CNR ExploRA

Articolo in rivista, 2019, ENG, 10.1016/j.clnu.2018.05.019

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

Veronese, N.; Demurtas, J.; Celotto, S.; Caruso, M. G.; Maggi, S.; Bolzetta, .; Firth, J.; Smith, L.; Schofield, P.; Koyanagi, A.; Yang, L.; Solmi, M.; Stubbs, B.

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; 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, United Kingdom; 8: The Cambridge Centre for Sport & Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom; 9: Faculty of Health, Social Care and Education, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, CM1 1SQ, United Kingdom; 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, United Kingdom - Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, United Kingdom - Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom

Background&aims:The literature regarding the potential health benefits of chocolate consumption areunclear and the epidemiological credibility has not been systematically scrutinized, while the strength ofthe evidence is undetermined. We therefore aimed to map and grade the diverse health outcomesassociated with chocolate consumption using an umbrella review of systematic reviews.Methods:Umbrella review of systematic reviews of observational and intervention studies (randomizedplacebo-controlled trials, RCTs). For each association, random-effects summary effect size, 95% confi-dence interval, and 95% prediction interval were estimated. We also assessed heterogeneity, evidence forsmall-study effect and evidence for excess significance bias. For significant outcomes of the RCTs, theGRADE 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 1,061,637participants, the best available evidence suggests that chocolate consumption is associated with reducedrisk of cardiovascular disease (CVD) death (n¼4 studies), acute myocardial infarction (n¼6), stroke(n¼5) and diabetes (n¼6), although this was based on a weak evidence of credibility. Across meta-analyses of intervention studies, chocolate consumption was positively associated withflow-mediateddilatation at 90e150 min (n¼3) and at 2e18 weeks (n¼3), and insulin resistance markers (n¼2).However, using the GRADE assessment, the evidence for these outcomes was low or very low. Data fromtwo systematic reviews, reported that chocolate consumption was not associated with better depressivemood or cognitive function.Conclusions:There is weak evidence to suggest that chocolate consumption may be associated withfavorable health outcomes

Clinical nutrition (Edinb.) 38 (3), pp. 1101–1108