Abstract
Few studies with mixed results have examined the association between chocolate consumption and mortality. We aimed to examine this association in a US population. A population-based cohort of 91891 participants aged 55 to 74 years was identified. Chocolate consumption was assessed via a food frequency questionnaire. Cox regression was used to estimate risk estimates. After an average follow-up of 13.5 years, 19586 all-cause deaths were documented. Compared with no regular chocolate consumption, the maximally adjusted hazard ratios of all-cause mortality were 0.89 [95% confidence interval (CI) 0.84–0.94], 0.84 (95% CI 0.79–0.90), 0.86 (95% CI 0.81–0.93), and 0.87 (95% CI 0.82–0.93) for >0–0.5 servings/week, >0.5–1 serving/week, >1–2 servings/week, and >2 servings/week, respectively (Ptrend = 0.009). A somewhat stronger inverse association was observed for mortality from cardiovascular disease and Alzheimer’s disease. A nonlinear dose–response pattern was found for all-cause and cardiovascular mortality (all Pnonlinearity < 0.01), with the lowest risk observed at chocolate consumption of 0.7 servings/week and 0.6 servings/week, respectively. The favorable associations with all-cause and cardiovascular mortality were found to be more pronounced in never smokers than in current or former smokers (all Pinteraction < 0.05). In conclusion, chocolate consumption confers reduced risks of mortality from all causes, cardiovascular disease, and Alzheimer’s disease in this US population.
Highlights
Because of its exquisite taste and flavor, chocolate is a widely consumed confectionery product, especially in Western countries [1]
Chocolate consumption was found to be inversely associated with cardiovascular mortality, with somewhat stronger magnitude of the association observed, while no significant association was observed for cancer mortality
The initial associations of chocolate consumption with risks of death from all causes, cardiovascular disease (CVD), and cancer did not www.aging-us.com www.aging-us.com change materially in a large range of sensitivity analyses (Supplementary Table 1). In this post hoc analysis, chocolate consumption was found to be inversely associated with all-cause and cardiovascular mortality in a nonlinear dose–response manner, with the lowest risk observed at chocolate consumption of 0.7 servings/week and 0.6 servings/ week, respectively, whereas no significant association was found for cancer mortality
Summary
Because of its exquisite taste and flavor, chocolate is a widely consumed confectionery product, especially in Western countries [1]. Higher chocolate consumption was found to be significantly associated with lower mortality from all causes [9] and cardiovascular disease (CVD) [9, 10], whereas no significant association was observed for chocolate consumption and coronary heart disease mortality [11]. These inconclusive results may be due to the differences in study population, study outcome, and/or study method. A study of 470 elderly men observed that higher cocoa intake conferred lower all-cause and cardiovascular mortality [12]. Findings from this study may not be applicable to chocolate, as cocoa is only a natural product of cocoa beans while chocolate is a solid food product mainly including cocoa, cocoa butter, and sugar [13]; this study has a small sample size, and could be subject to small study effects (i.e., small studies are conducted with less methodological rigor and tend to report larger risk estimates compared with large studies) [14]
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