Table 3.
Adjusted hazard ratios (95% CIs)* of T2D for total chocolate intake in NHS (1986-2018), NHSII (1991-2021), and HPFS (1986-2020)
| Total chocolate consumption levels | P trend† | Per serving/week | ||||
|---|---|---|---|---|---|---|
| 0 or <1 serving/month | 1 serving/month to <1 serving/week | 1-4 servings/week | ≥5 servings/week | |||
| NHS | ||||||
| Case/person years | 2287/579 899 | 3254/682 452 | 1541/305 768 | 169/35 041 | ||
| Age adjusted | 1 | 1.22 (1.16 to 1.29) | 1.32 (1.23 to 1.41) | 1.30 (1.11 to 1.53) | <0.001 | 1.04 (1.02 to 1.05) |
| Multivariable adjusted | 1 | 1.05 (0.99 to 1.11) | 1.05 (0.98 to 1.12) | 0.98 (0.83 to 1.15) | 0.76 | 1.00 (0.98 to 1.02) |
| NHSII | ||||||
| Case/person years | 1084/416 282 | 3391/1 021 600 | 2740/725 061 | 350/105 441 | ||
| Age adjusted | 1 | 1.21 (1.13 to 1.30) | 1.38 (1.28 to 1.48) | 1.27 (1.12 to 1.43) | <0.001 | 1.05 (1.03 to 1.07) |
| Multivariable adjusted | 1 | 1.00 (0.94 to 1.08) | 0.99 (0.92 to 1.06) | 0.84 (0.74 to 0.95) | 0.02 | 0.99 (0.97 to 1.00) |
| HPFS | ||||||
| Case/person years | 1146/302 010 | 1742/390 683 | 1026/232 552 | 132/32 386 | ||
| Age adjusted | 1 | 1.19 (1.11 to 1.29) | 1.21 (1.11 to 1.32) | 1.15 (0.96 to 1.38) | 0.008 | 1.01 (0.99 to 1.03) |
| Multivariable adjusted | 1 | 1.04 (0.96 to 1.13) | 1.04 (0.95 to 1.14) | 0.92 (0.76 to 1.11) | 0.65 | 0.98 (0.96 to 1.01) |
| Pooled‡ | ||||||
| Case/person years | 4520/1 299 997 | 8395/2 097 808 | 5309/1 264 790 | 651/173 110 | ||
| Age adjusted | 1 | 1.21 (1.16 to 1.25) | 1.32 (1.27 to 1.38) | 1.24 (1.14 to 1.35) | <0.001 | 1.03 (1.02 to 1.04) |
| Multivariable adjusted | 1 | 1.03 (1.00 to 1.07) | 1.02 (0.98 to 1.07) | 0.90 (0.83 to 0.98) | 0.07 | 0.99 (0.98 to 1.00) |
Multivariable models adjusted for age, calendar year, ethnicity (white, African American, Asian, and others), smoking status (never, former, current (1-14, 15-24, or ≥25 cigarettes/day), or missing), alcohol intake (g/day: 0, 0.1-4.9, 5.0-14.9, and ≥15.0 in women, 0, 0.1-4.9, 5.0-14.9, 15.0-29.9, and ≥30.0 in men, or missing), family history of diabetes (yes/no), menopausal status and postmenopausal hormone use (premenopausal, postmenopausal (never, former, or current hormone use), or missing, for women), use of oral contraceptives (yes, no, NHSII only), physical activity (<3, 3.0-8.9, 9.0-17.9, 18.0-26.9, ≥27.0 MET-h/week, or missing), baseline BMI (<21.0, 21.0-22.9, 23.0-24.9, 25.0-26.9, 27.0-29.9, 30.0-32.9, 33.0-34.9, ≥35.0, or missing), multivitamin use (yes/no), baseline hypertension, baseline hypercholesterolemia, total energy intake, and AHEI (five groups).
AHEI=Alternate Healthy Eating Index; BMI=body mass index; CI=confidence interval; NHS=Nurses’ Health Study; NHSII=Nurses’ Health Study II; HPFS=Health Professionals Follow-up Study; MET-h= metabolic equivalent tasks per hour; T2D=type 2 diabetes.
Calculated using Cox proportional hazards models.
Calculated using median levels of chocolate consumption categories as continuous predictor in the model.
Data from three cohorts were combined to run the pooled results. Pooled models further adjusted for study origin (NHS, NHSII, HPFS).