Acute Cocoa Supplementation Increases Postprandial HDL Cholesterol and Insulin in Obese Adults with Type 2 Diabetes after Consumption of a High-Fat Breakfast.
BACKGROUND
Dietary cocoa is an important source of flavonoids and is associated with favorable cardiovascular disease effects, such as improvements in vascular function and lipid profiles, in nondiabetic adults. Type 2 diabetes (T2D) is associated with adverse effects on postprandial serum glucose, lipids, inflammation, and vascular function.


OBJECTIVE
We examined the hypothesis that cocoa reduces metabolic stress in obese T2D adults after a high-fat fast-food-style meal.


METHODS
Adults with T2D [n = 18; age (mean ± SE): 56 ± 3 y; BMI (in kg/m(2)): 35.3 ± 2.0; 14 women; 4 men] were randomly assigned to receive cocoa beverage (960 mg total polyphenols; 480 mg flavanols) or flavanol-free placebo (110 mg total polyphenols; <0.1 mg flavanols) with a high-fat fast-food-style breakfast [766 kcal, 50 g fat (59% energy)] in a crossover trial. After an overnight fast (10-12 h), participants consumed the breakfast with cocoa or placebo, and blood sample collection [glucose, insulin, lipids, and high-sensitivity C-reactive protein (hsCRP)] and vascular measurements were conducted at 0.5, 1, 2, 4, and 6 h postprandially on each study day. Insulin resistance was evaluated by homeostasis model assessment.


RESULTS
Over the 6-h study, and specifically at 1 and 4 h, cocoa increased HDL cholesterol vs. placebo (overall Δ: 1.5 ± 0.8 mg/dL; P ≤ 0.01) but had no effect on total and LDL cholesterol, triglycerides, glucose, and hsCRP. Cocoa increased serum insulin concentrations overall (Δ: 5.2 ± 3.2 mU/L; P < 0.05) and specifically at 4 h but had no overall effects on insulin resistance (except at 4 h, P < 0.05), systolic or diastolic blood pressure, or small artery elasticity. However, large artery elasticity was overall lower after cocoa vs. placebo (Δ: -1.6 ± 0.7 mL/mm Hg; P < 0.05), with the difference significant only at 2 h.


CONCLUSIONS
Acute cocoa supplementation showed no clear overall benefit in T2D patients after a high-fat fast-food-style meal challenge. Although HDL cholesterol and insulin remained higher throughout the 6-h postprandial period, an overall decrease in large artery elasticity was found after cocoa consumption. This trial was registered at clinicaltrials.gov as NCT01886989.
Department of Nutritional Sciences, College of Human Sciences, Oklahoma State University, Stillwater, OK; arpita.basu@okstate.edu.
Arpita
A
Basu
Department of Nutritional Sciences, College of Human Sciences, Oklahoma State University, Stillwater, OK;
Nancy M
NM
Betts
Department of Health Promotion Sciences, College of Public Health.
Misti J
MJ
Leyva
Centre for Experimental Medicine, Queen's University of Belfast, Belfast, Northern Ireland, United Kingdom.
Dongxu
D
Fu
Department of Pediatrics, and.
Christopher E
CE
Aston
Section of Diabetes & Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK; and Centre for Experimental Medicine, Queen's University of Belfast, Belfast, Northern Ireland, United Kingdom.
Timothy J
TJ
Lyons
D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D001628:Beverages / Q000009:adverse effects / Q000032:analysis; D015992:Body Mass Index; D062408:Breakfast; D002099:Cacao / Q000009:adverse effects / Q000737:chemistry; D008076:Cholesterol, HDL / Q000819:agonists / Q000032:analysis; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000378:metabolism; D003925:Diabetic Angiopathies / Q000150:complications / Q000517:prevention & control; D059305:Diet, High-Fat / Q000009:adverse effects; D004311:Double-Blind Method; D005419:Flavonoids / Q000009:adverse effects / Q000032:analysis / Q000627:therapeutic use; D007328:Insulin / Q000819:agonists / Q000097:blood; D007333:Insulin Resistance; D009765:Obesity / Q000150:complications; D019518:Postprandial Period; D059289:Vascular Stiffness
D008076:Cholesterol, HDL; D005419:Flavonoids; D007328:Insulin
HDL cholesterol; dietary cocoa; insulin; postprandial metabolism; type 2 diabetes