TY - JOUR
T1 - Chocolate Candy and Incident Invasive Cancer Risk in the Women's Health Initiative
T2 - An Observational Prospective Analysis
AU - Greenberg, James A.
AU - Neuhouser, Marian L.
AU - Tinker, Lesley F.
AU - Lane, Dorothy S.
AU - Paskett, Electra D.
AU - Van Horn, Linda V.
AU - Wassertheil-Smoller, Sylvia
AU - Shikany, James M.
AU - Qi, Lihong
AU - Sealy-Jefferson, Shawnita
AU - Manson, Jo Ann E.
N1 - Funding Information:
FUNDING/SUPPORT The Women’s Health Initiative (WHI) program is funded by National Institutes of Health (NIH)/ National Heart, Lung, and Blood Institute (NHLBI), US Department of Health and Human Services through contracts HHSN268201600018C , HHSN268201600001C , HHSN268201600002C , HHSN268201600003C , and HHSN268201600004C . In addition, the following authors had funding related to this project: J. E. Manson had partial support from HHSN268201100001C from NIH/NHLBI, the Women’s Health Initiative program. J. E. Manson and colleagues at Brigham and Women’s Hospital, Harvard Medical School are recipients of funding from Mars Symbioscience for an investigator-initiated randomized trial of cocoa flavanols and chronic disease outcomes. L. F. Tinker and M. L. Neuhouser received support from NIH/NHLBI, US Department of Health and Human Services contract HHSN268201100046C. D. S. Lane received support from Stony Brook WHI Center grant, NHLBI contract no. NO1-WH-4-2115.
Funding Information:
STATEMENT OF POTENTIAL CONFLICT OF INTEREST J. E. Manson and colleagues at Brigham and Women's Hospital, Harvard Medical School are recipients of funding from Mars Symbioscience for an investigator-initiated randomized trial of cocoa flavanols and chronic disease outcomes. No potential conflict of interest was reported by the other authors.FUNDING/SUPPORT The Women's Health Initiative (WHI) program is funded by National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI), US Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C. In addition, the following authors had funding related to this project: J. E. Manson had partial support from HHSN268201100001C from NIH/NHLBI, the Women's Health Initiative program. J. E. Manson and colleagues at Brigham and Women's Hospital, Harvard Medical School are recipients of funding from Mars Symbioscience for an investigator-initiated randomized trial of cocoa flavanols and chronic disease outcomes. L. F. Tinker and M. L. Neuhouser received support from NIH/NHLBI, US Department of Health and Human Services contract HHSN268201100046C. D. S. Lane received support from Stony Brook WHI Center grant, NHLBI contract no. NO1-WH-4-2115.
Publisher Copyright:
© 2021 Academy of Nutrition and Dietetics
PY - 2021/2
Y1 - 2021/2
N2 - Background: Laboratory and animal studies suggest an inverse association between chocolate consumption and the risk of cancer. Epidemiological studies have yielded inconsistent evidence. Objective: To assess the association of chocolate candy consumption with incident, invasive total, breast, colorectal, and lung cancers in a large cohort of postmenopausal American women. Design: Prospective cohort study with a mean 14.8-year follow-up. Chocolate candy intake was assessed by food frequency questionnaire. Invasive cancer events were assessed by physician adjudication. Participants/setting: The Women's Health Initiative Study enrolled 161,808 postmenopausal women at 40 clinical centers nationwide between 1993 and 1998. Of these women, 114,281 with plausible food frequency or biometric data and no missing data on chocolate candy exposure were selected for analysis. Main outcome measures: Cancer risk in quartiles of chocolate candy consumption with the first quartile as referent. Statistical analyses: Multivariable Cox regression was used to calculate hazard ratios and 95% confidence intervals. Results: There were 16,164 documented incident invasive cancers, representing an incidence rate of 17.0 per 100 participants and 12.3 per 1000 person years during follow-up among participants without any preexisting cancers or missing outcome data. There were no statistically significant associations for total invasive cancer (P-linear = .47, P-curvature = .14), or invasive breast cancer (P-linear = .77, P-curvature = .26). For colorectal cancer P-linear was. 02, P-curvature was. 03, and compared with women eating a 1 oz (28.4 g) chocolate candy serving <1 time per month, the hazard ratio for ≥1.5 times/wk was 1.18 (95% confidence interval: 1.04-1.35). This result may be attributable to the excess adiposity associated with frequent chocolate candy consumption. Conclusions: In the Women's Health Initiative, there was no significant association between chocolate candy consumption and invasive total or breast cancer. There was a modest 18% higher risk of invasive colorectal cancer for women who ate chocolate candy at least 1.5 times/wk. These results require confirmation.
AB - Background: Laboratory and animal studies suggest an inverse association between chocolate consumption and the risk of cancer. Epidemiological studies have yielded inconsistent evidence. Objective: To assess the association of chocolate candy consumption with incident, invasive total, breast, colorectal, and lung cancers in a large cohort of postmenopausal American women. Design: Prospective cohort study with a mean 14.8-year follow-up. Chocolate candy intake was assessed by food frequency questionnaire. Invasive cancer events were assessed by physician adjudication. Participants/setting: The Women's Health Initiative Study enrolled 161,808 postmenopausal women at 40 clinical centers nationwide between 1993 and 1998. Of these women, 114,281 with plausible food frequency or biometric data and no missing data on chocolate candy exposure were selected for analysis. Main outcome measures: Cancer risk in quartiles of chocolate candy consumption with the first quartile as referent. Statistical analyses: Multivariable Cox regression was used to calculate hazard ratios and 95% confidence intervals. Results: There were 16,164 documented incident invasive cancers, representing an incidence rate of 17.0 per 100 participants and 12.3 per 1000 person years during follow-up among participants without any preexisting cancers or missing outcome data. There were no statistically significant associations for total invasive cancer (P-linear = .47, P-curvature = .14), or invasive breast cancer (P-linear = .77, P-curvature = .26). For colorectal cancer P-linear was. 02, P-curvature was. 03, and compared with women eating a 1 oz (28.4 g) chocolate candy serving <1 time per month, the hazard ratio for ≥1.5 times/wk was 1.18 (95% confidence interval: 1.04-1.35). This result may be attributable to the excess adiposity associated with frequent chocolate candy consumption. Conclusions: In the Women's Health Initiative, there was no significant association between chocolate candy consumption and invasive total or breast cancer. There was a modest 18% higher risk of invasive colorectal cancer for women who ate chocolate candy at least 1.5 times/wk. These results require confirmation.
KW - Chocolate consumption
KW - Invasive cancer
KW - Invasive colorectal cancer
KW - Obesity
KW - Women's Health Initiative
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U2 - 10.1016/j.jand.2020.06.014
DO - 10.1016/j.jand.2020.06.014
M3 - Article
C2 - 32763064
AN - SCOPUS:85088939957
SN - 2212-2672
VL - 121
SP - 314-326.e4
JO - Journal of the Academy of Nutrition and Dietetics
JF - Journal of the Academy of Nutrition and Dietetics
IS - 2
ER -
