Cocoa Flavanol Intake and Biomarkers for Cardiometabolic Health

MedicalResearch.com Interview with:
Xiaochen Lin, PhD Student and
Simin Liu MD ScD MPH
Professor of Epidemiology and Medicine
Department of Epidemiology and Center for Global Cardiometabolic Health
Brown University
Providence, RI

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There have been quite a few studies implicating cocoa as a beneficial nutritional strategy to improve cardiometabolic health, and we and others have done work indicating that cocoa flavanol may be the active compound responsible for the beneficial effects. Therefore, we conducted this systematic review and meta-analysis of randomized trials that we could identify in studying cocoa flavanol and a variety of circulating cardio-metabolic biomarkers. The meta-analysis of 19 RCTs, involving 1,139 participants, shows that flavanol intake from cocoa products may reduce dyslipidemia, insulin resistance and systemic inflammation, and therefore improve cardiometabolic health. Through this research, we also identify the additional gaps in the current knowledge and potential target for future investigations.

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Cocoa Flavanols Improves Markers of Cardiovascular Health

PD Dr. med. Christian Heiß Sektion Angiologie Oberarzt, Facharzt für Innere Medizin und Angiologie Klinik für Kardiologie, Pneumologie und Angiologie Universitätsklinikum Düsseldorf MedicalResearch.com Interview with:
PD Dr. med. Christian Heiß
Sektion Angiologie
Oberarzt, Facharzt für Innere Medizin und Angiologie
Klinik für Kardiologie, Pneumologie und Angiologie
Universitätsklinikum Düsseldorf

Medical Research: What is the background for this study? What are the main findings?

Response:  There is an extensive body of research which has shown that cocoa flavanols can improve healthy blood vessel function. However, for the most part, these investigations have focused on high-risk individuals like smokers and people that have already been diagnosed with conditions like hypertension and coronary heart disease. The purpose of the FLAVIOLA HEALTH study, published in BJN, was to find out whether the beneficial cardiovascular effects of cocoa flavanols would hold true for the general population.

The studies demonstrated that consumption of cocoa flavanols significantly improves several of the hallmarks of cardiovascular health, including increased flow-mediated vasodilation. Flow-mediated vasodilation is a sign of improved endothelial function and has been shown by some studies to be associated with decreased risk of developing cardiovascular disease. In addition, consuming flavanols decreased both systolic and diastolic blood pressure, and improved the blood cholesterol profile by decreasing total cholesterol, decreasing LDL cholesterol, and increasing HDL cholesterol.

The results demonstrate that flavanols are effective at mitigating age-related changes in blood vessels, and could thereby reduce the risk of cardiovascular disease in healthy individuals.

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Chocolate Linked To Lowered Heart Disease and Stroke Risk

Professor Phyo Kyaw Myint MBBS MD FRCP(Edin) FRCP(Lond) Clinical Chair in Medicine of Old Age Epidemiology Group, Division of Applied Health Sciences University of Aberdeen ScotlandMedicalResearch.com Interview with:
Professor Phyo Kyaw Myint MBBS MD FRCP(Edin) FRCP(Lond)

Clinical Chair in Medicine of Old Age
Epidemiology Group, Division of Applied Health Sciences
University of Aberdeen
Scotland

Medical Research: What is the background for this study? What are the main findings?

Response: The research was carried out by academics from the Universities of Aberdeen, Manchester, Cambridge and East Anglia, as well as the Lancashire Teaching Hospital, the Medical Research Council Epidemiology Unit, Cambridge and the Academic Medical Centre, Amsterdam. It has been published online in the journal Heart. The team base their findings on almost 21,000 adults taking part in the EPIC-Norfolk study, which is tracking the impact of diet on the long term health of 25,000 men and women in Norfolk, England, using food frequency and lifestyle questionnaires. The researchers also carried out a systematic review of the available international published evidence on the links between chocolate and cardiovascular disease, involving almost 158,000 people—including the EPIC study participants.

The EPIC-Norfolk participants (9214 men and 11 737 women) were monitored for an average of almost 12 years, during which time 3013 (14%) people experienced either an episode of fatal or non-fatal coronary heart disease or stroke. Around one in five (20%) participants said they did not eat any chocolate, but among the others, daily consumption averaged 7 g, with some eating up to 100 g.

Higher levels of consumption were associated with younger age and lower weight (BMI), waist: hip ratio, systolic blood pressure, inflammatory proteins, diabetes and more regular physical activity —all of which add up to a favourable cardiovascular disease risk profile. Eating more chocolate was also associated with higher energy intake and a diet containing more fat and carbs and less protein and alcohol.

The calculations showed that compared with those who ate no chocolate higher intake was linked to an 11% lower risk of cardiovascular disease and a 25% lower risk of associated death. It was also associated with a 9% lower risk of hospital admission or death as a result of coronary heart disease, after taking account of dietary factors. And among the 16,000 people whose inflammatory protein (CRP) level had been measured, those eating the most chocolate seemed to have an 18% lower risk than those who ate the least. The highest chocolate intake was similarly associated with a 23% lower risk of stroke, even after taking account of other potential risk factors.

Of nine relevant studies included in the systematic review, five studies each assessed coronary heart disease and stroke outcome, and they found a significantly lower risk of both conditions associated with regular chocolate consumption. And it was linked to a 25% lower risk of any episode of cardiovascular disease and a 45% lower risk of associated death.

The study concluded that cumulative evidence suggests higher chocolate intake is associated with a lower risk of future cardiovascular events.

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Dark Chocolate May Improve Exercise Capacity and Metabolic Parameters

Pam R. Taub, MD, FACC Assistant  Professor of Medicine UC San Diego Health System Division of Cardiology Encinitas, CA 92024MedicalResearch.com Interview with:
Pam R. Taub, MD, FACC
Assistant  Professor of Medicine
UC San Diego Health System
Division of Cardiology Encinitas, CA 92024

Medical Research: What is the background for this study?

Dr. Taub: Epidemiological studies indicate that the consumption of modest amounts of dark chocolate (DC), which contains the natural cacao flavanol (-)-epicatechin (Epi,) is associated with reductions in the incidence of cardiovascular diseases (CVD). The health benefits of dark chocolate have been attributed to Epi. Clinical studies using cocoa and/or DC in normal volunteers or subjects with CVD have reported improvements in peripheral and coronary vascular endothelial function, blood pressure, lipids, insulin resistance, and inflammatory markers. The mechanism underlying these improvements is thought to be due to increased nitric oxide levels and improved endothelial function. We have also shown that capacity of Epi to favorable impact mitochondria under normal and disease states.

We previously conducted pilot study in five patients with heart failure and type II diabetes, and showed that in skeletal muscle (SkM) biopsies there is a severe reduction in mitochondrial volume and cristae, as well as, in structural/functional proteins. After treatment with Epi rich dark chocolate , there was a significant recovery of SkM mitochondrial cristae, structural/functional proteins (e.g. mitofilin), as well as in regulators of mitochondrial biogenesis. However, no studies have examined the capacity of Epi rich dark chocolate to enhance exercise capacity in normal subjects and assess its impact on mitochondrial and oxidative control systems.

Medical Research: What are the main findings?

Dr. Taub: Seventeen subjects were randomized to placebo (n=8) or DC groups (n=9) and consumed 2 squares of chocolate (20 g, provided by Hershey) for 3 months.

We showed in the chocolate group subjects had improved levels of HDL cholesterol and enhanced exercise capacity that is linked to the stimulation of SkM metabolic control endpoints which enhance mitochondrial function.

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PAD: Polyphenols in Dark Chocolate May Improve Peripheral Artery Disease

MedicalResearch.com Interview with:
Lorenzo Loffredo, MD and Francesco Violi, MD
Department of Internal Medicine and Medical Specialties
Sapienza University of Rome, Rome, Italy;

MedicalResearch: What are the main findings of the study?

Answer: Dark chocolate is rich of polyphenols; these natural substances exert antioxidant properties and, through an increase of nitric oxide, dilate arteries. Our research group applied this effect to enhance blood flow in a very common disease, the peripheral arterial disease. This disease is characterized by reduced blood flow to the limbs. There are not any drugs that improve this blood flow, but dark chocolate could.

Our study suggest that dark chocolate, and only dark chocolate, could reduce oxidative stress and improve blood flow and walking autonomy in patients with peripheral arterial disease. We observed no effect on blood flow, oxidative stress and on walking autonomy in PAD patients after milk chocolate assumption. This lack of effect was probably due to the low concentration of polyphenols in milk chocolate.

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High Chocolate Intake and Lower Body Fat

Magdalena Cuenca García, PhD University of Granada Department of Physiology, School of Medicine Avd. Madrid 12; 18012 Granada (Spain)MedicalResearch.com Interview with:
Magdalena Cuenca García, PhD
University of Granada
Department of Physiology, School of Medicine
Avd. Madrid 12; 18012 Granada (Spain)


MedicalResearch.com: What are the main findings of the study?

Answer: In conclusion, the results of the present study showed that a higher chocolate consumption was associated with lower levels of central and total fatness in European adolescents. Of note is that the observed association was independent of total energy intake and saturated fat intake as well as objectively measured physical activity. In addition, results remained unchanged after adjusting for foods with high catechins concentration as fruit, vegetables and tea; as well as other products such as coffee that could influence the observed association between chocolate consumption and markers of total and central body fat.
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