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

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