Acute dark chocolate and cocoa ingestion and endothelial function: a randomized controlled crossover trial

Faridi, Zubaida; Njike, Valentine Yanchou; Dutta, Suparna; Ali, Ather; Katz, David L.

doi:10.1093/ajcn/88.1.58

Cited by 194 publications

(163 citation statements)

References 28 publications

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“…Specifically acute cocoa/chocolate ingestion increases brachial artery FMD in young healthy adults (44), adults with risk factors for cardiovascular disease (13,19), smokers (22,23), and diabetics (1). However, acute intake does not increase endothelium-dependent vasodilation in all populations (14).…”

Section: Discussionmentioning

confidence: 99%

Dose-dependent increases in flow-mediated dilation following acute cocoa ingestion in healthy older adults

Monahan

Feehan

Kunselman

et al. 2011

Journal of Applied Physiology

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Monahan KD, Feehan RP, Kunselman AR, Preston AG, Miller DL, Lott ME. Dose-dependent increases in flow-mediated dilation following acute cocoa ingestion in healthy older adults. J Appl Physiol 111: 1568 -1574. First published September 8, 2011 doi:10.1152/japplphysiol.00865.2011.-An inverse relation exists between intake of flavonoid-rich foods, such as cocoa, and cardiovascular-related mortality. Favorable effects of flavonoids on the endothelium may underlie these associations. We performed a randomized, double-blind, placebo-controlled study to test the hypothesis that acute cocoa ingestion dose dependently increases endothelium-dependent vasodilation, as measured by an increase in brachial artery flow-mediated dilation (FMD), in healthy older adults. Measurements were obtained before (preingestion) and after (1-and 2-h postingestion) ingestion of 0 (placebo), 2, 5, 13, and 26 g of cocoa in 23 adults (63 Ϯ 2 yr old, mean Ϯ SE). Changes in brachial artery FMD 1-and 2-h postingestion compared with preingestion were used to determine the effects of cocoa. FMD was unchanged 1 (⌬Ϫ0.3 Ϯ 0.2%)-and 2-h (⌬0.1 Ϯ 0.1%) after placebo (0 g cocoa). In contrast, FMD increased both 1-h postingestion (2 g cocoa ⌬0.0 Ϯ 0.2%, 5 g cocoa ⌬0.8 Ϯ 0.3%, 13 g cocoa ⌬1.0 Ϯ 0.3%, and 26 g cocoa ⌬1.6 Ϯ 0.3%: P Ͻ 0.05 compared with placebo for 5, 13, and 26 g cocoa) and 2-h postingestion (2 g cocoa ⌬0.5 Ϯ 0.3%, 5 g cocoa ⌬1.0 Ϯ 0.3%, 13 g cocoa ⌬1.4 Ϯ 0.2%, and 26 g cocoa ⌬2.5 Ϯ 0.4%: P Ͻ 0.05 compared with placebo for 5, 13, and 26 g cocoa) on the other study days. A serum marker of cocoa ingestion (total epicatechin) correlated with increased FMD 1-and 2-h postingestion (r ϭ 0.44 -0.48; both P Ͻ 0.05). Collectively, these results indicate that acute cocoa ingestion dose dependently increases brachial artery FMD in healthy older humans. These responses may help to explain associations between flavonoid intake and cardiovascular-related mortality in humans.flavonoid; flavanol; chocolate; endothelium; endothelial function THE ENDOTHELIUM CONTRIBUTES critically to cardiovascular homeostasis by influencing factors such as vascular tone, vascular permeability, platelet aggregation, and thrombosis. As abnormal function of the endothelium is a key event in the atherosclerotic process (15), it is not surprising that endothelial dysfunction is a hallmark feature of many cardiovascular disease states (33). Moreover, it is not surprising that aging, which is a primary risk factor for the development of cardiovascular disease and atherosclerosis (29,36), is associated with marked endothelial dysfunction. Specifically, in response to stimulation of the vascular endothelium via pharmacological substances, such as acetylcholine, or physiological stimuli, such as increases in vascular shear stress, a reduced endothelium-dependent vasodilatory response occurs in healthy older adults compared with healthy young adults (7,11,12,41). As low levels of brachial artery flow-mediated dilation (FMD), a commonly used method to assess endothelium-dependent vasodi...

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Section: Discussionmentioning

confidence: 99%

Dose-dependent increases in flow-mediated dilation following acute cocoa ingestion in healthy older adults

Monahan

Feehan

Kunselman

et al. 2011

Journal of Applied Physiology

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“…The cocoa, equivalent to a 40 g portion of chocolate with only 55% cocoa, had a markedly favorable effect on FMD (Figure 3). 45 Sugar (45 g, an amount present in many 12 ounce sodas) abolished about two-thirds of that benefit. Dark chocolate with low sugar content (for example, 5-6 g per 40 g portion) is available with good flavor and would provide the maximum benefit on NO and vascular health.…”

Section: Excessive Alcoholmentioning

confidence: 99%

“…flowmediated dilation (FMD) compared with placebo, and sugar markedly suppressed its beneficial effect (both Po0.001). 45 Adapted with permission. 16 Lifestyle, metabolism and erectile function DR Meldrum et al each advancing decade is much lower in the absence of coronary artery disease.…”

Section: Agingmentioning

confidence: 99%

Lifestyle and metabolic approaches to maximizing erectile and vascular health

et al. 2011

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Oxidative stress and inflammation, which disrupt nitric oxide (NO) production directly or by causing resistance to insulin, are central determinants of vascular diseases including ED. Decreased vascular NO has been linked to abdominal obesity, smoking and high intakes of fat and sugar, which all cause oxidative stress. Men with ED have decreased vascular NO and circulating and cellular antioxidants. Oxidative stress and inflammatory markers are increased in men with ED, and all increase with age. Exercise increases vascular NO, and more frequent erections are correlated with decreased ED, both in part due to stimulation of endothelial NO production by shear stress. Exercise and weight loss increase insulin sensitivity and endothelial NO production. Potent antioxidants or high doses of weaker antioxidants increase vascular NO and improve vascular and erectile function. Antioxidants may be particularly important in men with ED who smoke, are obese or have diabetes. Omega-3 fatty acids reduce inflammatory markers, decrease cardiac death and increase endothelial NO production, and are therefore critical for men with ED who are under age 60 years, and/or have diabetes, hypertension or coronary artery disease, who are at increased risk of serious or even fatal cardiac events. Phosphodiesterase inhibitors have recently been shown to improve antioxidant status and NO production and allow more frequent and sustained penile exercise. Some angiotensin II receptor blockers decrease oxidative stress and improve vascular and erectile function and are therefore preferred choices for lowering blood pressure in men with ED. Lifestyle modifications, including physical and penile-specific exercise, weight loss, omega-3 and folic acid supplements, reduced intakes of fat and sugar, and improved antioxidant status through diet and/or supplements should be integrated into any comprehensive approach to maximizing erectile function, resulting in greater overall success and patient satisfaction, as well as improved vascular health and longevity.

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“…Randomization and subject assignment was arranged by the University of Glasgow School of Mathematics and Statistics; the study team was blinded to the allocation sequence. Previous studies using nutritional interventions to modify vascular markers were consulted for power estimations and a target of 40 completed subjects determined (12)(13)(14)(15)(16). There were no changes to the study protocol entry criteria or outcome measures following commencement.…”

Section: Methodsmentioning

confidence: 99%

Effects of a beverage rich in (poly)phenols on established and novel risk markers for vascular disease in medically uncomplicated overweight or obese subjects: A four week randomized placebo-controlled trial

et al. 2016

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Objective: To determine if (poly)phenols alter cardiovascular risk factors, we assessed the potential of a high (poly)phenol beverage drink, rich in hydroxycinnamates and flavonoids, to modify vascular function in middle aged, overweight or obese subjects without medical comorbidity in a randomized placebo controlled pilot study. Methods: Randomly assigned active 250ml beverages containing 361mg of (poly)phenols and 120mg of vitamin C or placebo (no polyphenol / vitamin C) were taken twice daily for 4 weeks. Both beverages contained 40 kcals/250 ml. The primary end-points were pulse wave velocity (PWV) and cutaneous microvascular responses to sodium nitroprusside (SNP) and acetyl choline (ACh) laser doppler iontophoresis. A range of established and novel plasma markers were also measured. Results:Twenty subjects received active beverage and 19 placebo; all completed the study. There was no difference in cutaneous vascular response to either SNP or ACh with mean group differences (log∆ area under perfusion curve) of 0.30 (-0.65, 1.26) and 0.35 (-0.11, 0.81) respectively. Nor was there evidence of a change in log PWV with a mean group difference of 0.029m/s (-0.042, 0.10). No significant differences were seen in plasma leptin, apolipoproteins, cystatin C, insulin, adiponectin, CRP, ICAM-1, E-Selectin or t-PA, but IL-6 increased in active versus placebo recipients (0.32 vs -0.18 pg/ml; p=0.010). Conculsion: There was no evidence for a short-term beneficial effect of (poly)phenol intervention on microcutaneous vascular response or pulse wave velocity, and no evidence for a benefit on established or novel risk factors in overweight or obese subjects. Our results do not support a short-term benefit of (poly)phenol supplementation on cardiometabolic risk. PWV pulse wave velocity; SNP sodium nitroprusside; ACh acetyl choline, HPLC-MS 2 high performance liquid chromatography-tandem mass spectrometry

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Acute dark chocolate and cocoa ingestion and endothelial function: a randomized controlled crossover trial

Abstract: The acute ingestion of both solid dark chocolate and liquid cocoa improved endothelial function and lowered blood pressure in overweight adults. Sugar content may attenuate these effects, and sugar-free preparations may augment them.

Cited by 194 publications

References 28 publications

Dose-dependent increases in flow-mediated dilation following acute cocoa ingestion in healthy older adults

Dose-dependent increases in flow-mediated dilation following acute cocoa ingestion in healthy older adults

Lifestyle and metabolic approaches to maximizing erectile and vascular health

Effects of a beverage rich in (poly)phenols on established and novel risk markers for vascular disease in medically uncomplicated overweight or obese subjects: A four week randomized placebo-controlled trial

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