Original Article | Published:

Carbohydrates, insulin resistance and diabetes mellitus

Chocolate intake and diabetes risk in postmenopausal American women

European Journal of Clinical Nutrition volume 71, pages 10881093 (2017) | Download Citation



Recent long-term prospective cohort studies found inverse associations between chocolate consumption and the risk of type 2 diabetes, but provided conflicting evidence on the nature of the association among women. To assess this association in a large cohort of American women.


Multivariable Cox regression was used with the data from 92 678 postmenopausal women in the prospective Women’s Health Initiative study. Chocolate intake was assessed by food frequency questionnaire. Incidence of type 2 diabetes was determined by self-report of the first treatment with oral medication or insulin.


Among women free of diabetes at baseline, there were 10 804 cases, representing an incidence rate of 11.7% during 13.1 years and 1 164 498 person-years of follow-up. There was no significant linear association between long-term chocolate intake and type 2 diabetes risk, but there was significantly reduced risk at moderate levels of intake. Compared to women who ate 1 oz. of chocolate <1 time per month, those who ate this amount 1–<1.5 times per month, 1.5–<3.5 times per month, 3.5 times per month to <3 times per week and 3 times per week had hazard ratios of 0.97 (95% confidence interval: 0.92, 1.04), 0.92 (0.87, 0.98), 0.93 (0.88, 0.98) and 0.98 (0.92, 1.04) (P for linear trend=0.79). There was only evidence of such inverse associations for women with below-median physical activity (P for interaction <0.0001) and those with age<65 years (P=0.01).


We only found an inverse association between chocolate consumption and type 2 diabetes at moderate levels of consumption in two subgroups of postmenopausal women in the Women’s Health initiative cohort.

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We thank the WHI Investigators (see Online Supplement) for their efforts in the collection of the WHI data.

Author contributions

JG, JM, LT, MN, LG and MV conceived the work that led to the submission. JM, LT, MN, LG and MV acquired the data. JG performed the statistical analysis. JG, JM, LT and MN played an important role in interpreting results. JG drafted the manuscript. JG, JM, LT, MN, LG, MV and LP contributed to the revision of the manuscript. JG had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final version.

Author information


  1. Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York, Brooklyn, NY, USA

    • J A Greenberg
  2. Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    • J E Manson
  3. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    • L Tinker
    •  & M L Neuhouser
  4. Department of Public Health Sciences, Davis, CA, USA

    • L Garcia
  5. Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA

    • M Z Vitolins
  6. Clinical Studies Center, Atlanta VA Medical Center, Decatur, GA, USA

    • L S Phillips
  7. Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA

    • L S Phillips


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Competing interests

JM 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 cardiovascular disease. JG is the recipient of funding from the City University of New York Research Award Program to conduct a pilot randomized trial of cocoa compounds and appetite. LP has served on Scientific Advisory Boards for Boehringer Ingelheim and Janssen within the past several years, and has or had research support from Merck, Amylin, Eli Lilly, Novo Nordisk, Sanofi, PhaseBio, Roche, and the Cystic Fibrosis Foundation. In the past, he was a speaker for Novartis and Merck. He is also a co-founder of a company, Diasyst LLC, which aims to develop and commercialize diabetes management software programs. These activities involve diabetes, but have nothing to do with this manuscript. The remaining authors declare no conflict of interest.

Corresponding author

Correspondence to J A Greenberg.

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Supplementary Information accompanies this paper on European Journal of Clinical Nutrition website (http://www.nature.com/ejcn)