title: 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.
authors.affiliation: Harvard School of Public Health, Boston, MA, USA. shrime@gmail.com
authors.forename: Mark G
authors.initials: MG
authors.lastname: Shrime
authors.forename: Scott R
authors.initials: SR
authors.lastname: Bauer
authors.forename: Anna C
authors.initials: AC
authors.lastname: McDonald
authors.forename: Nubaha H
authors.initials: NH
authors.lastname: Chowdhury
authors.forename: Cordelia E M
authors.initials: CE
authors.lastname: Coltart
authors.forename: Eric L
authors.initials: EL
authors.lastname: Ding
mesh_terms: D002099:Cacao; D002319:Cardiovascular System / Q000503:physiopathology*; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D005419:Flavonoids / Q000008:administration & dosage*; D006801:Humans; D012307:Risk Factors
chemical_list: D005419:Flavonoids