title: Impact of Cocoa Consumption on Inflammation Processes-A Critical Review of Randomized Controlled Trials.
abstract: BACKGROUND
  Cocoa flavanols have strong anti-inflammatory properties in vitro. If these also occur in vivo, cocoa consumption may contribute to the prevention or treatment of diseases mediated by chronic inflammation. This critical review judged the evidence for such effects occurring after cocoa consumption.
  
  
  METHODS
  A literature search in Medline was performed for randomized controlled trials (RCTs) that investigated the effects of cocoa consumption on inflammatory biomarkers.
  
  
  RESULTS
  Thirty-three RCTs were included, along with 9 bolus and 24 regular consumption studies. Acute cocoa consumption decreased adhesion molecules and 4-series leukotrienes in serum, nuclear factor κB activation in leukocytes, and the expression of CD62P and CD11b on monocytes and neutrophils. In healthy subjects and in patients with cardiovascular diseases, most regular consumption trials did not find any changes except for a decreased number of endothelial microparticles, but several cellular and humoral inflammation markers decreased in patients suffering from type 2 diabetes and impaired fasting glucose.
  
  
  CONCLUSIONS
  Little evidence exists that consumption of cocoa-rich food may reduce inflammation, probably by lowering the activation of monocytes and neutrophils. The efficacy seems to depend on the extent of the basal inflammatory burden. Further well-designed RCTs with inflammation as the primary outcome are needed, focusing on specific markers of leukocyte activation and considering endothelial microparticles as marker of vascular inflammation.
authors.affiliation: Faculty of Food, Nutrition and Hospitality Sciences Hochschule Niederrhein, University of Applied Sciences, Rheydter Str. 277, M&#246;nchengladbach 41065, Germany. Sabine.Ellinger@hs-niederrhein.de.
authors.forename: Sabine
authors.initials: S
authors.lastname: Ellinger
authors.affiliation: Department of Nutrition and Food Sciences, Nutritional Physiology, University of Bonn, Endenicher Allee 11-13, Bonn 53115, Germany. pstehle@uni-bonn.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Stehle
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000032:analysis / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002099:Cacao / Q000737:chemistry; D000069956:Chocolate / Q000032:analysis; D019317:Evidence-Based Medicine; D044948:Flavonols / Q000032:analysis / Q000627:therapeutic use*; D055951:Functional Food; D006801:Humans; D018836:Inflammation Mediators / Q000037:antagonists & inhibitors / Q000097:blood / Q000378:metabolism; D009000:Monocytes / Q000276:immunology / Q000378:metabolism; D009504:Neutrophils / Q000276:immunology / Q000378:metabolism; D016032:Randomized Controlled Trials as Topic; D012639:Seeds / Q000737:chemistry; D014657:Vasculitis / Q000097:blood / Q000276:immunology / Q000378:metabolism / Q000517:prevention & control*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D044948:Flavonols; D018836:Inflammation Mediators
keywords: chocolate; cocoa; critical review; evidence; inflammation; randomized controlled trials