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Nutrients 2017, 9(8), 855; doi:10.3390/nu9080855

Reply: “Comment on: Chocolate Consumption and Risk of Coronary Heart Disease, Stroke, and Diabetes: A Meta-Analysis of Prospective Studies, Nutrients 2017, 9, 688”
Department of Geratology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan 430071, China
Author to whom correspondence should be addressed.
Received: 4 August 2017 / Accepted: 4 August 2017 / Published: 10 August 2017
To the editor,
We would like to thank Dr. Hurtado-Torres for his valuable comments on our article entitled “Chocolate Consumption and Risk of Coronary Heart Disease, Stroke, and Diabetes: A Meta-Analysis of Prospective Studies”, which was published in Nutrients in July 2017 [1]. As he pointed out, Buitrago-Lopez et al. [2] also demonstrated the protective effect of chocolate against cardiometabolic disease. However, only one Japanese study published in 2010 [3] was included in their analysis of diabetes, with no quantitative pooling of data. That means Buitrago-Lopez’s description of the benefits of chocolate in preventing diabetes was based on a systematical review, not on a meta-analysis. We therefore stated in the discussion that “our study is the first meta-analysis investigating the protective role of chocolate consumption against diabetes”.
In addition, Dr. Hurtado-Torres also mentioned an interesting difference regarding the optimum dose of chocolate intake in our and Buitrago-Lopez’s studies. In our highest versus lowest meta-analysis (Figures 2A–4A in Reference [1]) we reached a similar finding as Buitrago-Lopez et al., that is, higher chocolate consumption is associated with lower risk of cardiovascular disease and diabetes. Nevertheless, in our dose-response meta-analysis (Figures 2B–4B in Reference [1]), we found that chocolate consumption in moderation (1–6 servings/week) may be ideal for the prevention of cardiometabolic disease, while no dose-response analyses were performed in Buitrago-Lopez’s study. As categories of chocolate consumption differed between the original studies included, highest versus lowest meta-analysis may complicate the interpretation of the final results. Thus, our study with additional dose-response analyses represents a more accurate evaluation of the relationship between chocolate consumption and risk of cardiometabolic disease. It also should be noted that both our and Buitrago-Lopez’s studies are meta-analyses with inherent limitations; thus, large prospective studies are still required to delimitate the optimal chocolate recommendation.

Conflicts of Interest

The authors declare no conflict of interest.


  1. Yuan, S.; Li, X.; Jin, Y.; Lu, J. Chocolate consumption and risk of coronary heart disease, stroke, and diabetes: A Meta-analysis of prospective studies. Nutrients 2017, 9, 688. [Google Scholar] [CrossRef] [PubMed]
  2. Buitrago-Lopez, A.; Sanderson, J.; Johnson, L.; Warnakula, S.; Wood, A.; Di Angelantonio, E.; Franco, O.H. Chocolate consumption and cardiometabolic disorders: Systematic review and meta-analysis. BMJ 2011, 343, d4488. [Google Scholar] [CrossRef] [PubMed]
  3. Oba, S.; Nagata, C.; Nakamura, K.; Fujii, K.; Kawachi, T.; Takatsuka, N.; Shimizu, H. Consumption of coffee, green tea, oolong tea, black tea, chocolate snacks and the caffeine content in relation to risk of diabetes in Japanese men and women. Br. J. Nutr. 2010, 103, 453–459. [Google Scholar] [CrossRef] [PubMed]
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