Cocoa Flavanol Intake and Biomarkers for Cardiometabolic Health 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 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. What should readers take away from your report?

Response: Taken into account the heterogeneities across studies, our meta-analysis found small-to-modest but statistically significant improvements among those who ate flavanol-rich cocoa product vs. those who did not. However, whether daily consumption of flavanol-rich products or cocoa flavanol supplements would make a significant difference cannot be determined without further investigations, especially large long-term RCTs. The treatment groups of the trials included in our meta-analysis are primarily dark chocolate — a few were using cocoa powder-based beverages. Therefore, the findings from the current study shouldn’t be generalized to different sorts of chocolate candies or white chocolates, of which the content of calories/sugar/food additives could be substantially different from that of the dark chocolate. What recommendations do you have for future research as a result of this study?

Response:Our study highlighted the limitations of the existing trials included in the meta-analysis:

1) all studies were small and of short duration;

2) most of trials compared flavanol-rich cocoa products vs. cocoa products with negligible flavanol content, instead of directly using cocoa flavanol supplements as the treatment. Recently, the COSMOS trial, as the first large-scale randomized trial of cocoa flavanols, has been initiated to investigate the heart health benefits of cocoa flavanols.

Further evidence from large, long-term RCTs like the COSMOS trial is in urgent need to improve our understanding of

1) whether cocoa flavanol is the exact compound underlying the beneficial effects of cocoa, and

2) how the short-term benefits of cocoa flavonol intake on cardiometabolic biomarkers may be translated into clinical outcomes. Thank you for your contribution to the community.

Xiaochen Lin, Isabel Zhang, Alina Li, JoAnn E Manson, Howard D Sesso, Lu Wang,and Simin Liu
Cocoa Flavanol Intake and Biomarkers for Cardiometabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled TrialsJ. Nutr. jn237644; first published online September 28, 2016.doi:10.3945/jn.116.237644
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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