Effect of Cocoa Beverage and Dark Chocolate Intake on Lipid Profile in People Living with Normal and Elevated LDL Cholesterol: A Systematic Review and Meta-Analysis

Cocoa beverage and dark chocolate are important dietary sources of polyphenol and have been hypothesised to improve the lipid profile. This systematic review and meta-analysis aimed to investigate the effect of cocoa beverage and dark chocolate intake on lipid profile in individuals living with normal and elevated LDL cholesterol. The question on whether cocoa beverage and chocolate differentially modify the lipid profile was also explored. A systematic literature search was conducted on PubMed and Cochrane Library on 26 February 2022 following the PRISMA guideline. Cocoa beverage and chocolate consumption had no significant effect on circulating concentrations of total cholesterol, LDL cholesterol, and triglycerides (p > 0.05, all), but favourably and significantly increased circulating concentration of HDL cholesterol by 0.05 (95% CI [0.02, 0.09]) mmol/L (p = 0.002). Changes in lipid profile were similar when comparing populations with normal vs. elevated LDL cholesterol (p > 0.05, all). When considering the food matrix, cocoa beverage intake significantly increased HDL cholesterol by 0.11 (95% CI [0.06, 0.17]) mmol/L (p < 0.001), but the improvement in HDL cholesterol was not significant when chocolate (p = 0.10) or a combination of cocoa beverage and chocolate (p = 0.19) (subgroup differences, p = 0.03) was administered. Cocoa consumption could be recommended as part of a healthy diet in the general population with normal and elevated LDL cholesterol.