Associations Between Chocolate Consumption and Cardiometabolic Risk Markers Across Metabolic Profiles: Insights from a Population-Based Study.

Background/Objectives: Studies evaluating the association between chocolate consumption and cardiometabolic health have reported inconsistent findings, and whether these associations differ according to underlying metabolic status remains unclear. This cross-sectional study analysed whether metabolic profile modifies the associations between chocolate consumption and cardiometabolic risk markers in 1960 adults from the SALMANTICOR population-based cohort. Methods: Chocolate consumption was classified by chocolate type (dark or milk) and frequency of intake (occasional: 1-3 days/week; regular: ≥4 days/week). Multivariable linear regression models were used to evaluate associations with fasting glucose, glycated haemoglobin (HbA1c), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, body mass index (BMI), waist circumference, and systolic blood pressure (SBP), with additional interaction analyses for diabetes, hypertension, and dyslipidaemia. Models were adjusted for age, sex, BMI (except when BMI was the outcome), smoking, alcohol consumption, physical activity, olive oil intake, and commercial pastry consumption. Results: Overall, 30.1% of participants reported habitual chocolate consumption. In multivariable models without interaction terms, both dark and milk chocolate consumption were associated with lower BMI, whereas dark chocolate consumption was associated with higher LDL cholesterol. After Bonferroni correction for multiple comparisons, diabetes modified the associations of dark chocolate consumption with fasting glucose and HbA1c and of milk chocolate consumption with HbA1c. Among individuals with diabetes, dark chocolate consumption was associated with lower fasting glucose and HbA1c, whereas milk chocolate consumption was associated with lower HbA1c compared with non-consumption. No such associations were observed among individuals without diabetes. Conclusions: These findings suggest that the association between chocolate consumption and cardiometabolic health is not uniform across the population but differs according to the underlying metabolic profile. In particular, the associations with glycaemic markers were confined to individuals with diabetes, suggesting that metabolic status may modify the relationship between habitual chocolate consumption and glycaemic control. Further prospective population-based studies and intervention trials are needed to confirm these findings.