Abstract
Background
Laboratory and animal studies suggest an inverse association between chocolate consumption
and the risk of cancer. Epidemiological studies have yielded inconsistent evidence.
Objective
To assess the association of chocolate candy consumption with incident, invasive total,
breast, colorectal, and lung cancers in a large cohort of postmenopausal American
women.
Design
Prospective cohort study with a mean 14.8-year follow-up. Chocolate candy intake was
assessed by food frequency questionnaire. Invasive cancer events were assessed by
physician adjudication.
Participants/setting
The Women’s Health Initiative Study enrolled 161,808 postmenopausal women at 40 clinical
centers nationwide between 1993 and 1998. Of these women, 114,281 with plausible food
frequency or biometric data and no missing data on chocolate candy exposure were selected
for analysis.
Main outcome measures
Cancer risk in quartiles of chocolate candy consumption with the first quartile as
referent.
Statistical analyses
Multivariable Cox regression was used to calculate hazard ratios and 95% confidence
intervals.
Results
There were 16,164 documented incident invasive cancers, representing an incidence
rate of 17.0 per 100 participants and 12.3 per 1000 person years during follow-up
among participants without any preexisting cancers or missing outcome data. There
were no statistically significant associations for total invasive cancer (P-linear = .47, P-curvature = .14), or invasive breast cancer (P-linear = .77, P-curvature = .26). For colorectal cancer P-linear was .02, P-curvature was .03, and compared with women eating a 1 oz (28.4 g) chocolate candy
serving <1 time per month, the hazard ratio for ≥1.5 times/wk was 1.18 (95% confidence
interval: 1.04-1.35). This result may be attributable to the excess adiposity associated
with frequent chocolate candy consumption.
Conclusions
In the Women’s Health Initiative, there was no significant association between chocolate
candy consumption and invasive total or breast cancer. There was a modest 18% higher
risk of invasive colorectal cancer for women who ate chocolate candy at least 1.5
times/wk. These results require confirmation.
Keywords
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Biography
J. A. Greenberg is an emeritus professor, Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York, Brooklyn.
Biography
M. L. Neuhouser is the program head and, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.
Biography
L. F. Tinker is a nutrition scientist, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.
Biography
D. S. Lane is a distinguished service professor and vice chair, Department of Family, Population and Preventive Medicine, School of Medicine, Stony Brook University, Stony Brook, NY.
Biography
E. D. Paskett is a Marion N. Rowley professor of cancer research, Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine, Comprehensive Cancer Center, Ohio State University, Columbus, OH.
Biography
S. Sealy-Jefferson is an assistant professor, Division of Epidemiology, College of Public Health, both at Ohio State University, Columbus, OH.
Biography
L. V. Van Horn is the chief of nutrition, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Biography
S. Wassertheil-Smoller is a distinguished university professor emerita, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
Biography
J. M. Shikany is an endowed professor of cardiovascular disease and associate director for research, Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham. , Boston, MA
Biography
L. Qi is a professor, Department of Public Health Sciences, School of Medicine, University of California Davis. , Boston, MA
Biography
J. E. Manson is a professor, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
Article info
Publication history
Published online: August 04, 2020
Accepted:
June 9,
2020
Received:
October 10,
2019
Footnotes
Supplementary materials: Tables 3, 4, and 5 and the Appendix are available at www.jandonline.org.
STATEMENT OF POTENTIAL CONFLICT OF INTEREST J. E. Manson and colleagues at Brigham and Women’s Hospital, Harvard Medical School are recipients of funding from Mars Symbioscience for an investigator-initiated randomized trial of cocoa flavanols and chronic disease outcomes. No potential conflict of interest was reported by the other authors.
FUNDING/SUPPORT The Women’s Health Initiative (WHI) program is funded by National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI), US Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C. In addition, the following authors had funding related to this project: J. E. Manson had partial support from HHSN268201100001C from NIH/NHLBI, the Women’s Health Initiative program. J. E. Manson and colleagues at Brigham and Women’s Hospital, Harvard Medical School are recipients of funding from Mars Symbioscience for an investigator-initiated randomized trial of cocoa flavanols and chronic disease outcomes. L. F. Tinker and M. L. Neuhouser received support from NIH/NHLBI, US Department of Health and Human Services contract HHSN268201100046C. D. S. Lane received support from Stony Brook WHI Center grant, NHLBI contract no. NO1-WH-4-2115.
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