Can chocolate consumption reduce cardio-cerebrovascular risk? A systematic review and meta-analysis

Study of the post-harvest processes of the peruvian chuncho cocoa using multivariate and multi-block analysis

A screening of 24 Chuncho cacao postharvest processes was carried out and three treatments were identified with the best levels of functional non-volatile metabolites and the best profile of volatile metabolites. The relationship between the sensory profile of flavor and aroma, volatile and non-volatile metabolites was investigated by multiblock analysis. The most prominent volatile metabolites were benzaldehyde (Bz), 2,3,5-trimethylpyrazine (TriMP), 2,3,5,6-tetramethylpyrazine (TetraMP), myrcene (Myr), limonene (LM), ethylphenyl acetate (EpHAc) and 2-phenylethyl acetate (pHEthAc), and functional nonvolatile metabolites were total flavonoids (Tflav), total polyphenols (TppH), catechins (Cat), epicatechin (EpCat), caffeine (Caf), and theobromine (TeoB). Sensory analysis by MFA (multiple factorial analysis) allowed checking the substrates of the metabolites and highlighting correlated flavor and aroma descriptors. Based on multiblock analysis, four new descriptors were identified for Bz, Myr, and LM, such as nut, astringent, bitter, and crude. For TetraMP the fruity flavor was identified and for TriMP it was identified as Malt flavor. For Cat, EpCat, Caf, TeoB, Tflav, and TppH, the descriptors bitter, astringent, floral, and fruity were identified. This study will allow Chuncho cocoa farmers and producers to have a cocoa paste production scheme with a high value of functional metabolites and sensory profile, and value this Peruvian accession.

Association of ultra-processed foods consumption with risk of cardio-cerebrovascular disease: A systematic review and meta-analysis of cohort studies

AIMS

The epidemiological evidence regarding the impact of ultra-processed foods (UPFs) on the risk of cardio-cerebrovascular diseases (CCVDs) is controversial. The aim of this systematic review and meta-analysis is to examine the association between UPF consumption and the risk of CCVDs within cohort studies.

DATA SYNTHESIS

A systematic literature search was conducted across multiple databases, including PubMed/Medline, Embase, Web of Science, Scopus, and the Cochrane Library databases, covering the inception of these databases up until January 1st, 2023. A total of 39 cohort studies involving 63,573,312 human participants were deemed eligible according to the inclusion criteria. Utilizing random-effects models, risk ratios (RRs) were estimated to determine the pooled results. Our findings indicate a significant association between a higher consumption of UPF and an increased likelihood of CCVDs (RR: 1.08, 95% CI: 1.01-1.16, I2 = 89%; p < 0.01) compared to individuals who either abstain from or consume lesser amounts of UPF. Nonlinear dose-response meta-analyses showed that a consistent high intake of UPFs was associated with an elevated risk of developing CCVDs (p non-linearity <0.001). Notably, the risk of CCVDs escalated by approximately 7% with an UPF intake of up to 1 serving per day. Subgroup analysis further revealed a significant augmentation in the risk of total CVD and hypertension with increased UPF consumption.

CONCLUSIONS

A higher intake of UPF significantly increases the risk of developing CCVDs. Prospective studies controlling for confounding factors are needed to validate the relationship between UPF intake and the development of CCVDs.

Dietary Recommendations for Ethiopians on the Basis of Priority Diet-Related Diseases and Causes of Death in Ethiopia: An Umbrella Review

Food-based dietary guidelines (FBDG) need to be evidence-based. As part of the development of Ethiopian FBDG, we conducted an umbrella review to develop dietary recommendations. Protein-energy malnutrition (PEM), deficiencies of vitamin A, zinc, calcium, or folate, cardiovascular diseases (CVD), and type 2 diabetes mellitus (T2DM) were selected as a priority. Systematic reviews were eligible if they investigated the impact of foods, food groups, diet, or dietary patterns on priority diseases. After a search, 1513 articles were identified in PubMed, Scopus, and Google Scholar published from January 2014 to December 2021. The results showed that 19 out of 164 systematic reviews reported the impact of diet on PEM or micronutrient deficiencies. Daily 30-90 g whole-grain consumption reduces risk of CVD and T2DM. Pulses improve protein status, and consuming 50-150 g/d is associated with a reduced incidence of CVD and T2DM. Nuts are a good source of minerals, and consuming 15-35 g/d improves antioxidant status and is inversely associated with CVD risk. A daily intake of 200-300 mL of milk and dairy foods is a good source of calcium and contributes to bone mineral density. Limiting processed meat intake to <50 g/d reduces CVD risk. Fruits and vegetables are good sources of vitamins A and C. CVD and T2DM risks are reduced by consuming 200-300 g of vegetables plus fruits daily. Daily sugar consumption should be below 10% of total energy to lower risk of obesity, CVD, and T2DM. Plant-based fat has favorable nutrient profiles and modest saturated fat content. The association of saturated fatty acids with CVD and T2DM is inconclusive, but intake should be limited because of the low-density lipoprotein cholesterol-raising effect. Plant-based diets lower risk of CVD and T2DM but reduce micronutrient bioavailability. The review concludes with 9 key dietary recommendations proposed to be implemented in the Ethiopian FBDG. This review was registered at PROSPERO (CRD42019125490).

Metabolomic analysis and ecofriendly enrichment of sunflower meal extract

BACKGROUND

The presence of phenolic compounds in sunflower is well reported in the literature; however, knowledge is scarce when it comes to the composition of other secondary metabolites in this species and their by-products. This work evaluated, for the first time, the phytochemical composition of sunflower meal produced in Brazil. A combination of mixture design and central composite rotatable design 2³ models was then applied to maximize the recovery of bioactive compounds using ecologically friendly solvents and concentrating by applying activated carbon, a sustainable adsorbent. The product of this extraction-concentration was also evaluated by an untargeted metabolomic approach using ultra-performance liquid chromatography coupled to mass spectrometry.

RESULTS

A diverse and abundant profile of phenolic compounds was obtained from Brazilian sunflower meal: in total, 51 natural products were tentatively identified, 35 of which for the first time in sunflower. The sorption capacity of the activated charcoal, in the optimized process conditions, was effective in the separation and concentration of minority secondary metabolites. The ecofriendly extract proved to be enriched in plumberoside, p-coumaric acid, and alkaloids.

CONCLUSIONS

Investigation of the phytochemical profile of sunflower meal produced in Brazil pointed to several secondary metabolites reported for the first time in sunflower samples, including phenolic compounds, alkaloids, and terpenes. The use of activated charcoal in an alkaline medium as an adsorbent for the concentration of these phytochemicals, from an aqueous extract, generated a potentially cost-effective, ecofriendly extract, enriched in minor metabolites, indicating a possible innovative way to selectively obtain these compounds from sunflower meal. © 2022 Society of Chemical Industry.

Dark chocolate: An overview of its biological activity, processing, and fortification approaches

Dark chocolate gets popularity for several decades due to its enormous health benefits. It contains several health-promoting factors (bioactive components - polyphenols, flavonoids, procyanidins, theobromines, etc, and vitamins and minerals) that positively modulate the immune system of human beings. It confers safeguards against cardiovascular diseases, certain types of cancers, and other brain-related disorders like Alzheimer's disease, Parkinson's disease, etc. Dark chocolate is considered a functional food due to its anti-diabetic, anti-inflammatory, and anti-microbial properties. It also has a well-established role in weight management and the alteration of a lipid profile to a healthy direction. But during the processing of dark chocolate, several nutrients are lost (polyphenol, flavonoids, flavan 3 ol, ascorbic acid, and thiamine). So, fortification would be an effective method of enhancing the overall nutrient content and also making the dark chocolate self-sufficient. Thus, the focus of this review study is to gather all the experimental studies done on dark chocolate fortification. Several ingredients were used for the fortification, such as fruits (mulberry, chokeberries, and elderberries), spices (cinnamon), phytosterols, peanut oil, probiotics (mainly Lactobacillus, bacillus spices), prebiotics (inulin, xanthan gum, and maltodextrin), flavonoids, flavan-3-ols, etc. Those fortifications were done to raise the total antioxidant content as well as essential fatty acid content simultaneously reducing total calorie content. Sometimes, the fortification was done to improve physical properties like viscosity, rheological propertiesand also improve overall consumer acceptance by modifying its bitter taste.

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Dark chocolate gets popularity for several decades due to its enormous health benefits.

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Dark chocolate is considered a functional food due to its health benefits.

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During the processing of dark chocolate, several nutrients are lost.

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Fortification would be an effective method of enhancing the overall nutrient content.

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This review study is to gather all the experimental studies done on dark chocolate fortification.

Altered Food Behavior and Cancer: A Systematic Review of the Literature

There is evidence of an association between cancer and certain types of altered eating behaviors, including orthorexia, food cravings, and food addiction. Given the growing interest in the topic throughout the scientific community we conducted a systematic review to summarize current evidence on the development of altered food behavior, including food addiction and cancer. The Cochrane Collaboration and the Meta-analysis Of Observational Studies in Epidemiology guidelines were followed to perform this systematic review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to report the process and results. The structured literature search was conducted on 19 April 2022, on PubMed/Medline and Scopus, combining free-text terms and medical subject headings. A total of seven articles were included once the selection process was completed. Food craving has been associated with different types of cancer in adults and young patients, as well as with orthorexia; conversely, compulsive eating has only been explored in patients with prolactinoma treated with dopamine agonists. This systematic review explored a new area of research that warrants further investigation. More research is required to better understand the relationship between cancer and food behavior.

Role of diet in stroke incidence: an umbrella review of meta-analyses of prospective observational studies

BACKGROUND

Stroke is one of the major challenges for the global healthcare system, which makes it necessary to explore the relationship between various modifiable factors and stroke risk. Recently, numerous meta-analyses of prospective observational studies have reported that dietary factors played a key role in the occurrence of stroke. However, the conclusions of previous studies have remained controversial and unclear. Accordingly, we conducted an umbrella review synthesizing and recalculating available evidence to assess the certainty of the associations between dietary factors and stroke.

METHODS

Relevant meta-analyses examining the associations between dietary factors and stroke were searched in PubMed and Embase databases up to September 1, 2021. For each eligible meta-analysis, two independent reviewers appraised the methodologic quality using the AMSTAR 2 criteria and estimated the summary effect size, 95% confidence intervals, 95% prediction intervals, heterogeneity between studies, and small-study effects. Moreover, we further assessed the associations between dietary factors and ischemic stroke as well as hemorrhagic stroke. Lastly, a set of pre-specified criteria was applied to qualitatively evaluate the epidemiological credibility of each dietary factor.

RESULTS

Overall, our umbrella review included 122 qualified meta-analyses for qualitative synthesis, involving 71 dietary factors related to food groups, foods, macronutrients, and micronutrients. Using the AMSTAR 2 criteria, 5 studies were assessed as high quality, 4 studies as moderate quality, and 113 studies as low or critically low quality. We identified 34 dietary factors associated with stroke occurrence, 25 dietary factors related to ischemic stroke, and 11 factors related to hemorrhagic stroke. Among them, high/moderate certainty epidemiological evidence demonstrated an inverse association between intake of fruits (RR: 0.90) and vegetables (RR: 0.92) and stroke incidence, but a detrimental association between red meat (RR: 1.12), especially processed red meat consumption (RR:1.17), and stroke incidence. Besides, the evidence of high/moderate certainty suggested that the intake of processed meat, fruits, coffee, tea, magnesium, and dietary fiber was associated with ischemic stroke risk, while consumption of tea, fruits, and vegetables was relevant to hemorrhagic stroke susceptibility.

CONCLUSIONS

Our study has reported that several dietary factors have a significant impact on stroke risk and offered a new insight into the relationship between dietary modification and stroke occurrence. Our results may provide an effective strategy for stroke prevention.

Assessments of risk of bias in systematic reviews of observational nutritional epidemiologic studies are often not appropriate or comprehensive: a methodological study

BACKGROUND

An essential component of systematic reviews is the assessment of risk of bias. To date, there has been no investigation of how reviews of non-randomised studies of nutritional exposures (called 'nutritional epidemiologic studies') assess risk of bias.

OBJECTIVE

To describe methods for the assessment of risk of bias in reviews of nutritional epidemiologic studies.

METHODS

We searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews (Jan 2018-Aug 2019) and sampled 150 systematic reviews of nutritional epidemiologic studies.

RESULTS

Most reviews (n=131/150; 87.3%) attempted to assess risk of bias. Commonly used tools neglected to address all important sources of bias, such as selective reporting (n=25/28; 89.3%), and frequently included constructs unrelated to risk of bias, such as reporting (n=14/28; 50.0%). Most reviews (n=66/101; 65.3%) did not incorporate risk of bias in the synthesis. While more than half of reviews considered biases due to confounding and misclassification of the exposure in their interpretation of findings, other biases, such as selective reporting, were rarely considered (n=1/150; 0.7%).

CONCLUSION

Reviews of nutritional epidemiologic studies have important limitations in their assessment of risk of bias.

Cardiovascular Effects of Chocolate and Wine-Narrative Review

The consumption of food for pleasure is mainly associated with adverse health effects. This review was carried out to verify recent reports on the impact of chocolate and wine consumption on cardiovascular health, with a particular focus on atherosclerosis. On one side, these products have proven adverse effects on the cardiovascular system, but on the other hand, if consumed in optimal amounts, they have cardiovascular benefits. The submitted data suggest that the beneficial doses are 30–50 g and 130/250 mL for chocolate and wine, respectively, for women and men. The accumulated evidence indicates that the active ingredients in the products under consideration in this review are phenolic compounds, characterized by anti-inflammatory, antioxidant, and antiplatelet properties. However, there are also some reports of cardioprotective properties of other compounds such as esters, amines, biogenic amines, amino acids, fatty acids, mineral ingredients, and vitamins. Our narrative review has shown that in meta-analyses of intervention studies, consumption of chocolate and wine was positively associated with the beneficial outcomes associated with the cardiovascular system. In contrast, the assessment with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) scale did not confirm this phenomenon. In addition, mechanisms of action of bioactive compounds present in chocolate and wine depend on some factors, such as age, sex, body weight, and the presence of additional medical conditions. Patients using cardiovascular drugs simultaneously with both products should be alert to the risk of pharmacologically relevant interactions during their use. Our narrative review leads to the conclusion that there is abundant evidence to prove the beneficial impact of consuming both products on cardiovascular health, however some evidence still remains controversial. Many authors of studies included in this review postulated that well-designed, longitudinal studies should be performed to determine the effects of these products and their components on atherosclerosis and other CVD (Cardiovascular Disease) disease.

Lifestyle, WCRF/AICR Recommendations, and Esophageal Adenocarcinoma Risk: A Systematic Review of the Literature

One of the most notable changes in the epidemiology of esophageal cancer (EC) is the rising incidence and prevalence of esophageal adenocarcinoma (EAC) in developed countries. The aim of this systematic review was to collect and summarize all the available evidence regarding lifestyle, diet, and EAC risk. We searched the PubMed and Scopus databases in January 2021 for studies providing information about lifestyle, diet, WCRF/AICR recommendations, and EAC risk; published in English; without a time filter. The Newcastle-Ottawa Scale was used to assess risk of bias. The results are stratified by risk factor. A total of 106 publications were included. Half of the case-control studies were judged as high quality, whilst practically all cohort studies were judged as high quality. Body mass index and waist circumference were associated with increased EAC risk. Physical activity did not appear to have a significant direct role in EAC risk. A diet rich in fruit, vegetables, and whole grains appeared to be more protective than a Western diet. Alcohol does not seem to be related to EAC, whereas smokers, particularly heavy smokers, have an increased risk of EAC. Prevention remains the best option to avert EAC. Comprehensible and easy to follow recommendations should be provided to all subjects. Protocol ID number: CRD-42021228762, no funds received.

Design of polyphenol-rich diets in clinical trials: A systematic review

Most randomized clinical trials of polyphenols focus on individual foods. Nevertheless, due to their presence in many foods and in order to reflect a real situation, clinical trials based on polyphenol-rich diets are particularly important. This systematic review explores the characteristics of the polyphenol-rich diets used in intervention studies. The bibliography search for English-language scientific papers was performed in the Elsevier Scopus Database and PUBMED in March 2020, and focused on intervention studies with whole polyphenol-rich diets, establishing several exclusion criteria. In studies fulfilling the requirements, information on the design of the polyphenol-rich diet and associated polyphenol intake was extracted and compared. A total of 5 studies were selected. Among them, substantial differences were found in the design of the polyphenol-rich diets, regarding specific instructions and concerning the foods provided. Similarly, although a median daily polyphenol intake of 2,564 mg/day (17,945 mg/week) was obtained from the studies, which corresponds to a nutritional dose, intake values varied widely both for total polyphenols (the difference between studies reached threefold), and for individual polyphenol intake (for hydroxycinnamic acids, a tenfold difference was found between percentile 25 and percentile 75 values). These differences made the comparison of results difficult and may affected the observed health effects. Thus, despite the relevance of studying polyphenol-rich diets as a whole, this systematic review found substantial differences between the studies performed, making direct comparisons difficult.

The Health Effects of Chocolate and Cocoa: A Systematic Review

Chocolate has a history of human consumption tracing back to 400 AD and is rich in polyphenols such as catechins, anthocyanidins, and pro anthocyanidins. As chocolate and cocoa product consumption, along with interest in them as functional foods, increases worldwide, there is a need to systematically and critically appraise the available clinical evidence on their health effects. A systematic search was conducted on electronic databases such as MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) using a search strategy and keywords. Among the many health effects assessed on several outcomes (including skin, cardiovascular, anthropometric, cognitive, and quality of life), we found that compared to controls, chocolate or cocoa product consumption significantly improved lipid profiles (triglycerides), while the effects of chocolate on all other outcome parameters were not significantly different. In conclusion, low-to-moderate-quality evidence with short duration of research (majority 4–6 weeks) showed no significant difference between the effects of chocolate and control groups on parameters related to skin, blood pressure, lipid profile, cognitive function, anthropometry, blood glucose, and quality of life regardless of form, dose, and duration among healthy individuals. It was generally well accepted by study subjects, with gastrointestinal disturbances and unpalatability being the most reported concerns.

Association between Dietary Fibre Intake and Colorectal Adenoma: A Systematic Review and Meta-Analysis

PubMed/Medline, Excerpta Medica dataBASE (EMBASE) and Scopus were searched in January 2021 in order to retrieve evidence assessing the association between dietary fibre intake and the risk of colorectal adenoma in adults. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for the reporting of results. Only primary observational studies were included. Publication bias was estimated through the Egger's test and the visual inspection of the funnel plot. Heterogeneity between studies was calculated with I2 statistics. The search strategy identified 683 papers, 21 of which were included in our meta-analysis. Having evaluated a total of 157,725 subjects, the results suggest a protective effect of dietary fibre intake against colorectal adenoma. Effect Size (ES) was [0.71 (95% CI = 0.68-0.75), p = 0.000)]. Moderate statistical heterogeneity (Chi2 = 61.68, df = 23, I2 = 62.71%, p = 0.000) was found. Findings show a statistically significant (p = 0.000) and robust association between a higher intake of dietary fibre and a lower risk of colorectal adenoma, considering both the prevalent and incident risk. Moreover, the meta-regression analysis showed a borderline significant negative linear correlation between the amount of dietary fibre intake and colorectal adenoma. Lastly, we performed a subgroup analysis by sex, showing a higher protective effect for men.

Isolation of Bacillus spp. with High Fibrinolytic Activity and Performance Evaluation in Fermented Douchi

ABSTRACT

Fibrinolytic enzymes are effective and highly safe in treating cardiovascular and cerebrovascular diseases. Therefore, screening fibrinolytic enzyme-producing microbial strains with excellent fermentation performance is of great value to industrial applications. The fibrin plate method was used in screening strains with high yields of fibrinolytic enzymes from different fermented food products, and the screened strains were preliminarily identified using molecular biology. Then, the strains were used for solid-state fermentation of soybeans. Moreover, the fermentation product douchi was subjected to fibrinolytic activity measurement, sensory evaluation, and biogenic amine content determination. The fermentation performance of each strain was comprehensively evaluated through principal component analysis. Finally, the target strain was identified based on strain morphology, physiological and biochemical characteristics, 16S rDNA sequence, and phylogenetic analysis results. A total of 15 Bacillus species with high fibrinolysin activity were selected. Their fibrinolytic enzyme-producing activity levels were higher than 5,500 IU/g. Through molecular biology analysis, we found 4 strains of Bacillus subtilis, 10 strains of Bacillus amyloliquefaciens, and 1 strain of Bacillus velezensis. The principal component analysis results showed that SN-14 had the best fermentation performance and reduced the accumulation of histamine and total amine, the fibrinolytic activity of fermented douchi reached 5,920.5 ± 107.7 IU/g, and the sensory score was 4.6 ± 0.3 (out of 5 points). Finally, the combined results of physiological and biochemical analyses showed SN-14 was Bacillus velezensis. The high-yield fibrinolytic and excellent fermentation performance strain Bacillus velezensis SN-14 has potential industrial application.

HIGHLIGHTS

Saturated Fats and Health: A Reassessment and Proposal for Food-Based Recommendations: JACC State-of-the-Art Review

The recommendation to limit dietary saturated fatty acid (SFA) intake has persisted despite mounting evidence to the contrary. Most recent meta-analyses of randomized trials and observational studies found no beneficial effects of reducing SFA intake on cardiovascular disease (CVD) and total mortality, and instead found protective effects against stroke. Although SFAs increase low-density lipoprotein (LDL) cholesterol, in most individuals, this is not due to increasing levels of small, dense LDL particles, but rather larger LDL particles, which are much less strongly related to CVD risk. It is also apparent that the health effects of foods cannot be predicted by their content in any nutrient group without considering the overall macronutrient distribution. Whole-fat dairy, unprocessed meat, and dark chocolate are SFA-rich foods with a complex matrix that are not associated with increased risk of CVD. The totality of available evidence does not support further limiting the intake of such foods.

Relation of Fruits and Vegetables with Major Cardiometabolic Risk Factors, Markers of Oxidation, and Inflammation

Noncommunicable diseases (NCDs) are considered to be the leading cause of death worldwide. Inadequate fruit and vegetable intake have been recognized as a risk factor for almost all NCDs (type 2 diabetes mellitus, cancer, and cardiovascular and neurodegenerative diseases). The main aim of this review is to examine the possible protective effect that fruit and vegetable consumption or their bioactive compounds may have on the development of NCDs such as atherosclerosis. The accumulated evidence on the protective effects of adequate consumption of fruits and vegetables in some cases, or the lack of evidence in others, are summarized in the present review. The main conclusion of this review is that well-designed, large-scale, long-term studies are needed to truly understand the role fruit and vegetable consumption or their bioactive compounds have in atherosclerosis.

Association of Chocolate Consumption with Hearing Loss and Tinnitus in Middle-Aged People Based on the Korean National Health and Nutrition Examination Survey 2012⁻2013

Chocolate, which is produced from cocoa, exerts antioxidant and anti-inflammatory effects that ameliorate neurodegenerative diseases. We hypothesized that chocolate consumption would protect against hearing loss and tinnitus. We evaluated the hearing and tinnitus data, as well as the chocolate consumption, of middle-aged participants (40–64 years of age) of the 2012–2013 Korean National Health and Nutrition Examination Survey. All of the subjects underwent a medical interview, physical examination, audiological evaluation, tinnitus questionnaire, and nutrition examination. A total of 3575 subjects 40–64 years of age were enrolled. The rate of any hearing loss (unilateral or bilateral) in the subjects who consumed chocolate (26.78% (338/1262)) was significantly lower than that in those who did not (35.97% (832/2313)) (p < 0.001). Chocolate consumption was independently associated with low odds of any hearing loss (adjusted odds ratio = 0.83, 95% confidence interval = 0.70 to 0.98, p = 0.03). Moreover, the severity of hearing loss was inversely correlated with the frequency of chocolate consumption. In contrast to chocolate, there was no association between hearing loss and the consumption of sweet products without cocoa. Chocolate consumption was also not associated with tinnitus or tinnitus-related annoyance. Our results suggest that a chocolate-based diet may protect middle-aged people from hearing loss.

Chocolate and chocolate constituents influence bone health and osteoporosis risk

Bone loss resulting in increased risk for osteoporosis is a major health issue worldwide. Chocolate is a rich source of antioxidant and antiinflammatory flavonoids and dietary minerals with the potential to benefit bone health. However, other chocolate constituents such as cocoa butter, sugar, and methylxanthines may be detrimental to bone. Human studies investigating the role of chocolate consumption on serum bone markers and bone mineral density (BMD) have been inconsistent. A contributing factor is likely the different composition and thereby the nutrient and bioactive content among chocolate types. White and milk chocolate are high in sugar and low in flavonoids and most minerals. Dark chocolate (45-85% cocoa solids) is high in flavonoids, most minerals, and low in sugar with ≥70% cocoa solids resulting in higher fat and methylxanthine content. The aim of this review was to examine the relationship between chocolate consumption and its constiuents, including flavonoid content, on bone health and osteoporosis risk. Studies showed postmenopausal women had no bone effects at moderate chocolate intakes, whereas adolescents consuming chocolate had greater longitudinal bone growth. Based on flavonoid and mineral content, unsweetened cocoa powder appeared to be the best option followed by dark chocolate with higher cocoa content in terms of supporting and preserving bone health. Determining dietary recommendations for chocolate consumption relative to bone health is important because of the growing popularity of chocolate, particularly dark chocolate, and an expected increase in consumption owing to suggestions of health benefits against various degenerative diseases.

Chocolate and risk of chronic disease: a systematic review and dose-response meta-analysis

Purpose

Evidence for the association between chocolate intake and risk of chronic diseases is inconclusive. Therefore, we aimed to synthesize and evaluate the credibility of evidence on the dose-response association between chocolate consumption with risk of all-cause mortality, coronary heart disease (CHD), stroke, heart failure (HF), type 2 diabetes (T2D), colorectal cancer (CRC), and hypertension.

Methods

Prospective studies were searched until July 2018 in PubMed, Embase, and Web of Science. Random-effects meta-analyses comparing highest versus lowest intake categories, linear, and non-linear dose-response analyses were conducted. The credibility of evidence was evaluated with the NutriGrade scoring-system.

Results

Overall, 27 investigations were identified (n = 2 for all-cause mortality, n = 9 for CHD, n = 8 for stroke, n = 6 for HF, n = 6 for T2D, n = 2 for hypertension and CRC, respectively). No associations with HF (RR 0.99, 95% CI 0.94, 1.04) and T2D (RR 0.94, 95% CI 0.88, 1.01) per each 10 g/day increase in chocolate intake were observed in the linear dose-response meta-analyses. However, a small inverse association for each 10 g/daily increase could be shown for the risk of CHD (RR 0.96, 95% CI 0.93, 0.99), and stroke (RR 0.90, 95% CI 0.82, 0.98). The credibility of evidence was rated either very low (all-cause mortality, HF, T2D, CRC or hypertension) or low (CHD, stroke).

Conclusion

Chocolate consumption is not related to risk for several chronic diseases, but could have a small inverse association with CHD and stroke. Our findings are limited by very low or low credibility of evidence, highlighting important uncertainty for chocolate–disease associations.

Electronic supplementary material

The online version of this article (10.1007/s00394-019-01914-9) contains supplementary material, which is available to authorized users.

Hydro-ethanol seed extract of Theobroma cacao exhibits antioxidant activities and potential anticancer property

Despite the nutritional value of Theobroma cacao seed (cocoa), the antiproliferative activity is yet to be fully elucidated. Therefore, the current study investigated the antioxidant and potential anticancer activities of the seed extract. The in-vitro free radical scavenging activity was evaluated via DPPH, nitric oxide, lipid peroxidation, and reducing power activity. The effect of the cocoa extract on mitotic cell division was determined using Allium cepa assay. The phytochemical screening of the seed extract revealed the presence of cardiac glycoside, phenol, tannin, steroid, terpinoid, alkaloid, saponin, and flavonoid at the following concentrations; 31.21 ± 0.57, 29.16 ± 0.43, 18.51 ± 0.06, 9.57 ± 0.08, 23.77 ± 0.08, 6.58 ± 0.04, 28.65 ± 0.13, and 22.16 ± 0.18 mg/100 g, respectively. The A. cepa assay revealed a significant influence of the extract on mitotic cell division in a concentration dependent manner, the antiproliferative effect suggests a potential anticancer property. PRACTICAL APPLICATIONS: The Cocoa plant has been of great nutritional benefit over the years. The seeds (Theobroma cacao) is used for making varieties of chocolate food beverages, chocolate candies, confectioneries, and food thickening, however, the anticancer activity is still an area of deliberation. Theobroma cacao seed extract scavenged diphenyl-2-picrylhydrazyl radical, nitric oxide, lipid peroxidation at 50.03 ± 1.48% at a concentration of 60 µg/ml, 50.84 ± 0.88% at 40 µg/ml, and 50.79 ± 0.37% at 40 µg/ml, respectively. The reducing power activity was 0.329 ± 0.001 per 100 µg/ml. The Gas Chromatography Mass Spectroscopy analysis showed the most abundant compound to be caffeine (98.09%). Mild quantities of hexa-decanoic acid, methyl extract were also detected. The hydro-alcohol extract of Theobroma cacao seeds exhibited high antioxidant and antimitotic activities, suggesting a possible cytotoxic potential against abnormal cell growth, such as cancer. This study substantiates its ethno-medicinal use in the prevention and control of cancer.