigations were identified (n = 2 for all-cause mortality, n = 9 for CHD, n = 8 for stroke, n = 6 for HF, n = 6 for T2D, n = 2 for hypertension and CRC, respectively). No associations with HF (RR 0.99, 95% CI 0.94, 1.04) and T2D (RR 0.94, 95% CI 0.88, 1.01) per each 10 g/day increase in chocolate intake were observed in the linear dose-response meta-analyses. However, a small inverse association for each 10 g/daily increase could be shown for the risk of CHD (RR 0.96, 95% CI 0.93, 0.99), and stroke (RR 0.90, 95% CI 0.82, 0.98). The credibility of evidence was rated either very low (all-cause mortality, HF, T2D, CRC or hypertension) or low (CHD, stroke).

Conclusion

Chocolate consumption is not related to risk for several chronic diseases, but could have a small inverse association with CHD and stroke. Our findings are limited by very low or low credibility of evidence, highlighting important uncertainty for chocolate–disease associations.

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Title: Chocolate and risk of chronic disease: a systematic review and dose-response meta-analysis
Authors: Jakub Morze
Carolina Schwedhelm
Aleksander Bencic
Georg Hoffmann
Heiner Boeing
Katarzyna Przybylowicz
Lukas Schwingshackl
Publication date: 01-02-2020
Publisher: Springer Berlin Heidelberg
Keywords: Coronary Heart Disease
Stroke
Heart Failure
Hypertension
Type 2 Diabetes
Colorectal Cancer
Colorectal Cancer
Hypertension
Published in: European Journal of Nutrition / Issue 1/2020
Print ISSN: 1436-6207
Electronic ISSN: 1436-6215
DOI: https://doi.org/10.1007/s00394-019-01914-9

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