Table 4.
Adjusted hazard ratios (95% CIs)* of T2D for chocolate intake by subtype in NHS (2006-18), NHSII (2007-21), and HPFS (2006-20)
| Chocolate subtypes 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 | |||
| Dark chocolate | ||||||
| NHS: | ||||||
| Case/person years | 789/229 604 | 300/104 135 | 174/51 245 | 32/10 517 | ||
| Age adjusted | 1 | 0.91 (0.79 to 1.04) | 0.94 (0.80 to 1.11) | 0.90 (0.63 to 1.29) | 0.42 | 0.98 (0.94 to 1.02) |
| Multivariable adjusted | 1 | 0.92 (0.80 to 1.06) | 0.99 (0.83 to 1.17) | 0.99 (0.68 to 1.43) | 0.92 | 0.99 (0.95 to 1.04) |
| NHSII: | ||||||
| Case/person years | 1339/291 824 | 971/241 896 | 505/145 064 | 88/35 192 | ||
| Age adjusted | 1 | 0.87 (0.80 to 0.94) | 0.75 (0.67 to 0.83) | 0.53 (0.43 to 0.66) | <0.001 | 0.91 (0.88 to 0.93) |
| Multivariable adjusted | 1 | 0.95 (0.87 to 1.03) | 0.91 (0.82 to 1.02) | 0.80 (0.64 to 1.01) | 0.03 | 0.97 (0.94 to 1.00) |
| HPFS: | ||||||
| Case/person years | 263/70 984 | 202/52 587 | 97/30 207 | 11/7093 | ||
| Age adjusted | 1 | 1.09 (0.91 to 1.32) | 0.90 (0.71 to 1.14) | 0.44 (0.24 to 0.80) | 0.006 | 0.90 (0.84 to 0.97) |
| Multivariable adjusted | 1 | 1.08 (0.89 to 1.31) | 0.95 (0.74 to 1.22) | 0.49 (0.26 to 0.92) | 0.04 | 0.92 (0.85 to 0.99) |
| Pooled‡: | ||||||
| Case/person years | 2404/594 879 | 1481/399 934 | 777/227 163 | 132/52 895 | ||
| Age adjusted | 1 | 0.91 (0.85 to 0.97) | 0.81 (0.74 to 0.88) | 0.58 (0.49 to 0.70) | <0.001 | 0.92 (0.90 to 0.95) |
| Multivariable adjusted | 1 | 0.95 (0.89 to 1.02) | 0.93 (0.85 to 1.01) | 0.79 (0.66 to 0.95) | 0.006 | 0.97 (0.95 to 0.99) |
| Milk chocolate | ||||||
| NHS: | ||||||
| Case/person years | 530/183 122 | 445/135 119 | 280/66 828 | 40/10 432 | ||
| Age adjusted | 1 | 1.12 (0.99 to 1.28) | 1.30 (1.12 to 1.51) | 1.29 (0.93 to 1.78) | 0.002 | 1.03 (0.99 to 1.06) |
| Multivariable adjusted | 1 | 0.95 (0.83 to 1.08) | 1.05 (0.90 to 1.23) | 1.02 (0.72 to 1.44) | 0.52 | 1.00 (0.96 to 1.04) |
| NHSII: | ||||||
| Case/person years | 815/236 945 | 1229/295 724 | 752/158 452 | 107/22 855 | ||
| Age adjusted | 1 | 1.24 (1.13 to 1.36) | 1.43 (1.29 to 1.58) | 1.41 (1.15 to 1.72) | <0.001 | 1.05 (1.03 to 1.07) |
| Multivariable adjusted | 1 | 0.96 (0.88 to 1.05) | 0.97 (0.87 to 1.08) | 0.90 (0.72 to 1.12) | 0.49 | 0.98 (0.96 to 1.01) |
| HPFS: | ||||||
| Case/person years | 180/56 529 | 235/63 694 | 136/35 662 | 22/4988 | ||
| Age adjusted | 1 | 1.24 (1.02 to 1.51) | 1.21 (0.96 to 1.51) | 1.32 (0.84 to 2.08) | 0.17 | 1.03 (0.98 to 1.08) |
| Multivariable adjusted | 1 | 1.05 (0.86 to 1.29) | 0.95 (0.74 to 1.22) | 1.00 (0.61 to 1.63) | 0.69 | 0.99 (0.93 to 1.05) |
| Pooled‡: | ||||||
| Case/person years | 1533/478 373 | 1918/496 219 | 1177/261 872 | 169/38 409 | ||
| Age adjusted | 1 | 1.21 (1.13 to 1.29) | 1.36 (1.26 to 1.47) | 1.36 (1.16 to 1.59) | <0.001 | 1.04 (1.02 to 1.06) |
| Multivariable adjusted | 1 | 0.97 (0.90 to 1.04) | 0.99 (0.91 to 1.08) | 0.94 (0.79 to 1.12) | 0.75 | 0.99 (0.97 to 1.01) |
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, AHEI (five groups), and total chocolate intake before baseline (as cumulative averages for 1980-2002 (NHS), 1991-2003 (NHSII), 1986-2002 (HPFS)).
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).