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Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis

BMJ 2011; 343 doi: (Published 29 August 2011) Cite this as: BMJ 2011;343:d4488

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Re:Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis

I read with interest the recent systematic review and meta-analysis
of chocolate consumption and cardio-metabolic disorders.(1) The number of
cohorts included in the meta-analysis is small (six in total and all
adults) and none were randomised controlled trials. The heterogeneity was
higher than 50% for the effect of chocolate on any cardiovascular event,
indicating a large range of effects; however, the results for stroke only,
were more robust with low levels of variation. No attempt was made to
compare different type of chocolate due to the limited evidence available.

Despite the limitations of this review, the results call into
question the scientific evidence to encourage the population to reduce
chocolate consumption. I refer particularly to the school meal standards
in England (and similar standards introduced throughout the UK) which are
described by the School Food Trust.(2) The food based standards were
introduced in 2006 closely followed by nutrient based standards in primary
schools in 2007 and secondary schools in 2008. An important component of
the standards was the exclusion of chocolate (with the exception of cocoa
powder). The reasons are clear; the association of cocoa solids with
sugar and fat in all but the strongest dark chocolate products is well

There are three important points to make here. Firstly, by excluding
chocolate covered confectionery and desserts, sugar and fat consumption is
not necessarily reduced if another sweet, fatty food is substituted such
as flapjack or jam sponge. Secondly, if the results from the recent
review are confirmed by randomised controlled trials, restricting
chocolate products may actually be detrimental to health. Thirdly, any
nutrition policy introduced must always be supported by the most rigorous
of scientific evidence. If this is not the case, those involved in
nutrition policy, are in danger of losing all credibility. I strongly
urge the governmental departments involved in legislating school meal
standards to regularly review the nutritional epidemiological evidence to
ensure that school food provides the best diet for children's future

1. Buitrago-Lopez A, Sanderson J, Johnson L, Warnakula S, Wood A, Di
Angelantonio E, et al. Chocolate consumption and cardiometabolic
disorders: systematic review and meta-analysis. BMJ 2011;343.

2. School Food Trust. Revised guide to standards for school lunches, 2008.

Competing interests: No competing interests

21 September 2011
Charlotte E.L. Evans
Lecturer in Nutrition Policy
University of Leeds