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. 2021 Aug 24;13(9):2909.
doi: 10.3390/nu13092909.

The Health Effects of Chocolate and Cocoa: A Systematic Review

Terence Yew Chin Tan  1 , Xin Yi Lim  1 , Julie Hsiao Hui Yeo  2 , Shaun Wen Huey Lee  3 , Nai Ming Lai  3   4
Affiliations

The Health Effects of Chocolate and Cocoa: A Systematic Review

Terence Yew Chin Tan et al. Nutrients. .

Abstract

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.

Keywords: chocolate; cocoa; health benefits.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flowchart that shows study flow in the review work to investigate the benefits of chocolate.
Figure 2
Figure 2
(a) Risk of bias assessment (ROB) graph and (b) ROB summary of included studies based on authors’ judgment.
Figure 3
Figure 3
Forest plot of comparison: chocolate versus control, with the outcome-systolic blood pressure (mmHg).
Figure 4
Figure 4
Forest plot of comparison: chocolate versus control, with the outcome-diastolic blood pressure (mmHg).
Figure 5
Figure 5
Forest plot of comparison: chocolate versus control, with the outcome-total cholesterol (mg/dL).
Figure 6
Figure 6
Forest plot of comparison: chocolate versus control, with the outcome-triglyceride (mg/dL).
Figure 7
Figure 7
Forest plot of comparison: chocolate versus control, with the outcome-low density lipoprotein (mg/dL). Nichols-Richardson (2014) and Nijike (2011) reported mean changes and their respective SD, instead of mean scores.
Figure 8
Figure 8
Forest plot of comparison: chocolate versus control, with the outcome-high density lipoprotein (mg/dL). Nichols-Richardson (2014) and Nijike (2011) reported mean changes and their respective SD, instead of mean scores.
Figure 9
Figure 9
Forest plot of comparison: chocolate versus control, with the outcome-body weight (kg). Nichols-Richardson (2014) and Nijike (2011) reported mean changes and their respective SD, instead of mean scores.
Figure 10
Figure 10
Forest plot of comparison: chocolate versus control, with the outcome—body mass index (kg/m2). Nichols-Richardson (2014) and Nijike (2011) reported mean changes and their respective SD, instead of mean scores.
Figure 11
Figure 11
Forest plot of comparison: chocolate versus control, with the outcome-waist circumference (cm).
Figure 12
Figure 12
Forest plot of comparison: chocolate versus control, with the outcome-body fat percentage (%).
Figure 13
Figure 13
Forest plot of comparison: chocolate versus control, with the outcome—fasting plasma glucose (mg/dL). Nichols-Richardson (2014) and Nijike (2011) reported mean changes and their respective SD, instead of mean scores.
Figure 14
Figure 14
Forest plot of comparison: chocolate versus control, with the outcome-trail marking test (attention) (seconds).
Figure 15
Figure 15
Forest plot of comparison: chocolate versus control, with the outcome—trail marking test (processing speed and cognitive flexibility) (seconds).
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