Cocoa

 

• In a human RCT, consuming 500 mg/d cocoa flavanols, including 80 mg epicatechins, resulted in -11% all-cause mortality (95% CI, 0.77, 1.03), -27% CVD death  (95% CI, 0.54, 0.98) after 3.6 yrs follow up. 

• Insulin resistance (HOMA-IR: −0.67; 95% CI: −0.98, −0.36) was improved by chocolate or cocoa due to significant reductions in serum insulin. Flow-mediated dilatation (FMD) improved after chronic (1.34%; 95% CI: 1.00%, 1.68%) and acute (3.19%; 95% CI: 2.04%, 4.33%) intakes. Reductions in diastolic blood pressure (BP; −1.60 mm Hg; 95% CI: −2.77, −0.43 mm Hg).

• Around 5-8% lifespan extension in mice.

• Chocolate consumption conferred reduced risks of mortality from all causes, cardiovascular disease, and Alzheimer’s disease in a US population.

Effect of cocoa flavanol supplementation for prevention of cardiovascular disease events: The COSMOS randomized clinical trial, 2022

Objectives

We examined whether cocoa extract supplementation decreases total cardiovascular disease (CVD) among older adults.

Methods

We conducted a randomized, double-blind, placebo-controlled, two-by-two factorial trial of cocoa extract supplementation and multivitamins for prevention of CVD and cancer among 21,442 U.S. adults (12,666 women aged ≥ 65 years and 8,776 men aged ≥ 60 years) free of major CVD and recently diagnosed cancer. Intervention phase was June 2015 through December 2020. This article reports on the cocoa extract intervention. Participants were randomly assigned to a cocoa extract supplement (500 mg/d flavanols, including 80 mg (–)-epicatechins) or placebo. The primary outcome was a composite of confirmed incident total cardiovascular events, including myocardial infarction (MI), stroke, coronary revascularization, cardiovascular death, carotid artery disease, peripheral artery surgery, and unstable angina.

Results

During a median follow-up of 3.6 years, 410 participants taking cocoa extract and 456 taking placebo had confirmed total cardiovascular events (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.78, 1.02; P = 0.11). For secondary endpoints, HRs were 0.73 (95% CI, 0.54, 0.98) for CVD death, 0.87 (95% CI, 0.66, 1.16) for MI, 0.91 (95% CI, 0.70, 1.17) for stroke, 0.95 (95% CI, 0.77, 1.17) for coronary revascularization, neutral for other individual cardiovascular endpoints, and 0.89 (95% CI, 0.77, 1.03) for all-cause mortality. Per-protocol analyses censoring follow-up at nonadherence supported a lower risk of total cardiovascular events (HR, 0.85; 95% CI, 0.72, 0.99). There were no safety concerns.

Conclusion

Cocoa extract supplementation did not significantly reduce total cardiovascular events among older adults but reduced CVD death by 27%. Potential reductions in total cardiovascular events were supported in per-protocol analyses. Additional research is warranted to clarify whether cocoa extract may reduce clinical cardiovascular events.

Trial testing cocoa flavanol supplement shows promise for reducing cardiovascular risk, 2022

“Second, when the study team took adherence to study pills into account (by looking at those taking their study pills regularly), the team saw a stronger, 15 percent reduction in total cardiovascular events and a 39 percent reduction in death from cardiovascular disease.”

Effects of chocolate, cocoa, and flavan-3-ols on cardiovascular health: a systematic review and meta-analysis of randomized trials, 2012

Results: We included 42 acute or short-term chronic (≤18 wk) RCTs that comprised 1297 participants. Insulin resistance (HOMA-IR: −0.67; 95% CI: −0.98, −0.36) was improved by chocolate or cocoa due to significant reductions in serum insulin. Flow-mediated dilatation (FMD) improved after chronic (1.34%; 95% CI: 1.00%, 1.68%) and acute (3.19%; 95% CI: 2.04%, 4.33%) intakes. Effects on HOMA-IR and FMD remained stable to sensitivity analyses. We observed reductions in diastolic blood pressure (BP; −1.60 mm Hg; 95% CI: −2.77, −0.43 mm Hg) and mean arterial pressure (−1.64 mm Hg; 95% CI: −3.27, −0.01 mm Hg) and marginally significant effects on LDL (−0.07 mmol/L; 95% CI: −0.13, 0.00 mmol/L) and HDL (0.03 mmol/L; 95% CI: 0.00, 0.06 mmol/L) cholesterol. Chocolate or cocoa improved FMD regardless of the dose consumed, whereas doses >50 mg epicatechin/d resulted in greater effects on systolic and diastolic BP.

Conclusions: We found consistent acute and chronic benefits of chocolate or cocoa on FMD and previously unreported promising effects on insulin and HOMA-IR. 

Dietary epicatechin improves survival and delays skeletal muscle degeneration in aged mice, 2018

We recently reported that epicatechin, a bioactive compound that occurs naturally in various common foods, promoted general health and survival of obese diabetic mice. It remains to be determined whether epicatechin extends health span and delays the process of aging. In the present study, epicatechin or its analogue epigallocatechin gallate (EGCG) (0.25% w/v in drinking water) was administered to 20-mo-old male C57BL mice fed a standard chow. The goal was to determine the antiaging effect. The results showed that supplementation with epicatechin for 37 wk strikingly increased the survival rate from 39 to 69%, whereas EGCG had no significant effect. Consistently, epicatechin improved physical activity, delayed degeneration of skeletal muscle (quadriceps), and shifted the profiles of the serum metabolites and skeletal muscle general mRNA expressions in aging mice toward the profiles observed in young mice. In particular, we found that dietary epicatechin significantly reversed age-altered mRNA and protein expressions of extracellular matrix and peroxisome proliferator-activated receptor pathways in skeletal muscle, and reversed the age-induced declines of the nicotinate and nicotinamide pathway both in serum and skeletal muscle. The present study provides evidence that epicatechin supplementation can exert an antiaging effect, including an increase in survival, an attenuation of the aging-related deterioration of skeletal muscles, and a protection against the aging-related decline in nicotinate and nicotinamide metabolism.

Around 5-8% lifespan extension in mice. (10/(20*30/7+35) = 8%).

Chocolate consumption and all-cause and cause-specific mortality in a US population: a post hoc analysis of the PLCO cancer screening trial, 2021

Few studies with mixed results have examined the association between chocolate consumption and mortality. We aimed to examine this association in a US population. A population-based cohort of 91891 participants aged 55 to 74 years was identified. Chocolate consumption was assessed via a food frequency questionnaire. Cox regression was used to estimate risk estimates. After an average follow-up of 13.5 years, 19586 all-cause deaths were documented. Compared with no regular chocolate consumption, the maximally adjusted hazard ratios of all-cause mortality were 0.89 [95% confidence interval (CI) 0.84–0.94], 0.84 (95% CI 0.79–0.90), 0.86 (95% CI 0.81–0.93), and 0.87 (95% CI 0.82–0.93) for >0–0.5 servings/week, >0.5–1 serving/week, >1–2 servings/week, and >2 servings/week, respectively (Ptrend = 0.009). A somewhat stronger inverse association was observed for mortality from cardiovascular disease and Alzheimer’s disease. A nonlinear dose–response pattern was found for all-cause and cardiovascular mortality (all Pnonlinearity < 0.01), with the lowest risk observed at chocolate consumption of 0.7 servings/week and 0.6 servings/week, respectively. The favorable associations with all-cause and cardiovascular mortality were found to be more pronounced in never smokers than in current or former smokers (all Pinteraction < 0.05). In conclusion, chocolate consumption confers reduced risks of mortality from all causes, cardiovascular disease, and Alzheimer’s disease in this US population.

Chocolate Consumption in Relation to All-Cause and Cause-Specific Mortality in Women: The Women's Health Initiative, 2020

Objectives

To examine the association of chocolate consumption with all-cause and cause-specific mortality.

Methods

We included 84,709 postmenopausal women free of cardiovascular disease (CVD) and cancer at baseline in the prospective Women's Health Initiative cohort who were enrolled during 1993–1998. Chocolate consumption was assessed using a validated food frequency questionnaire. These women were followed through March 2018.

Results

During 1608,856 person-years of follow up (19.0 years on average [SD = 4.2]), 25,388 deaths occurred, including 7069 deaths from CVD, 7030 deaths from cancer, and 3279 deaths from dementia. After adjustment for a variety of covariates, compared to no chocolate consumption, the HRs (95% CIs) for all-cause mortality were 0.95 (0.92, 0.98), 0.93 (0.89, 0.96), 0.97 (0.90, 1.04) and 0.90 (0.84, 0.97) for <1 serving/week, 1–3 servings/week, 4–6 servings/week and ≥1 serving/day of chocolate consumption, respectively (P for trend = 0.02). For CVD mortality, compared to no chocolate consumption, the HRs (95% CIs) were 0.96 (0.91, 1.01), 0.88 (0.82, 0.95), 0.96 (0.93, 1.12) and 0.92 (0.80, 1.05) for <1 serving/week, 1–3 servings/week, 4–6 servings/week and ≥1 serving/day of chocolate consumption, respectively (P for trend = 0.45). For dementia mortality, compared to no chocolate consumption, the HRs (95% CIs) were 0.91 (0.84, 0.99), 0.89 (0.80, 0.99), 0.97 (0.79, 1.18) and 0.97 (0.80, 1.08) for <1 serving/week, 1–3 servings/week, 4–6 servings/week and ≥1 serving/day of chocolate consumption, respectively (P for trend = 0.95). Chocolate consumption was not associated with cancer mortality.

Conclusions

Our results suggested modest inverse association of chocolate consumption with mortality from all-causes, CVD or dementia, specifically for a moderate chocolate consumption of ≤3 servings/week.