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Clin Nutr. 2019 Jun;38(3):1101-1108. doi: 10.1016/j.clnu.2018.05.019. Epub 2018 Jun 1.

Is chocolate consumption associated with health outcomes? An umbrella review of systematic reviews and meta-analyses.

Author information

1
National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy; Ambulatory of Nutrition, IRCCS "S. de Bellis" National Institute of Gastroenterology-Research Hospital, Castellana Grotte, Bari, Italy. Electronic address: ilmannato@gmail.com.
2
Primary Care Department, Azienda USL Toscana Sud Est, Grosseto, Italy.
3
Primary Care Department, Aziendale AAS3 Alto Friuli - Collina - Medio Friuli, Udine, Italy.
4
Ambulatory of Nutrition, IRCCS "S. de Bellis" National Institute of Gastroenterology-Research Hospital, Castellana Grotte, Bari, Italy.
5
National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy.
6
Medical Department, Geriatric Unit, Azienda ULSS (Unità Locale Socio Sanitaria) 3 "Serenissima", Dolo-Mirano District, Italy.
7
NICM, School of Science and Health, University of Western Sydney, Australia; Division of Psychology and Mental Health, University of Manchester, UK.
8
The Cambridge Centre for Sport & Exercise Sciences, Anglia Ruskin University, Cambridge, UK.
9
Faculty of Health, Social Care and Education, Anglia Ruskin University, Bishop Hall Lane, Chelmsford CM1 1SQ, UK.
10
Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.
11
Department of Epidemiology, Center for Public Health, Medical University of Vienna, Austria.
12
University of Padova, Department of Neuroscience, Padova, Italy.
13
Faculty of Health, Social Care and Education, Anglia Ruskin University, Bishop Hall Lane, Chelmsford CM1 1SQ, UK; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

Abstract

BACKGROUND & AIMS:

The literature regarding the potential health benefits of chocolate consumption are unclear and the epidemiological credibility has not been systematically scrutinized, while the strength of the evidence is undetermined. We therefore aimed to map and grade the diverse health outcomes associated with chocolate consumption using an umbrella review of systematic reviews.

METHODS:

Umbrella review of systematic reviews of observational and intervention studies (randomized placebo-controlled trials, RCTs). For each association, random-effects summary effect size, 95% confidence interval, and 95% prediction interval were estimated. We also assessed heterogeneity, evidence for small-study effect and evidence for excess significance bias. For significant outcomes of the RCTs, the GRADE assessment was furtherly used.

RESULTS:

From 240 articles returned, 10 systematic reviews were included (8 of which included a meta-analysis), including a total of 84 studies (36 prospective observational studies and 48 interventional). Nineteen different outcomes were included. Among observational studies, including a total of 1,061,637 participants, the best available evidence suggests that chocolate consumption is associated with reduced risk of cardiovascular disease (CVD) death (n = 4 studies), acute myocardial infarction (n = 6), stroke (n = 5) and diabetes (n = 6), although this was based on a weak evidence of credibility. Across meta-analyses of intervention studies, chocolate consumption was positively associated with flow-mediated dilatation at 90-150 min (n = 3) and at 2-18 weeks (n = 3), and insulin resistance markers (n = 2). However, using the GRADE assessment, the evidence for these outcomes was low or very low. Data from two systematic reviews, reported that chocolate consumption was not associated with better depressive mood or cognitive function.

CONCLUSIONS:

There is weak evidence to suggest that chocolate consumption may be associated with favorable health outcomes.

KEYWORDS:

Cardiovascular disease; Chocolate; Meta-analysis; Umbrella review

PMID:
29903472
DOI:
10.1016/j.clnu.2018.05.019

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