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 languageEnglish
Pages (from-to)722-734
Number of pages13
JournalNutrition, Metabolism, and Cardiovascular Diseases: NMCD
Volume26
Issue number8
Early online date28 Jan 2016
DOIs
Publication statusPublished - Aug 2016

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Heart Failure
Meta-Analysis
Incidence
Risk Reduction Behavior
Chocolate
Population
Life Style
Comorbidity
Prospective Studies
Food
Neoplasms

Keywords

  • heart failure
  • chocolate
  • cocoa
  • epidemiology
  • meta-analysis

Cite this

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

In: Nutrition, Metabolism, and Cardiovascular Diseases: NMCD, Vol. 26, No. 8, 08.2016, p. 722-734.

Research output: Contribution to journalArticle

Kwok, CS, Loke, YK, Welch, AA, Luben, RN, Lentjes, MAH, Boekholdt, SM, Pfister, R, Mamas, MA, Wareham, NJ, Khaw, K-T & Myint, PK 2016, 'Habitual chocolate consumption and the risk of incident heart failure among healthy men and women', Nutrition, Metabolism, and Cardiovascular Diseases: NMCD, vol. 26, no. 8, pp. 722-734. https://doi.org/10.1016/j.numecd.2016.01.003
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. / Habitual chocolate consumption and the risk of incident heart failure among healthy men and women. In: Nutrition, Metabolism, and Cardiovascular Diseases: NMCD. 2016 ; Vol. 26, No. 8. pp. 722-734.
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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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T1 - Habitual chocolate consumption and the risk of incident heart failure among healthy men and women

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

Y1 - 2016/8

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.

AB - 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.

KW - heart failure

KW - chocolate

KW - cocoa

KW - epidemiology

KW - meta-analysis

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DO - 10.1016/j.numecd.2016.01.003

M3 - Article

VL - 26

SP - 722

EP - 734

JO - Nutrition, Metabolism, and Cardiovascular Diseases: NMCD

JF - Nutrition, Metabolism, and Cardiovascular Diseases: NMCD

SN - 0939-4753

IS - 8

ER -