title: Effects of sugar-sweetened and sugar-free cocoa on endothelial function in overweight adults.
abstract: BACKGROUND
  Studies of cocoa suggest an array of cardiovascular benefits; however, the effects of daily intake of sugar-free and sugar-sweetened cocoa beverages on endothelial function (EF) have yet to be established.
  
  
  METHODS
  44 adults (BMI 25-35 kg/m2) participated in a randomized, controlled, crossover trial. Participants were randomly assigned to a treatment sequence: sugar-free cocoa beverage, sugar-sweetened cocoa beverage, and sugar-sweetened cocoa-free placebo. Treatments were administered daily for 6 weeks, with a 4-week washout period.
  
  
  RESULTS
  Cocoa ingestion improved EF measured as flow-mediated dilation (FMD) compared to placebo (sugar-free cocoa: change, 2.4% [95% CI, 1.5 to 3.2] vs. -0.8% [95% CI, -1.9 to 0.3]; difference, 3.2% [95% CI, 1.8 to 4.6]; p<0.001 and sugar-sweetened cocoa: change, 1.5% [95% CI, 0.6 to 2.4] vs. -0.8% [95% CI, -1.9 to 0.3]; difference, 2.3% [95% CI, 0.9 to 3.7]; p=0.002). The magnitude of improvement in FMD after consumption of sugar-free versus sugar-sweetened cocoa was greater, but not significantly. Other biomarkers of cardiac risk did not change appreciably from baseline. BMI remained stable throughout the study.
  
  
  CONCLUSIONS
  Daily cocoa ingestion improves EF independently of other biomarkers of cardiac risk, and does not cause weight gain. Sugar-free preparations may further augment endothelial function.
authors.affiliation: Prevention Research Center, Yale University School of Medicine, Derby, CT 06418, USA.
authors.forename: Valentine Yanchou
authors.initials: VY
authors.lastname: Njike
authors.forename: Zubaida
authors.initials: Z
authors.lastname: Faridi
authors.forename: Kerem
authors.initials: K
authors.lastname: Shuval
authors.forename: Suparna
authors.initials: S
authors.lastname: Dutta
authors.forename: Colin D
authors.initials: CD
authors.lastname: Kay
authors.forename: Sheila G
authors.initials: SG
authors.lastname: West
authors.forename: Penny M
authors.initials: PM
authors.lastname: Kris-Etherton
authors.forename: David L
authors.initials: DL
authors.lastname: Katz
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D001916:Brachial Artery / Q000187:drug effects / Q000502:physiology; D002099:Cacao; D002318:Cardiovascular Diseases / Q000178:diet therapy / Q000453:epidemiology / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood; D018592:Cross-Over Studies; D019422:Dietary Sucrose / Q000008:administration & dosage*; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000178:diet therapy* / Q000453:epidemiology; D010919:Placebos; D012307:Risk Factors; D014664:Vasodilation / Q000187:drug effects / Q000502:physiology
chemical_list: D015415:Biomarkers; D019422:Dietary Sucrose; D010919:Placebos; D002784:Cholesterol