Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, Iowa.
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa.
J Acad Nutr Diet. 2023 Jun;123(6):902-911.e3. doi: 10.1016/j.jand.2022.12.007. Epub 2022 Dec 19.
Chocolate contains both potentially harmful components (ie, stearic acid and added sugar) and beneficial components (ie, phenolics and flavonoids). Despite its popularity, the long-term health effects of chocolate consumption remain unclear.
The aim of this study was to examine the association of chocolate consumption with all-cause and cause-specific mortality.
This was a prospective cohort study.
PARTICIPANTS/SETTING: This study included 84,709 postmenopausal women free of cardiovascular disease (CVD) and cancer at baseline in the observational study and clinical trials control arms of the prospective Women's Health Initiative cohort who were enrolled during 1993 through 1998. These women were followed through March 2018.
The outcomes included all-cause mortality and cause-specific mortality from CVD, cancer, and dementia.
Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) of all-cause mortality and cause-specific mortality.
During 1,608,856 person-years of follow-up (mean [SD] of 19.0 [4.2] years), 25,388 deaths occurred, including 7,069 deaths from CVD, 7,030 deaths from cancer, and 3,279 deaths from dementia. After adjustment for a variety of covariates, compared with no chocolate consumption, the HRs (95% CI) for all-cause mortality were 0.95 (0.92 to 0.98), 0.93 (0.89 to 0.96), 0.97 (0.90 to 1.04), and 0.90 (0.84 to 0.97) for <1 serving/wk, 1 to 3 servings/wk, 4 to 6 servings/wk, and ≥1 serving/d of chocolate consumption, respectively (P for trend = .02). For CVD mortality, compared with no chocolate consumption, the HRs (95% CI) were 0.96 (0.91 to 1.01), 0.88 (0.82 to 0.95), 1.06 (0.93 to 1.21), and 0.92 (0.80 to 1.05) for <1 serving/wk, 1 to 3servings/wk, 4 to 6 servings/wk, and ≥1 serving/d of chocolate consumption, respectively (P for trend =.45). For dementia mortality, compared with no chocolate consumption, the HRs (95% CI) were 0.91 (0.84 to 0.99), 0.89 (0.80 to 0.99), 0.97 (0.79 to 1.18), and 0.97 (0.80 to 1.18) for <1 serving/wk, 1 to 3 servings/wk, 4-6 servings/wk, and ≥1 serving/d of chocolate consumption, respectively (P for trend = .95). Chocolate consumption was not associated with cancer mortality.
The results suggest a modest inverse association of chocolate consumption with mortality from all causes, CVD, or dementia, specifically for moderate chocolate consumption of 1 to 3 servings/wk.
巧克力既含有潜在有害成分（如硬脂酸和添加糖），也含有有益成分（如酚类化合物和类黄酮）。尽管巧克力广受欢迎，但长期食用巧克力对健康的影响仍不清楚。
本研究旨在探讨巧克力摄入量与全因和特定原因死亡率之间的关系。
这是一项前瞻性队列研究。
参与者/设置：本研究纳入了观察性研究和前瞻性妇女健康倡议队列临床试验对照组中 84709 名基线时无心血管疾病（CVD）和癌症的绝经后妇女，这些妇女于 1993 年至 1998 年期间入组。这些女性的随访时间截至 2018 年 3 月。
结局包括全因死亡率和 CVD、癌症和痴呆的特定原因死亡率。
采用多变量 Cox 比例风险模型来估计全因死亡率和特定原因死亡率的调整后风险比（HRs）。
在 1608856 人年的随访期间（平均[SD]19.0[4.2]年），发生了 25388 例死亡，其中包括 7069 例 CVD 死亡、7030 例癌症死亡和 3279 例痴呆死亡。在调整了多种协变量后，与不食用巧克力相比，全因死亡率的 HR（95%CI）分别为 0.95（0.92 至 0.98）、0.93（0.89 至 0.96）、0.97（0.90 至 1.04）和 0.90（0.84 至 0.97），对应的巧克力摄入量为<1 份/周、1 至 3 份/周、4 至 6 份/周和≥1 份/天（趋势 P =.02）。对于 CVD 死亡率，与不食用巧克力相比，HR（95%CI）分别为 0.96（0.91 至 1.01）、0.88（0.82 至 0.95）、1.06（0.93 至 1.21）和 0.92（0.80 至 1.05），对应的巧克力摄入量为<1 份/周、1 至 3 份/周、4 至 6 份/周和≥1 份/天（趋势 P =.45）。对于痴呆死亡率，与不食用巧克力相比，HR（95%CI）分别为 0.91（0.84 至 0.99）、0.89（0.80 至 0.99）、0.97（0.79 至 1.18）和 0.97（0.80 至 1.18），对应的巧克力摄入量为<1 份/周、1 至 3 份/周、4 至 6 份/周和≥1 份/天（趋势 P =.95）。巧克力摄入与癌症死亡率无关。
结果表明，巧克力摄入量与全因死亡率、CVD 死亡率或痴呆死亡率之间存在适度的负相关关系，尤其是对于 1 至 3 份/周的中等巧克力摄入量。
