SynthesisEuropean journal of nutrition2020
Chocolate and risk of chronic disease: a systematic review and dose-response meta-analysis.
Synthesis in European journal of nutrition, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- A systematic review of prospective evidence linking non-alcoholic fermented food consumption with lower mortality risk.Frontiers in nutrition · 2025Pooled it
- The Role of Diet in the Prevention of Hypertension and Management of Blood Pressure: An Umbrella Review of Meta-Analyses of Interventional and Observational Studies.Advances in nutrition (Bethesda, Md.) · 2024Pooled it
- Role of diet in stroke incidence: an umbrella review of meta-analyses of prospective observational studies.BMC medicine · 2022Pooled it
- Relationship between chocolate consumption and overall and cause-specific mortality, systematic review and updated meta-analysis.European journal of epidemiology · 2022Pooled it
- Evaluation of the Quality of Evidence of the Association of Foods and Nutrients With Cardiovascular Disease and Diabetes: A Systematic Review.JAMA network open · 2022Pooled it
- Cardiovascular Effects of Chocolate and Wine-Narrative Review.Nutrients · 2021Pooled it
- Effect of cocoa (Open heart · 2022Trial
- Effect of cocoa flavanol supplementation for the prevention of cardiovascular disease events: the COcoa Supplement and Multivitamin Outcomes Study (COSMOS) randomized clinical trial.The American journal of clinical nutrition · 2022Trial
- Trial
- Trial
- Effects of Cocoa Extract and Multivitamin Supplementation on Venous Thromboembolism in the COSMOS Trial.Thrombosis and haemostasis · 2026Article
- The impact of dietary interventions on cardiometabolic health.Cardiovascular diabetology · 2025Review
- The association between polyphenol consumption and stroke risk factors in Saudi Arabia.Frontiers in nutrition · 2025Article
- Association of ultra-processed food consumption with all cause and cause specific mortality: population based cohort study.BMJ (Clinical research ed.) · 2024Article
- Cardiovascular benefits of fermented foods and beverages: still up for debate.Nature reviews. Cardiology · 2023Article
- Can Chocolate Be Classified as an Ultra-Processed Food? A Short Review on Processing and Health Aspects to Help Answer This Question.Foods (Basel, Switzerland) · 2023Review
- Review
- Fermented foods and cardiometabolic health: Definitions, current evidence, and future perspectives.Frontiers in nutrition · 2022Review
- Chocolate consumption and risk of coronary artery disease: the Million Veteran Program.The American journal of clinical nutrition · 2021Article
- From Preclinical Stroke Models to Humans: Polyphenols in the Prevention and Treatment of Stroke.Nutrients · 2020Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeEvidence 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.
methodsProspective 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.
resultsOverall, 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).
conclusionChocolate 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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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.