Journal of Obesity & Weight Loss Category: Medical Type: Research Article
Chocolate Consumption and Health Beliefs and its Relation to BMI in College Students
- Charles Platkin1*, Patricia Estrella2, Caitlin MacShane2, Deborah Allinger2, Rebecca Elbaum2, Melissa Keeney2, Barbara Brumaru2, Ming-Chin Yeh3*, Katarzyna Wyka4
- 1 Nutrition And Food Science Program, School Of Urban Public Health, Hunter College, City University Of New York School Of Public Health, Silberman Building, 2180 Third Avenue RM 528, New York, NY 10035, United States
- 2 Nutrition And Food Science Program, School Of Urban Public Health, Hunter College, City University Of New York School Of Public Health, Manhattan, United States
- 3 Nutrition And Food Science Program, School Of Urban Public Health, Hunter College, City University Of New York School Of Public Health, Ilberman Bldg, 2180 Third Avenue, RM 614, New York, NY 10035, United States
- 4 Epidemiology And Biostatistics Program, School Of Urban Public Health, Hunter College, City University Of New York School Of Public Health, New York, United States
*Corresponding Author:Charles Platkin
Nutrition And Food Science Program, School Of Urban Public Health, Hunter College, City University Of New York School Of Public Health, Silberman Building, 2180 Third Avenue RM 528, New York, NY 10035, United States
Nutrition And Food Science Program, School Of Urban Public Health, Hunter College, City University Of New York School Of Public Health, Ilberman Bldg, 2180 Third Avenue, RM 614, New York, NY 10035, United States
Received Date: Nov 06, 2015 Accepted Date: Jan 06, 2016 Published Date: Jan 21, 2016
Methods: In 2013, a paper and electronic survey was conducted to assess personal health information, type of chocolate consumed, its typical serving size, and frequency of consumption. A series of statements pertaining to chocolate consumption and health was assessed using a five-point Likert scale. The survey was conducted between May 1 and August 5, 2013 and recruited participants from a multi-ethnic population of students and employees of an urban college.
Results: Participants (n=553) were 66.7% female, mean age of 23.75 years (SD=7.40) and a mean BMI of 23.61 (SD=5.11). Milk chocolate was consumed by 40% of participants and 28.4% consumed dark chocolate. Most respondents ate a small-medium or medium-large serving size of chocolate (66.8%) and consumed chocolate several times a week (48.9%). A significant association was observed with milk chocolate consumed in large serving sizes, whereas dark chocolate was consumed in small serving sizes (p=0.001). In comparison to males, females were more likely to have consumed dark chocolate (p<0.001) and in smaller servings sizes (p<.001). Racial/ethnic differences were observed with Whites consuming more dark chocolate and other racial/ethnic groups consuming more milk chocolate (p<0.001), while African-Americans and Asians consumed larger serving sizes (p=0.013). Most respondents agreed with a statement that dark chocolate is the healthiest chocolate (74.1%), this belief was stronger among females as compared to males (p<.001). While most chocolate health beliefs were similar between genders and racial and ethnic groups, males, African-Americans, and Hispanics held stronger beliefs that all chocolate is good for one’s health (p<.05). BMI was not associated with chocolate consumption nor was health beliefs about chocolate.
Conclusion: Our findings showed that this group of college-aged students tended to consume milk chocolate most commonly. Racial/ethnic and gender differences were observed in consumption and general health beliefs of chocolate. No association was observed between BMI and type of chocolate consumption, or between BMI and chocolate health beliefs.
Chocolate consumption and health status
There have been many studies indicating the cardiovascular benefits associated with consumption of dark chocolate and its flavonoids. In a randomized controlled crossover trial, Faridi et al.,  examined the cardio protective effects of solid dark chocolate and liquid cocoa and found that its consumption improved endothelial function and decreased blood pressure in overweight adults. Similarly, other studies have demonstrated that consuming 50 g of dark chocolate significantly improved endothelial function, increased nitric oxide levels, and decreased superoxide anion production [5,6]. In a related study pertaining to cardiovascular health, the National Heart, Lung, and Blood Institute (NHLBI) family heart study found an inverse association between the frequency of chocolate consumption and the calcified atherosclerotic plaque in the coronary arteries . Furthermore, meta-analyses of studies have found that dark chocolate and cocoa beverages decreased systolic blood pressure by 2.77 to 4.5 mmHg and diastolic blood pressure by 2.20 to 2.50 mmHg [12,13].
Cocoa and its polyphenols have been shown to prevent or slow down the progression of cancer by diminishing intracellular reactive oxygen species production, enhance the activity of endogenous antioxidant enzymes, act as a radical scavengers, prevent oxidative damage to DNA, inhibit inflammatory mediators, and induce apoptosis in cancer cells . For instance, cocoa was shown to be chemo protective as it induced antioxidant enzymes and suppressed the expression of inflammatory mediators in a mouse model of colitis-associated cancer cells . Another study found that a polyphenolic cocoa extract had an antioxidant effect at the molecular level by over expressing a gene, CYP1A1, in breast cancer cells which is important in metabolizing xenobiotics, carcinogens, and estrogen .
There is some evidence that dark chocolate may help with body fat or body weight. For example, an animal study found that mice that were fed a high-fat diet supplemented with an equivalent reasonable human dose of cocoa had a lower increase in fat mass compared to the high-fat control group . In another study examining the anti-obesity effects of cocoa in rats found that cocoa decreased body weight gain and the weight of white adipose tissue .
Although there have been an abundance of research focusing on the health contributions of chocolate, it is important to note that not all varieties offer the same benefits. Milk chocolate and, especially, white chocolate are higher in fat, calories, and added sugars in comparison to dark chocolate, thus may reduce healthful effects. A prospective cohort study found a dose-dependent relationship between chocolate-candy consumption and weight gain in women with each additional 1 oz serving per month associated with an average weight gain of 0.92 kg in the three-year study period . Furthermore, there is also research that addresses its potential adverse contributions to health. A study of older women aged 70-85 years of age that examined the relationship between chocolate consumption and bone density and strength found that a higher frequency of consumption was associated with lower bone density and strength .
Due to the controversy and inconsistencies in prior research, a study that assesses the relationship between BMI and chocolate consumption, differentiating between different types, is warranted. In addition, the study will explore if health beliefs affect chocolate consumption and BMI. To our knowledge, this is the first study to examine such relationship. The objectives of this study will be to evaluate: 1) chocolate consumption in college students, 2) their association with BMI, 3) the relationship between health beliefs about chocolate and their consumption.
Study design and survey development
Individual characteristics and attributes
Chocolate consumption and health beliefs
Lastly, linear and logistic regressions were conducted to test for associations between BMI index and BMI categories and chocolate consumption and chocolate health beliefs. All analyses were conducted using the Statistical Package for the Social Sciences (SPSS, version 12, SPSS, Inc., Chicago, IL, 2004). Significance was judged as p<.05 and analyses were not adjusted for inflated Type I error due to testing multiple hypotheses.
|Characteristic||n||M (SD) or %|
|$0 - $29,999||174||32.8|
|$30,000 - $49,999||126||23.8|
|$50,000 - $69,999||80||15.1|
|$70,000 or more||150||28.3|
|1-2 times per week||102||27.8|
|3 or more times per week||135||36.8|
|Neither healthy nor unhealthy||146||27.2|
|Overall n=494||Male n=182||Female n=371||White n=195||White n=195||Hispanic n=107||Asian n=126||Other/ Mixed n=78|
|Don’t eat chocolate||7.3||8||6.7||0.128||3.8||17.8||5.5||10.8||5.7||0.369|
|Type of chocolate usually consumed||<.001||<.001|
|Typical serving size||<.001||0.013|
|Frequency of chocolate eating||0.585||0.081|
|Several times a week||48.9||45.6||50.8||53.8||38.9||46.5||53.3||39.4|
bIncludes White chocolate
c, dp-values for gender differences and race/ethnic differences were based on bivariate 2x2 χ² tests. Pair wise comparisons for race/gender differences were assessed using the χ² goodness-of-fit tests. Significant differences (p < .05) are bolded.
Females were significantly more likely to consume dark chocolate (34.4% vs. 18.5%) and less likely to choose any type of chocolate (20.4% vs. 37.7%) than males (χ²(2, N=440)= 19.60, p<0.001). Likewise, females consumed smaller servings of chocolate overall (small/small-medium serving size 61.4% vs. 43.3%, χ²(3, N=456)= 15.59, p<.001). Chocolate preferences also differed by race/ethnicity, with Whites consuming significantly more dark chocolate than African Americans, Hispanic and Other/Mixed (40.9% vs. 11.4%, 21.7% and 15.6%, respectively; χ²(4, N=129)= 106.23, p<0.001). Milk chocolate consumption was significantly associated with being African-American (71.4% vs. 35.7% for Whites, 53.0% for Hispanics, 50.0% for Other/Mixed and 40.7% for Asians; χ2(4, N=197)= 19.52, p<0.001). In addition, African-Americans and Asians reported consuming generally larger serving sizes (χ²(12, N=455)= 25.33, p=0.013) (Table 2). There was no association between chocolate type, serving size or chocolate consumption frequency and respondent’s BMI.
Health beliefs about chocolate and chocolate consumption
Chocolate health beliefs regarding blood pressure, heart disease, and cancer were similar among females and males and racial/ethnic groups (Figure 1). However, males, African-Americans, and Hispanics reported a stronger belief that all chocolate is good for your health (χ²(2, N=451)= 8.99, p=0.011 and χ²(8, N=450)= 21.91, p=0.005, respectively) (Figure 1). In addition, women were significantly more likely to agree that dark chocolate (with 50% cocoa or more) is the healthiest chocolate (χ²(2, N=453)= 21.44, p<0.001). There were no differences in chocolate health beliefs and neither chocolate consumption patterns nor respondent’s BMI.
Chocolate consumption, chocolate health beliefs, and BMI
Women have been reported to have more cravings for chocolate and are more likely to choose chocolate as a “comfort food” compared to men . In this study, females were found to be significantly more likely to consume dark chocolate and in smaller servings. Contrastingly, a randomized controlled study that examined the psychoactive effects of tasting chocolate and the components to desire more consumption revealed that more men than women desired to consume more chocolate in spite of men’s lower chocolate craving and liking scores . On the other hand, a cross-sectional study of undergraduate psychology students found no gender differences in chocolate consumption .
We also observed significant differences in chocolate consumption among racial/ethnic groups. Dark chocolate consumption was greater among Whites and milk chocolate consumption greater among other racial/ethnic groups with Asians and African-Americans consuming the largest sizes. Milk chocolate is known to be considerably sweeter and less bitter than dark chocolate. Although there may be many factors to explain this finding, a study that examined sucrose preferences reported racial/ethnic differences with African-Americans preferring solutions with higher concentrations of sucrose compared to Whites .
We found that most participants believed that dark chocolate to be the healthiest choice, to help reduce blood pressure, and to lower the risk of heart disease. And overall, chocolate health beliefs did not differ between participants in most statements. However, this study did find gender and racial differences concerning chocolate’s health beliefs with males, African-Americans, and Hispanics reporting a stronger belief in all chocolate being good for one’s health and with females agreeing that dark chocolate is the healthiest choice. Our findings contradict the suggestion that chocolate, treated as a treat, has limited credibility of any health claims among its participants .
To our knowledge, this is the first study to examine the relationship between the type of chocolate consumption or chocolate health beliefs and BMI. We found that neither chocolate consumption nor type of chocolate is correlated to BMI category. The relationship between chocolate consumption and BMI in the current literature, however, is mixed. A meta-analysis found no significant relationship between BMI and flavonoid-rich cocoa in 11 short-term studies . Cross-sectional surveys have found those who consumed chocolate at higher frequencies had lower levels of BMI [35-37]. However, those authors did mention BMI-confounding factors such as physical activity [35,36]. A prospective study yielded a significant dose-response association between chocolate intake and BMI over time, but their cross-sectional analysis found an inverse association between chocolate intake and BMI .
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Citation:Ming-Chin Yeh, Platkin C, Estrella P, MacShane C, Allinger D, et al. (2016) Chocolate Preferences and Its Relation to BMI and Health Status in College Students. J Obes Weight Loss 1: 004.
Copyright: © 2016 Charles Platkin, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.