Flavonoid-Rich Cocoa Consumption Affects Multiple Cardiovascular Risk Factors in a Meta-Analysis of Short-Term Studies

Abstract

A growing body of evidence suggests that the consumption of foods rich in polyphenolic compounds, particularly cocoa, may have cardioprotective effects. No review, however, has yet examined the effect of flavonoid-rich cocoa (FRC) on all major cardiovascular risk factors or has examined potential dose-response relationships for these effects. A systematic review and meta-analysis of randomized, controlled trials was performed to evaluate the effect of FRC on cardiovascular risk factors and to assess a dose-response relationship. Inclusion and exclusion criteria as well as dependent and independent variables were determined a priori. Data were collected for: blood pressure, pulse, total cholesterol, HDL cholesterol, LDL cholesterol, TG, BMI, C-reactive protein, flow-mediated vascular dilation (FMD), fasting glucose, fasting insulin, serum isoprostane, and insulin sensitivity/resistance indices. Twenty-four papers, with 1106 participants, met the criteria for final analysis. In response to FRC consumption, systolic blood pressure decreased by 1.63 mm Hg (P = 0.033), LDL cholesterol decreased by 0.077 mmol/L (P = 0.038), and HDL cholesterol increased by 0.046 mmol/L (P = 0.037), whereas total cholesterol, TG, and C-reactive protein remained the same. Moreover, insulin resistance decreased (HOMA-IR: -0.94 points; P < 0.001), whereas FMD increased (1.53%; P < 0.001). A nonlinear dose-response relationship was found between FRC and FMD (P = 0.004), with maximum effect observed at a flavonoid dose of 500 mg/d; a similar relationship may exist with HDL cholesterol levels (P = 0.06). FRC consumption significantly improves blood pressure, insulin resistance, lipid profiles, and FMD. These short-term benefits warrant larger long-term investigations into the cardioprotective role of FRC.

Oxidised LDL levels decreases after the consumption of ready-to-eat meals supplemented with cocoa extract within a hypocaloric diet

“…The improvements were observed in both groups, indicating that cocoa supplementation did not have additional effect on those variables and attributing the observed changes to the hypocaloric diet followed by the volunteers. Our results are in agreement with two previous studies and one meta-analysis, in which no changes were observed in body size and composition of overweight/obese subjects after the cocoa supplementation (9,16,17). Golomb et al observed a negative correlation between the frequency of dark chocolate consumption and BMI (18).…”

“…No significant changes of TG, total cholesterol and glucose were observed in the metaanalysis by Shrime et al (17). However, Hooper et al (13) suggest a possible beneficial effect on TG and HOMA after the daily consumption of 50-100mg of epicatechins (13), although no effects were evident at higher or lower doses.…”

“…Some studies have reported that cocoa flavanols may increase HDL-c and decrease LDL-c levels (10,11), although these outcomes are controversial and there is not a consensus on these effects (17). A meta-analysis carried out by Shrime et al (17), suggests that HDL-c levels increase in longer term trials with low fat consumption, whereas LDL-c and total cholesterol decrease in short-term studies in patients younger than 50 years-old (17). This finding is in agreement with our results.…”

Effect of Sauropus Androgynus Leaves Extract (Sale) on Fat Deposition in Broiler Fed Low Protein Diets

“…This means SALE supplementation alone was not enough to lower cholesterol content to below control. Compounds that play a role in lowering cholesterol might be alkaloids and non-alkaloids (Santoso et al, 2010), saponins (Son et al, 2007), polyphenol (Ngamukote et al, 2011;Zang et al, 2006), flavonoid (Shrime et al, 2011). Patil et al (2010) reported that the reduction of cholesterol and triglycerides by alkaloids were in part caused by the reduction of lipogenic enzymes activities and increased bile acid excretion in feces.…”

A new food frequency questionnaire to assess chocolate and cocoa consumption

“…Clinical studies have associated cocoa consumption with a decrease of several cardiovascular risk factors, because it improves vascular functions [4], shows anti-hypertensive effects [5], decreases insulin resistance [6], and reduced body weight/body fat [7]. Overall, a positive scientific opinion has existed on the substantiation of a health claim related to cocoa flavanols and vasodilatation [8].…”