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Eating Dark Chocolate Reduces CRP

  • Authors: News Author: Lisa Nainggolan
    CME Author: Désirée Lie, MD, MSEd
  • CME/CE Released: 9/30/2008
  • Valid for credit through: 9/30/2009
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This article is intended for primary care clinicians, cardiologists, and other specialists who care for patients at risk of cardiovascular disease.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  1. Describe the effect of dark chocolate consumption on serum C-reactive protein levels in healthy subjects.
  2. Identify the dosage of dark chocolate affecting serum C-reactive protein levels in healthy adults.


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  • Lisa Nainggolan

    is a journalist for, part of the WebMD Professional Network. She has been with since 2000. Previously, she was science editor of Scrip World Pharmaceutical News, covering news about research and development in the pharmaceutical industry, and a consultant editor of Scrip Magazine. Graduating in physiology from Sheffield University, UK, she began her career as a poisons information specialist at Guy's Hospital before becoming a medical journalist in 1995. She can be reached at [email protected]


    Disclosure: Lisa Nainggolan has disclosed no relevant financial relationships.


  • Brande Nicole Martin

    is the News CME editor for Medscape Medical News.


    Disclosure: Brande Nicole Martin has disclosed no relevant financial information.


  • Laurie E. Scudder, MS, NP-C

    Nurse Planner, Medscape; Adjunct Assistant Professor, School of Health Sciences, George Washington University, Washington, DC; Curriculum Coordinator, Nurse Practitioner Alternatives, Inc., Ellicott City; Nurse Practitioner, Baltimore City School-Based Health Centers, Baltimore, Maryland


    Disclosure: Laurie Scudder, MS, NP-C, has disclosed no relevant financial information.

CME Author(s)

  • Désirée Lie, MD, MSEd

    Clinical Professor, Family Medicine, University of California, Orange; Director, Division of Faculty Development, UCI Medical Center, Orange, California


    Disclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.

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Eating Dark Chocolate Reduces CRP

Authors: News Author: Lisa Nainggolan CME Author: Désirée Lie, MD, MSEdFaculty and Disclosures

CME/CE Released: 9/30/2008

Valid for credit through: 9/30/2009


From Heartwire — a professional news service of WebMD

September 30 — A new Italian study has shown, for the first time, that consuming moderate amounts of dark chocolate can significantly reduce levels of C-reactive protein (CRP) [1]. Dr Romina di Giuseppe (Catholic University, Campobasso, Italy) and colleagues report their findings in the October 2008 issue of the Journal of Nutrition.

The results are the first to come out of a large epidemiological study, the Moli-sani Project, which is aiming to recruit 25,000 individuals living in the Molise region of Italy to investigate environmental and genetic factors responsible for cardiovascular disease and cancers.

"The reduction induced by moderate consumption of dark chocolate corresponds in clinical terms to a significant reduction in the risk of cardiovascular disease," senior author Dr Licia Iacoviello (Catholic University, Campobasso, Italy) told heartwire . "The lowering of CRP that we saw corresponds to a shift from medium risk of cardiovascular disease to low risk and is the first time an association between consumption of dark chocolate and inflammation has been found in a population study," she added.

But don't eat too much

Of 4849 subjects in good health and free of risk factors in the Moli-sani Project, the researchers identified 1317 who did not eat any chocolate and 824 people who ate dark chocolate regularly. They related the levels of CRP in their blood to their usual chocolate intake.

After adjustment for age, sex, social status, physical activity, systolic blood pressure (BP), body-mass index (BMI), waist/hip ratio, food groups, and total energy intake, dark-chocolate consumption was inversely associated with CRP (p=0.038). Mean serum CRP concentrations were 1.32 mg/L in nonconsumers of dark chocolate and 1.10 mg/L in those who ate dark chocolate (p<0.0001).

The 17% average reduction observed may appear small, but it is enough to decrease the risk of cardiovascular disease for one-third in women and one-fourth in men, the researchers say.

But they stress that a J-shaped curve was observed between dark-chocolate consumption and CRP concentrations: those who ate up to 1 serving (20 g) every 3 days had CRP concentrations significantly lower than those who ate none or those who ate larger amounts.

This moderate amount corresponds to a small square of chocolate two or three times a week, the researchers note, stressing that, beyond these amounts, the beneficial effect tends to disappear. "If you increase the consumption, the protection is lost, similar to the effects of wine," Iacoviello said.

"It could be that if you increase the amount of chocolate by too much, the increase in lipids and calories overcomes the effects of the antioxidants," she speculates.

The present study adds to previous work that has shown that moderate amounts of dark chocolate appear to have a beneficial effect on blood pressure, the researchers note, and "adds new insight into the relationship between flavonoid-rich foods, inflammation, and cardiovascular protection."

Nevertheless, "additional studies are necessary to explain the mechanisms linking dark-chocolate consumption and regulation of serum CRP concentrations," they conclude.

The authors have disclosed no relevant financial relationships. The Moli-sani Project is supported by research grants from Pfizer Foundation (Rome).


  1. Di Giuseppe R, di Castelnuovo A, Centritto F et al. Regular consumption of dark chocolate is associated with low serum concentrations of C-reactive protein in a healthy Italian population. J Nutr 2008; 138: 1939-1945

The complete contents of Heartwire , a professional news service of WebMD, can be found at, a Web site for cardiovascular healthcare professionals.

Clinical Context

Cocoa, the seed of the cocoa tree, is a flavonoid with antioxidant qualities and has been found to have a higher flavonoid antioxidant quantity-quality index than fruit, vegetables, red wine, and black tea and could be more beneficial to health than these other items. In the short term, cocoa-containing foods may improve endothelial function and reduce BP in hypertensive subjects.

This is a cohort study of adults to examine the association between dark chocolate consumption and CRP levels in a healthy population within CVD at baseline.

Study Highlights

  • Included were participants from a township aged 35 years or older who were not pregnant or in a coma.
  • Trained interviewers administered structured questionnaires, and the European Prospective Investigation into cancer and nutrition Food Frequency Questionnaire was used to determine daily nutrition intakes.
  • The questionnaire has been validated in 10 European countries.
  • Chocolate consumption was investigated by asking participants about the frequency of intake of a standard dose of 20 g and about the type of chocolate consumed (dark, milk, nut, or other type).
  • A software program was used to analyze the nutritional content of the diet.
  • BP, BMI and waist circumference were measured.
  • Participants were classified as nonsmokers, ex-smokers, or current smokers.
  • Blood samples were taken for CRP concentration and serum lipid levels.
  • Of 10,994 persons recruited, 34% did not consume any type of chocolate, and 18% consumed only dark chocolate.
  • 3513 were excluded for CVD at baseline and 1676 for being on a special diet.
  • 4849 subjects were examined: a control group of 1317 patients (27.2%) who did not consume any type of chocolate and a group of 824 patients (17.0%) who consumed only dark chocolate.
  • Mean age was 53 years, over 50% of the participants were men, BMI was 27 kg/m2, and one quarter of the participants were current smokers.
  • Among consumers, the median intake of dark chocolate was 5.7 g/day.
  • Dark chocolate consumers were younger and had a lower BMI and systolic BP than nonconsumers of chocolate.
  • Dark chocolate consumption was independently associated with younger age, male sex, social status, lower physical activity, higher total energy intake, cereals, nuts and seeds, fish, dairy products, sweets, tea, alcohol, calcium, and zinc.
  • The percentage of subjects with CRP levels over 3 mg/L was higher in nonconsumers (19%) than in dark chocolate consumers (14%), whereas the percentage of subjects with low CRP levels (less than 1 mg/L) was lower (38% vs 45%; P = .0006).
  • Age-adjusted serum levels of CRP were lower in dark chocolate users (1.13 mg/L) than in nonconsumers (1.30 mg/L; P < .0005).
  • After adjustment, dark chocolate consumption was still associated with serum CRP level.
  • There was a J-shaped relationship between dark chocolate consumption and CRP level, with a decrease in CRP levels to a plateau of 6.7 g/day intake (corresponding to a consumption of 20 g every 3 days) that reversed at the highest levels of consumption explored.
  • Consumption of tea, coffee, nuts, and seeds was not associated with change in CRP levels, suggesting a specific effect of chocolate.
  • The authors concluded that an increase in consumption of dark chocolate can decrease CRP levels from moderate to mild quintile, reflecting inflammation — a magnitude equivalent to a 26% risk reduction in CVD in men and a 33% reduction in women.

Pearls for Practice

  • Dark chocolate consumption compared with no chocolate consumption is associated with reduction in CRP level independent of consumption of tea, coffee, nuts, and seeds.
  • The amount of dark chocolate consumption associated with significant reduction in CRP level is 20 g (1 serving) every 3 days or 6.7 g/day.


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