Habitual chocolate consumption and the risk of incident heart failure among healthy men and women

C. S. Kwok; Y. K. Loke; A. A. Welch; R. N. Luben; M. A. H. Lentjes; S. M. Boekholdt; R. Pfister; M. A. Mamas; N. J. Wareham; K.-T. Khaw; P. K. Myint

doi:10.1016/j.numecd.2016.01.003

Habitual chocolate consumption and the risk of incident heart failure among healthy men and women

C. S. Kwok, Y. K. Loke, A. A. Welch, R. N. Luben, M. A. H. Lentjes, S. M. Boekholdt, R. Pfister, M. A. Mamas, N. J. Wareham, K.-T. Khaw, P. K. Myint

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Abstract

BACKGROUND: We aimed to examine the association between chocolate intake and the risk of incident heart failure in a UK general population. We conducted a systematic review and meta-analysis to quantify this association.

METHODS AND RESULTS: We used data from a prospective population-based study, the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort. Chocolate intake was quantified based on a food frequency questionnaire obtained at baseline (1993-1997) and incident heart failure was ascertained up to March 2009. We supplemented the primary data with a systematic review and meta-analysis of studies which evaluated risk of incident heart failure with chocolate consumption. A total of 20,922 participants (53% women; mean age 58 ± 9 years) were included of whom 1101 developed heart failure during the follow up (mean 12.5 ± 2.7 years, total person years 262,291 years). After adjusting for lifestyle and dietary factors, we found 19% relative reduction in heart failure incidence in the top (up to 100 g/d) compared to the bottom quintile of chocolate consumption (HR 0.81 95%CI 0.66-0.98) but the results were no longer significant after controlling for comorbidities (HR 0.87 95%CI 0.71-1.06). Additional adjustment for potential mediators did not attenuate the results further. We identified five relevant studies including the current study (N = 75,408). The pooled results showed non-significant 19% relative risk reduction of heart failure incidence with higher chocolate consumption (HR 0.81 95%CI 0.66-1.01).

CONCLUSIONS: Our results suggest that higher chocolate intake is not associated with subsequent incident heart failure.

Original language	English
Pages (from-to)	722-734
Number of pages	13
Journal	Nutrition, Metabolism, and Cardiovascular Diseases: NMCD
Volume	26
Issue number	8
Early online date	28 Jan 2016
DOIs	https://doi.org/10.1016/j.numecd.2016.01.003
Publication status	Published - Aug 2016

Bibliographical note

Acknowledgments
The authors would like to thank the participants of the EPIC-Norfolk cohort. We thank the nutritionist team and data management team of the EPIC-Norfolk cohort. The EPIC-Norfolk study was supported by grants from the Medical Research Council and Cancer Research UK. Funders had no role in study design or interpretation of the findings.

Keywords

heart failure
chocolate
cocoa
epidemiology
meta-analysis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Habitual chocolate consumption and the risk of incident heart failure among healthy men and women
Open Access funded by Medical Research Council Under a Creative Commons license https://creativecommons.org/licenses/by/4.0/
Final published version, 1.3 MBLicence: CC BY

Phyo Myint, Clinical Chair in Medicine of Old Age
- School of Medicine, Medical Sciences & Nutrition, Aberdeen Cardiovascular and Diabetes Centre
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Chair in Old Age Medicine (Clinical)
- Institute of Applied Health Sciences
Person: Clinical Academic

Cite this

Kwok, C. S., Loke, Y. K., Welch, A. A., Luben, R. N., Lentjes, M. A. H., Boekholdt, S. M., Pfister, R., Mamas, M. A., Wareham, N. J., Khaw, K.-T., & Myint, P. K. (2016). Habitual chocolate consumption and the risk of incident heart failure among healthy men and women. Nutrition, Metabolism, and Cardiovascular Diseases: NMCD, 26(8), 722-734. https://doi.org/10.1016/j.numecd.2016.01.003

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abstract = "BACKGROUND: We aimed to examine the association between chocolate intake and the risk of incident heart failure in a UK general population. We conducted a systematic review and meta-analysis to quantify this association.METHODS AND RESULTS: We used data from a prospective population-based study, the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort. Chocolate intake was quantified based on a food frequency questionnaire obtained at baseline (1993-1997) and incident heart failure was ascertained up to March 2009. We supplemented the primary data with a systematic review and meta-analysis of studies which evaluated risk of incident heart failure with chocolate consumption. A total of 20,922 participants (53% women; mean age 58 ± 9 years) were included of whom 1101 developed heart failure during the follow up (mean 12.5 ± 2.7 years, total person years 262,291 years). After adjusting for lifestyle and dietary factors, we found 19% relative reduction in heart failure incidence in the top (up to 100 g/d) compared to the bottom quintile of chocolate consumption (HR 0.81 95%CI 0.66-0.98) but the results were no longer significant after controlling for comorbidities (HR 0.87 95%CI 0.71-1.06). Additional adjustment for potential mediators did not attenuate the results further. We identified five relevant studies including the current study (N = 75,408). The pooled results showed non-significant 19% relative risk reduction of heart failure incidence with higher chocolate consumption (HR 0.81 95%CI 0.66-1.01).CONCLUSIONS: Our results suggest that higher chocolate intake is not associated with subsequent incident heart failure.",

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note = "Acknowledgments The authors would like to thank the participants of the EPIC-Norfolk cohort. We thank the nutritionist team and data management team of the EPIC-Norfolk cohort. The EPIC-Norfolk study was supported by grants from the Medical Research Council and Cancer Research UK. Funders had no role in study design or interpretation of the findings.",

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AU - Kwok, C. S.

AU - Loke, Y. K.

AU - Welch, A. A.

AU - Luben, R. N.

AU - Lentjes, M. A. H.

AU - Boekholdt, S. M.

AU - Pfister, R.

AU - Mamas, M. A.

AU - Wareham, N. J.

AU - Khaw, K.-T.

AU - Myint, P. K.

N1 - Acknowledgments The authors would like to thank the participants of the EPIC-Norfolk cohort. We thank the nutritionist team and data management team of the EPIC-Norfolk cohort. The EPIC-Norfolk study was supported by grants from the Medical Research Council and Cancer Research UK. Funders had no role in study design or interpretation of the findings.

PY - 2016/8

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N2 - BACKGROUND: We aimed to examine the association between chocolate intake and the risk of incident heart failure in a UK general population. We conducted a systematic review and meta-analysis to quantify this association.METHODS AND RESULTS: We used data from a prospective population-based study, the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort. Chocolate intake was quantified based on a food frequency questionnaire obtained at baseline (1993-1997) and incident heart failure was ascertained up to March 2009. We supplemented the primary data with a systematic review and meta-analysis of studies which evaluated risk of incident heart failure with chocolate consumption. A total of 20,922 participants (53% women; mean age 58 ± 9 years) were included of whom 1101 developed heart failure during the follow up (mean 12.5 ± 2.7 years, total person years 262,291 years). After adjusting for lifestyle and dietary factors, we found 19% relative reduction in heart failure incidence in the top (up to 100 g/d) compared to the bottom quintile of chocolate consumption (HR 0.81 95%CI 0.66-0.98) but the results were no longer significant after controlling for comorbidities (HR 0.87 95%CI 0.71-1.06). Additional adjustment for potential mediators did not attenuate the results further. We identified five relevant studies including the current study (N = 75,408). The pooled results showed non-significant 19% relative risk reduction of heart failure incidence with higher chocolate consumption (HR 0.81 95%CI 0.66-1.01).CONCLUSIONS: Our results suggest that higher chocolate intake is not associated with subsequent incident heart failure.

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KW - chocolate

KW - cocoa

KW - epidemiology

KW - meta-analysis

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SP - 722

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JO - Nutrition, Metabolism, and Cardiovascular Diseases: NMCD

JF - Nutrition, Metabolism, and Cardiovascular Diseases: NMCD

IS - 8

ER -

Habitual chocolate consumption and the risk of incident heart failure among healthy men and women

Abstract

Bibliographical note

Keywords

UN SDGs

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Phyo Myint, Clinical Chair in Medicine of Old Age

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