Chocolate Candy and Incident Invasive Cancer Risk in the Women's Health Initiative: An Observational Prospective Analysis

James A. Greenberg; Marian L. Neuhouser; Lesley F. Tinker; Dorothy S. Lane; Electra D. Paskett; Linda V. Van Horn; Sylvia Wassertheil-Smoller; James M. Shikany; Lihong Qi; Shawnita Sealy-Jefferson; Jo Ann E. Manson

doi:10.1016/j.jand.2020.06.014

Chocolate Candy and Incident Invasive Cancer Risk in the Women's Health Initiative: An Observational Prospective Analysis

James A. Greenberg^*, Marian L. Neuhouser, Lesley F. Tinker, Dorothy S. Lane, Electra D. Paskett, Linda V. Van Horn, Sylvia Wassertheil-Smoller, James M. Shikany, Lihong Qi, Shawnita Sealy-Jefferson, Jo Ann E. Manson

^*Corresponding author for this work

Preventive Medicine

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	314-326.e4
Journal	Journal of the Academy of Nutrition and Dietetics
Volume	121
Issue number	2
DOIs	https://doi.org/10.1016/j.jand.2020.06.014
State	Published - Feb 2021

Funding

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. 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.

Keywords

Chocolate consumption
Invasive cancer
Invasive colorectal cancer
Obesity
Women's Health Initiative

ASJC Scopus subject areas

Food Science
Nutrition and Dietetics

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jand.2020.06.014

Cite this

Greenberg, J. A., Neuhouser, M. L., Tinker, L. F., Lane, D. S., Paskett, E. D., Van Horn, L. V., Wassertheil-Smoller, S., Shikany, J. M., Qi, L., Sealy-Jefferson, S., & Manson, J. A. E. (2021). Chocolate Candy and Incident Invasive Cancer Risk in the Women's Health Initiative: An Observational Prospective Analysis. Journal of the Academy of Nutrition and Dietetics, 121(2), 314-326.e4. https://doi.org/10.1016/j.jand.2020.06.014

@article{34873153acc041e18e61a962a4e4bf1c,

title = "Chocolate Candy and Incident Invasive Cancer Risk in the Women's Health Initiative: An Observational Prospective Analysis",

abstract = "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.",

keywords = "Chocolate consumption, Invasive cancer, Invasive colorectal cancer, Obesity, Women's Health Initiative",

author = "Greenberg, {James A.} and Neuhouser, {Marian L.} and Tinker, {Lesley F.} and Lane, {Dorothy S.} and Paskett, {Electra D.} and {Van Horn}, {Linda V.} and Sylvia Wassertheil-Smoller and Shikany, {James M.} and Lihong Qi and Shawnita Sealy-Jefferson and Manson, {Jo Ann E.}",

note = "Publisher Copyright: {\textcopyright} 2021 Academy of Nutrition and Dietetics",

year = "2021",

month = feb,

doi = "10.1016/j.jand.2020.06.014",

language = "English (US)",

volume = "121",

pages = "314--326.e4",

journal = "Journal of the Academy of Nutrition and Dietetics",

issn = "2212-2672",

publisher = "Elsevier USA",

number = "2",

}

Greenberg, JA, Neuhouser, ML, Tinker, LF, Lane, DS, Paskett, ED, Van Horn, LV, Wassertheil-Smoller, S, Shikany, JM, Qi, L, Sealy-Jefferson, S & Manson, JAE 2021, 'Chocolate Candy and Incident Invasive Cancer Risk in the Women's Health Initiative: An Observational Prospective Analysis', Journal of the Academy of Nutrition and Dietetics, vol. 121, no. 2, pp. 314-326.e4. https://doi.org/10.1016/j.jand.2020.06.014

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.

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

UR - http://www.scopus.com/inward/record.url?scp=85088939957&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85088939957&partnerID=8YFLogxK

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 -

Chocolate Candy and Incident Invasive Cancer Risk in the Women's Health Initiative: An Observational Prospective Analysis

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this