Objective To prospectively investigate the associations between dark, milk, and total chocolate consumption and risk of type 2 diabetes (T2D) in three US cohorts. Design Prospective cohort studies. Setting Nurses’ Health Study (NHS; 1986-2018), Nurses’ Health Study II (NHSII; 1991-2021), and Health Professionals Follow-Up Study (HPFS; 1986-2020). Participants At study baseline for total chocolate analyses (1986 for NHS and HPFS; 1991 for NHSII), 192 208 participants without T2D, cardiovascular disease, or cancer were included. 111 654 participants were included in the analysis for risk of T2D by intake of chocolate subtypes, assessed from 2006 in NHS and HPFS and from 2007 in NHSII. Main outcome measure Self-reported incident T2D, with patients identified by follow-up questionnaires and confirmed through a validated supplementary questionnaire. Cox proportional hazards regression was used to estimate hazard ratios and 95% confidence intervals (CIs) for T2D according to chocolate consumption. Results In the primary analyses for total chocolate, 18 862 people with incident T2D were identified during 4 829 175 person years of follow-up. After adjusting for personal, lifestyle, and dietary risk factors, participants consuming ≥5 servings/week of any chocolate showed a significant 10% (95% CI 2% to 17%; P trend=0.07) lower rate of T2D compared with those who never or rarely consumed chocolate. In analyses by chocolate subtypes, 4771 people with incident T2D were identified. Participants who consumed ≥5 servings/week of dark chocolate showed a significant 21% (5% to 34%; P trend=0.006) lower risk of T2D. No significant associations were found for milk chocolate intake. Spline regression showed a linear dose-response association between dark chocolate intake and risk of T2D (P for linearity=0.003), with a significant risk reduction of 3% (1% to 5%) observed for each serving/week of dark chocolate consumption. Intake of milk, but not dark, chocolate was positively associated with weight gain. Conclusions Increased consumption of dark, but not milk, chocolate was associated with lower risk of T2D. Increased consumption of milk, but not dark, chocolate was associated with long term weight gain. Further randomized controlled trials are needed to replicate these findings and further explore the mechanisms. No additional data available.

中文翻译：

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巧克力摄入量和 2 型糖尿病风险：前瞻性队列研究


目的 前瞻性调查三个美国队列中黑巧克力、牛奶巧克力和总巧克力消费量与 2 型糖尿病 （T2D） 风险之间的关联。设计前瞻性队列研究。环境护士健康研究（NHS;1986-2018）、护士健康研究 II（NHSII;1991-2021）和卫生专业人员随访研究（HPFS;1986-2020）。参与者 在总巧克力分析的研究基线（NHS 和 HPFS 为 1986 年;NHSII 为 1991 年），包括 192 208 名没有 T2D、心血管疾病或癌症的参与者。111 654 名参与者被纳入按巧克力亚型摄入量划分的 T2D 风险分析，从 2006 年在 NHS 和 HPFS 以及 2007 年的 NHSII 中进行评估。主要结局指标 自我报告事件 T2D，患者通过随访问卷确定并通过经过验证的补充问卷确认。Cox 比例风险回归用于根据巧克力消费量估计 T2D 的风险比和 95% 置信区间 （CI）。结果 在总巧克力的初步分析中，在 4 829 175 人年的随访中确定了 18 862 例 T2D 事件患者。在调整了个人、生活方式和饮食风险因素后，参与者每周食用 ≥5 份任何巧克力显示出显著的 10%（95% CI 2% 至 17%;P 趋势 = 0.07） 与从不或很少食用巧克力的人相比，T2D 的发生率较低。在按巧克力亚型进行的分析中，确定了 4771 例 T2D 新发患者。每周食用 ≥5 份黑巧克力的参与者显示出显着的 21%（5% 至 34%;P 趋势=0.006） 降低 T2D 的风险。未发现牛奶巧克力摄入量的显著关联。 样条回归显示黑巧克力摄入量与 T2D 风险之间存在线性剂量反应关联（线性 P = 0.003），观察到每份/每周食用黑巧克力的风险显著降低 3%（1% 至 5%）。摄入牛奶而不是黑巧克力与体重增加呈正相关。结论 增加黑巧克力而非牛奶巧克力的消费量与降低 T2D 风险相关。牛奶巧克力的摄入量增加，而不是黑巧克力的摄入量增加与长期体重增加有关。需要进一步的随机对照试验来复制这些发现并进一步探索其机制。没有其他可用数据。