title: Blood pressure is reduced and insulin sensitivity increased in glucose-intolerant, hypertensive subjects after 15 days of consuming high-polyphenol dark chocolate.
abstract: Flavanols from chocolate appear to increase nitric oxide bioavailability, protect vascular endothelium, and decrease cardiovascular disease (CVD) risk factors. We sought to test the effect of flavanol-rich dark chocolate (FRDC) on endothelial function, insulin sensitivity, beta-cell function, and blood pressure (BP) in hypertensive patients with impaired glucose tolerance (IGT). After a run-in phase, 19 hypertensives with IGT (11 males, 8 females; 44.8 +/- 8.0 y) were randomized to receive isocalorically either FRDC or flavanol-free white chocolate (FFWC) at 100 g/d for 15 d. After a wash-out period, patients were switched to the other treatment. Clinical and 24-h ambulatory BP was determined by sphygmometry and oscillometry, respectively, flow-mediated dilation (FMD), oral glucose tolerance test, serum cholesterol and C-reactive protein, and plasma homocysteine were evaluated after each treatment phase. FRDC but not FFWC ingestion decreased insulin resistance (homeostasis model assessment of insulin resistance; P < 0.0001) and increased insulin sensitivity (quantitative insulin sensitivity check index, insulin sensitivity index (ISI), ISI(0); P < 0.05) and beta-cell function (corrected insulin response CIR(120); P = 0.035). Systolic (S) and diastolic (D) BP decreased (P < 0.0001) after FRDC (SBP, -3.82 +/- 2.40 mm Hg; DBP, -3.92 +/- 1.98 mm Hg; 24-h SBP, -4.52 +/- 3.94 mm Hg; 24-h DBP, -4.17 +/- 3.29 mm Hg) but not after FFWC. Further, FRDC increased FMD (P < 0.0001) and decreased total cholesterol (-6.5%; P < 0.0001), and LDL cholesterol (-7.5%; P < 0.0001). Changes in insulin sensitivity (Delta ISI - Delta FMD: r = 0.510, P = 0.001; Delta QUICKI - Delta FMD: r = 0.502, P = 0.001) and beta-cell function (Delta CIR(120) - Delta FMD: r = 0.400, P = 0.012) were directly correlated with increases in FMD and inversely correlated with decreases in BP (Delta ISI - Delta 24-h SBP: r = -0.368, P = 0.022; Delta ISI - Delta 24-h DBP r = -0.384, P = 0.017). Thus, FRDC ameliorated insulin sensitivity and beta-cell function, decreased BP, and increased FMD in IGT hypertensive patients. These findings suggest flavanol-rich, low-energy cocoa food products may have a positive impact on CVD risk factors.
authors: Department of Internal Medicine and Public Health, University of L'Aquila, 67100 L'Aquila, Italy. davide.grassi@cc.univaq.it
authors: Davide
authors: D
authors: Grassi
authors: Giovambattista
authors: G
authors: Desideri
authors: Stefano
authors: S
authors: Necozione
authors: Cristina
authors: C
authors: Lippi
authors: Raffaele
authors: R
authors: Casale
authors: Giuliana
authors: G
authors: Properzi
authors: Jeffrey B
authors: JB
authors: Blumberg
authors: Claudio
authors: C
authors: Ferri
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000187:drug effects*; D002099:Cacao / Q000737:chemistry*; D018592:Cross-Over Studies; D005260:Female; D005419:Flavonoids / Q000032:analysis* / Q000494:pharmacology*; D005951:Glucose Tolerance Test; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010636:Phenols / Q000032:analysis* / Q000494:pharmacology*; D059808:Polyphenols
chemical_list: D005419:Flavonoids; D010636:Phenols; D059808:Polyphenols