Palliative care is about comfort, and what is more comforting than a piece of creamy chocolate? We know that chocolate actually is a beneficial food. It certainly can put a smile on someone’s face, and it contains polyphenols and other antioxidants. Therefore, a group from the Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo in Brazil, conducted a study to evaluate the effects of chocolate consumption on the nutritional status of older patients with cancer receiving palliative care.
As malignancies increase each year globally, the ages of patients undergoing cancer treatment also are increasing. Palliative care is need to help these patients and their relatives manage the physical, psychosocial, and spiritual effects of cancer. The goal is to reduce suffering and enhance quality of life. Maintaining proper nutritional status in patients with cancer is especially crucial, and oncology clinicians should always include nutritional assistance as part of palliative care, especially for older patients. This is not only to prevent malnutrition; it also is meant to provide the physical and psychological comfort that a favorite food may convey.
The percentage of cocoa content in chocolate correlates positively with its antioxidant and anti-inflammatory effects. As cancer progresses, patients experience more oxidative stress and systemic inflammation. Consuming chocolate can address that. Chocolate provides some of the patient’s nutritional requirements and also is a source of energy.
Dark Chocolate vs White Chocolate
To date, no studies have focused on chocolate consumption in older cancer populations; therefore, the researchers sought to better understand the palliative effects of consuming chocolate for older patients with cancer. The nonblind, randomized clinical trial explored body composition, oxidative stress, inflammatory activity, food consumption, and quality of life. The study site was the Services of Oncology and Palliative Care of the Ribeirão Preto, University of São Paulo.
Inclusion criteria were age 60 years and older, presence of cancer for which the patient was receiving ambulatory palliative care, normal thyroid function, no chemotherapy or radiotherapy for the past 15 days, and able to eat by mouth. Exclusions were a diagnosis of dementia, use of tobacco or alcohol during the prior 3 months, and gastrointestinal cancer with obstructions affecting nutritional status. Patients who refused to consume chocolate for any reason were excluded from the study.
Forty-six patients met the eligibility criteria for the study. The participants were randomly assigned as follows: 15 patients were assigned to the control group (CG), 16 patients were assigned the first intervention group (IG1), and 15 patients were assigned to the second intervention group (IG2). One participant in the IG1 group died as a result of worsening cancer during the study.
Participants in the IG1 group were instructed to consume 25 grams of chocolate containing 55% cocoa every day for 4 weeks; those in the IG2 group were instructed to consume 25 grams of white chocolate each day. Participants in the CG group could not consume extra chocolate, but they were instructed to eat other snacks or sweet foods as they chose.
Calorie consumption was lower in the CG group than in the IG1 group. Polyphenol consumption increased in the IG1 group, and was higher than in both CG and IG2 groups.
An interesting finding was that levels of the proinflammatory cytokine IL-6 were increased in the IG1 group, which correlated with a reduced antioxidant defense compared with the other groups. For these patients, who had already demonstrated greater nutritional impairment at the beginning of the study, this finding indicated a deteriorated clinical state. Systemic inflammation in patients with cancer parallels worse clinical outcomes and reduced survival.
However, the researchers found that patients in the IG2 group had lower IL-6 levels than those in the IG1 group.
“We believe that the beneficial action of white chocolate consumption on systemic inflammation and the defense against oxidative stress may be the effect of some not yet studied component,” the researchers concluded.
Nutritional status and functional quality of life were most improved in the IG1 group, which the researchers considered to be clinically significant.
Vettori JC, da-Silva LG, Pfrimer K, et al. Effect of chocolate on older patients with cancer in palliative care: a randomised controlled study. BMC Palliat Care. 2022;21(1):5. doi:10.1186/s12904-021-00893-1