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According to the World Health Organization cardiovascular diseases (CVDs) are the leading causes of death globally and by 2030 almost 23.6 million people are projected to die from cardiovascular disorders such as heart disease and stroke.1 Metabolic syndrome is a term used to describe a group of risk factors (abdominal obesity, high triglycerides, low HDL, high blood pressure, and high blood sugar) that raise your risk for CVD and Type 2 diabetes.2,3 A person who has metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes compared to someone without these risk factors.3 Cardiometabolic disorders are largely preventable and diet modifications can play an important role in prevention of many of these diseases.2 The flavanol contained in cocoa products is believed to be responsible for chocolate’s antioxidant, antihypertensive, anti-inflammatory, anti-atherogenic, and anti-thrombotic effects, as well as its influence on insulin sensitivity, vascular endothelial function, and activation of nitric oxide.2 There have been reviews suggesting that consumption of cacao and cocoa products may have the potential to reduce cardiovascular risk factors and prevent cardiometabolic disorders but available literature on this topic are limited.2 A study by Buitrago-Lopez and colleagues was the first attempt at a systematic evaluation that compared the difference between low and high chocolate consumption with the risk of developing cardiometabolic disorders in adults.2

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A systematic review and meta-analysis was carried out searching databases such as Medline, Embase, Cochrane Library, and Scopus, among others, to find studies that related chocolate intake to the primary outcome of incidence of cardiometabolic disorders; these included diabetes mellitus (DM), metabolic syndrome, and CVDs such as stroke, heart failure (HF), and myocardial infarction (MI). Studies were included in the analysis if they were randomized, cohort, case-control, or cross sectional studies; if they were carried out in adults 18 years or older; studied the effects of levels of chocolate consumption, and the outcomes of interest were related to cardiometabolic disorders. Exclusion criteria consisted of studies including only pregnant participants; studies carried out in non-humans; or letters, abstracts, systematic reviews, meta-analyses, ecological studies, and conference proceedings. Only 7 studies (6 cohort and 1 cross-sectional) met the inclusion criteria (114,009 participants). All the studies reported chocolate consumption in a different manner and considering the variability in intake measurements, only the group with the highest chocolate consumption was compared against the group with the lowest for each study. Chocolate consumption included the ingestion of chocolate bars, chocolate drinks, and chocolate snacks (biscuits, desserts, candy bars) but studies did not separate dark or white chocolate. Exposure was measured using food frequency questionnaires or patient food diaries. The studies included populations with and without prior cardiovascular disease so it was impossible to discern whether association would differ in terms of primary or secondary prevention or both.

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Out of the 7 studies, 5 reported a beneficial association between higher levels of chocolate consumption and the risk of cardiometabolic disorders. Based ...

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