title: Mechanisms by which cocoa flavanols improve metabolic syndrome and related disorders.
abstract: Dietary administration of cocoa flavanols may be an effective complementary strategy for alleviation or prevention of metabolic syndrome, particularly glucose intolerance. The complex flavanol composition of cocoa provides the ability to interact with a variety of molecules, thus allowing numerous opportunities to ameliorate metabolic diseases. These interactions likely occur primarily in the gastrointestinal tract, where native cocoa flavanol concentration is high. Flavanols may antagonize digestive enzymes and glucose transporters, causing a reduction in glucose excursion, which helps patients with metabolic disorders maintain glucose homeostasis. Unabsorbed flavanols, and ones that undergo enterohepatic recycling, will proceed to the colon where they can exert prebiotic effects on the gut microbiota. Interactions with the gut microbiota may improve gut barrier function, resulting in attenuated endotoxin absorption. Cocoa may also positively influence insulin signaling, possibly by relieving insulin-signaling pathways from oxidative stress and inflammation and/or via a heightened incretin response. The purpose of this review is to explore the mechanisms that underlie these outcomes, critically review the current body of literature related to those mechanisms, explore the implications of these mechanisms for therapeutic utility, and identify emerging or needed areas of research that could advance our understanding of the mechanisms of action and therapeutic potential of cocoa flavanols.
authors: Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA.
authors: Karen M
authors: KM
authors: Strat
authors: Department of Nutrition, Dietetics and Food Science, Brigham Young University, Provo, UT.
authors: Thomas J
authors: TJ
authors: Rowley
authors: Department of Food Science and Technology, Virginia Tech, Blacksburg, VA.
authors: Andrew T
authors: AT
authors: Smithson
authors: Department of Nutrition, Dietetics and Food Science, Brigham Young University, Provo, UT.
authors: Jeffery S
authors: JS
authors: Tessem
authors: Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA; Metabolic Phenotyping Core Facility, Virginia Tech, Blacksburg, VA.
authors: Matthew W
authors: MW
authors: Hulver
authors: Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA.
authors: Dongmin
authors: D
authors: Liu
authors: Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA.
authors: Brenda M
authors: BM
authors: Davy
authors: Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA.
authors: Kevin P
authors: KP
authors: Davy
authors: Department of Food Science and Technology, Virginia Tech, Blacksburg, VA. Electronic address: andrewn@vt.edu.
authors: Andrew P
authors: AP
authors: Neilson
mesh_terms: D000818:Animals; D000975:Antioxidants / Q000032:analysis / Q000378:metabolism / Q000627:therapeutic use*; D002099:Cacao / Q000737:chemistry*; D000069956:Chocolate / Q000032:analysis; D003106:Colon / Q000378:metabolism / Q000382:microbiology / Q000502:physiology / Q000503:physiopathology; D019587:Dietary Supplements; D064806:Dysbiosis / Q000178:diet therapy / Q000382:microbiology / Q000503:physiopathology / Q000517:prevention & control; D019317:Evidence-Based Medicine; D044948:Flavonols / Q000032:analysis / Q000378:metabolism / Q000627:therapeutic use*; D055951:Functional Food / Q000032:analysis; D000069196:Gastrointestinal Microbiome; D018149:Glucose Intolerance / Q000178:diet therapy* / Q000382:microbiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism / Q000382:microbiology / Q000502:physiology / Q000503:physiopathology; D024821:Metabolic Syndrome / Q000178:diet therapy* / Q000382:microbiology / Q000503:physiopathology / Q000517:prevention & control; D012639:Seeds / Q000737:chemistry*; D012720:Severity of Illness Index
chemical_list: D000975:Antioxidants; D044948:Flavonols
keywords: Diabetes; Endotoxin; Epicatechin; GLP-1; Procyanidins; β-Cells