Chocolate and prevention of cardiovascular disease: a systematic review

Evaluation of immunomodulatory (humoral as well as cell-mediated) and cytokines (TNF-α & IL-10) regulating potential of Neolamarckia cadamba fruit extract in Wistar albino rats

Current work has been designed to investigate the immunomodulatory efficacy with particular reference to humoral, cell-mediated and cytokine-modulating potential of hot aqueous extract of Neolamarckia cadamba (HAENC) fruits in Wistar albino rats. The effect of different concentrations of HAENC fruits over cell-mediated immune response was assessed using six groups (Gp-I as control, Gp-II with 20 µg/mL, Gp-III with 50 µg/mL, Gp-IV with 100 µg/mL, Gp-V with 250 µg/mL, and Gp-VI with 500 µg/mL) of Wistar albino rats having six animals in each. The amount of tumor necrosis factor-α (TNF-α) and interleukin (IL)-10 was measured by sandwich ELISA with different concentrations of HAENC (50-500 µg/mL) in splenocyte culture supernatant and their expression was determined by qRT-PCR Humoral immune response was determined by measuring the serum antibody titer of Wistar albino rats against Salmonella typhimurium 'O' antigen using four groups containing six animals each (Gp-I as control, Gp II, III & IV were respectively fed orally with 125, 250, and 500 mg/Kg body weight using HAENC fruits). LC-MS analysis suggested the presence of cadambine, chlorogenic acid, cadambagenic acid, stearic acid, octadecanoic acid ethyl ether, and 7-hydroxy-5,2'-4'-trimethoxyflavonon in the extract based on their m/z ratio. The result suggested significant (p < 0.01) dose-dependent proliferation of Concanavalin A (Con A)-treated splenocytes, depicting cell-mediated immunostimulatory potential of HAENC fruits. A dose-dependent significant decrease (p < 0.01) was found in the amount of TNF-α and IL-10 was found to increase significantly (p < 0.01) as extract concentrations increased. TNF-α and IL-10 expressions were confirmed at the molecular level by qRT-PCR analysis of mRNA transcripts of TNF-α and IL-10 genes. Fold expression of TNF-α and IL-10 gene was 0.197 and 3.58 at 250 µg/mL, 0.02 and 20.11 at 500 µg/mL concentrations of HAENC respectively in comparison to control. Serum antibody titer was significantly increased (p < 0.01) in animals fed with different doses of HAENC fruits. The present study suggested the anti-inflammatory effect of HAENC fruits which also influences the networking of cytokines, implying that it may play a role in regulating the activity of the host's immune system and can serve as a potent herbal drug with immuno-stimulatory potential.

Application of a Two-Dimensional Mapping-Based Visualization Technique: Nutrient-Value-Based Food Grouping

Worldwide, several food-based dietary guidelines, with diverse food-grouping methods in various countries, have been developed to maintain and promote public health. However, standardized international food-grouping methods are scarce. In this study, we used two-dimensional mapping to classify foods based on their nutrient composition. The Standard Tables of Food Composition in Japan were used for mapping with a novel technique-t-distributed stochastic neighbor embedding-to visualize high-dimensional data. The mapping results showed that most foods formed food group-based clusters in the Standard Tables of Food Composition in Japan. However, the beverages did not form large clusters and demonstrated scattered distribution on the map. Green tea, black tea, and coffee are located within or near the vegetable cluster whereas cocoa is near the pulse cluster. These results were ensured by the k-nearest neighbors. Thus, beverages made from natural materials can be categorized based on their origin. Visualization of food composition could enable an enhanced comprehensive understanding of the nutrients in foods, which could lead to novel aspects of nutrient-value-based food classifications.

The Effect of Bioactive Aliment Compounds and Micronutrients on Non-Alcoholic Fatty Liver Disease

In the current review, we focused on identifying aliment compounds and micronutrients, as well as addressed promising bioactive nutrients that may interfere with NAFLD advance and ultimately affect this disease progress. In this regard, we targeted: 1. Potential bioactive nutrients that may interfere with NAFLD, specifically dark chocolate, cocoa butter, and peanut butter which may be involved in decreasing cholesterol concentrations. 2. The role of sweeteners used in coffee and other frequent beverages; in this sense, stevia has proven to be adequate for improving carbohydrate metabolism, liver steatosis, and liver fibrosis. 3. Additional compounds were shown to exert a beneficial action on NAFLD, namely glutathione, soy lecithin, silymarin, Aquamin, and cannabinoids which were shown to lower the serum concentration of triglycerides. 4. The effects of micronutrients, especially vitamins, on NAFLD. Even if most studies demonstrate the beneficial role of vitamins in this pathology, there are exceptions. 5. We provide information regarding the modulation of the activity of some enzymes related to NAFLD and their effect on this disease. We conclude that NAFLD can be prevented or improved by different factors through their involvement in the signaling, genetic, and biochemical pathways that underlie NAFLD. Therefore, exposing this vast knowledge to the public is particularly important.

Safety and Effects of Lactobacillus paracasei TISTR 2593 Supplementation on Improving Cholesterol Metabolism and Atherosclerosis-Related Parameters in Subjects with Hypercholesterolemia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Probiotics have the potential as a multi-target approach to modulate hypercholesterolemia associated with premature atherosclerosis. Various strains of Lactobacillus paracasei have been reported to affect hypercholesterolemia positively. This study aimed to investigate the effects of L. paracasei TISTR 2593 on lipid profile, cholesterol metabolism, and atherosclerosis according to the registration of Thai Clinical Trial Registry as identification number TCTR 20220917002. A total of 50 participants with hypercholesterolemia were randomly and equally assigned to consume L. paracasei TISTR 2593 or a placebo in maltodextrin capsules daily. Biomarkers of lipid profiles, oxidative stress state, inflammatory state, and other biological indicators were examined on days 0, 45, and 90. The results showed that subjects taking the L. paracasei TISTR 2593 could significantly reduce the level of serum low-density lipoprotein-cholesterol (p < 0.05), malondialdehyde (p < 0.001), and tumor necrosis factor-α (p < 0.01). Moreover, L. paracasei TISTR 2593 increased the level of serum apolipoprotein E (p < 0.01) and adiponectin (p < 0.001) significantly. No changes in serum total cholesterol, high-density lipoprotein-cholesterol, triglyceride, total bile acids, and monocyte chemoattractant protein-1 were observed during L. paracasei TISTR 2593 supplementation. Therefore, L. paracasei TISTR 2593 could be an adjuvant probiotic supplement to ameliorate hypercholesterolemia and prevent or delay the development of atherosclerosis.

Fish oil and probiotics supplementation through milk chocolate improves spatial learning and memory in male Wistar rats

Background

Cognition and brain function is critical through childhood and should be improved with balanced diets. Incorporating bioactive ingredients such as omega-3 polyunsaturated fatty acids (ω3 PUFAs) and probiotics into food formulations could be used as an approach to improve cognitive function. This study evaluated the effects on cognitive capacity of complementing rodent diets with chocolate, by itself and in combination with ω3 PUFAs from fish oil and probiotics.

Methods

Spatial learning and memory in the rats were determined by the Barnes maze test in short- and long-term memory. Samples from the cecum were obtained to assess microbial counts (Lactobacillus, Bifidobacterium, Enterobacteriaceae, and total bacteria), and brains were recovered to analyze the neural morphology of the tissues. Also, glucose, brain weights, and epididymal tissue were analyzed.

Results

The combination of chocolate with fish oil and probiotics improved the memory of rats compared to the result of each bioactive compound when evaluated separately. Treatments did not affect sugar level, epididymal adipose tissue, or brain weight. On the other hand, consuming probiotics alone or in combination with chocolate decreased Enterobacteria counts, while Lactobacillus and Bifidobacteria counts were not affected. Neural morphological analysis showed that combining chocolate with probiotics and ω3 PUFAs increased the number of neurons in the hippocampal CA1 and CA3 regions.

Conclusion

Chocolate added with probiotics and ω3 PUFAs improved spatial memory and learning in the studied model.

Ageing, Age-Related Cardiovascular Risk and the Beneficial Role of Natural Components Intake

Ageing, in a natural way, leads to the gradual worsening of the functional capacity of all systems and, eventually, to death. This process is strongly associated with higher metabolic and oxidative stress, low-grade inflammation, accumulation of DNA mutations and increased levels of related damage. Detrimental changes that accumulate in body cells and tissues with time raise the vulnerability to environmental challenges and enhance the risk of major chronic diseases and mortality. There are several theses concerning the mechanisms of ageing: genetic, free radical telomerase, mitochondrial decline, metabolic damage, cellular senescence, neuroendocrine theory, Hay-flick limit and membrane theories, cellular death as well as the accumulation of toxic and non-toxic garbage. Moreover, ageing is associated with structural changes within the myocardium, cardiac conduction system, the endocardium as well as the vasculature. With time, the cardiac structures lose elasticity, and fibrotic changes occur in the heart valves. Ageing is also associated with a higher risk of atherosclerosis. The results of studies suggest that some natural compounds may slow down this process and protect against age-related diseases. Animal studies imply that some of them may prolong the lifespan; however, this trend is not so obvious in humans.

The mechanisms of calcium mobilization by procyanidins, flavonols and flavonoids from Cecropia glaziovii Sneth in pulmonary endothelial cell cultures endorse its popular use as vasodilator phytomedicine

The hypotensive and antihypertensive activities of the aqueous extract (AE) and butanolic fraction (ButF) isolated from Cecropia glaziovii Sneth have been demonstrated in previous studies in animal models. This study aimed to evaluate the molecular mechanism of action responsible for the vasodilatory effect of procyanidins, flavanols, and flavonoids found in C. glaziovii in endothelial cell culture. For this purpose, we analyzed the effect of procyanidin B2 and B3 compounds, catechin, epicatechin, orientin, isoorientin, and isovitexin in the mobilization of Ca2+ in rat endothelial cell cultures. Parallel associations with different antagonists were examined by considering the following in vivo hypotensive mechanisms: blockage of L-type calcium channels, action on β-2 adrenergic receptors, and vasodilation via the nitric oxide pathway. All measurements of calcium mobilization were carried out by using the fluorescence measurement methodology in a Flexstation M3 spectrophotometer. The results indicate that some of the compounds have mixed actions, acting through different calcium mobilization pathways. The mobilization induced by such compounds significantly decreased when they were incubated with their corresponding antagonists. Taken together, our data suggest that the beneficial effects seen with the popular use of Cecropia glaziovii Sneth in pathological conditions, such as systemic arterial hypertension, seem to be related to the plant's hypotensive effect, very probably promoted by the actions of flavonols, flavonoids, and procyanidins, by different pathways of calcium mobilization.

Dose-effect relation between regular consumption of 100% cocoa powder and blood pressure in young, healthy black Africans

BACKGROUND

Some previous works have focused on dose-response relationship between cocoa consumption and blood pressure in Caucasians. As black subjects have lower nitric oxide bioavailability, the aim of this work was to determine the dose-effect relation between cocoa and blood pressure in black Africans.

METHOD

One hundred and thirty healthy black African males aged 18-30 were randomly assigned into four groups: three groups consuming 10 g, 5 g, or 2 g of cocoa powder daily for three weeks and one control group that did not consume cocoa. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were measured on day 1 (D1, before any subject consumed cocoa), D8, D15, and D22. Means of the parameters at each of the four visits and changes of the means were compared among the groups.

RESULTS

Significant decrease in SBP was noted in consumers of 10 g compared to controls in the 1st week, and compared to consumers of 2 g in the 2nd and 3rd weeks of follow-up. Means and changes of DBP were statistically similar among the four groups.

CONCLUSION

Among our cohort, decrease in SBP was significantly greater in the heavy cocoa consumer group (10 g) compared to the low consumer group (2 g), but there was no statistically significant difference when compared with the intermediate consumer group (5 g). The dose-response relationship between cocoa consumption and changes in SBP was not linear. No relationship was found between cocoa consumption and DBP.

The Health Effects of Chocolate and Cocoa: A Systematic Review

Chocolate has a history of human consumption tracing back to 400 AD and is rich in polyphenols such as catechins, anthocyanidins, and pro anthocyanidins. As chocolate and cocoa product consumption, along with interest in them as functional foods, increases worldwide, there is a need to systematically and critically appraise the available clinical evidence on their health effects. A systematic search was conducted on electronic databases such as MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) using a search strategy and keywords. Among the many health effects assessed on several outcomes (including skin, cardiovascular, anthropometric, cognitive, and quality of life), we found that compared to controls, chocolate or cocoa product consumption significantly improved lipid profiles (triglycerides), while the effects of chocolate on all other outcome parameters were not significantly different. In conclusion, low-to-moderate-quality evidence with short duration of research (majority 4-6 weeks) showed no significant difference between the effects of chocolate and control groups on parameters related to skin, blood pressure, lipid profile, cognitive function, anthropometry, blood glucose, and quality of life regardless of form, dose, and duration among healthy individuals. It was generally well accepted by study subjects, with gastrointestinal disturbances and unpalatability being the most reported concerns.

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

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.

Dietary Epicatechin, A Novel Anti-aging Bioactive Small Molecule

Epicatechin (EC), a flavonoid present in various foods including cocoa, dark chocolate, berries, and tea, has recently been reported to promote general health and survival of old mice fed a standard chow diet. This is considered a novel discovery in the field of identifying natural compounds to extend lifespan, given that presumably popular anti-aging natural agents including resveratrol, green tea extract, and curcumin had failed in extending the lifespan of standard chow-diet-fed mice. However, the anti-aging mechanism of EC is not fully understood, thus impeding the potential application of this natural compound in improving a healthy lifespan in humans. In this review, we first summarized the main dietary sources that contain a significant amount of EC and recent research regarding the absorption, metabolism and distribution of EC in humans and rodents. The review is then focused on the anti-aging effects of EC in cultured cells, animals and humans with the possible physiological, cellular and molecular mechanisms underlying its lifespan-extending effects.

Effects of flavonoid-rich fruits on hypertension in adults: a systematic review

OBJECTIVE

The objective of this systematic review was to synthesize the best available research evidence on the effectiveness of flavonoid-rich fruits in the treatment of hypertension.

INTRODUCTION

Hypertension is a serious public health concern as it contributes to a significant burden of disease, leading to millions of deaths globally. Complementary therapies including flavonoids have generated interest in assisting the treatment of hypertension. Flavonoids are a type of polyphenol abundant in fruits and a growing body of evidence suggests antihypertensive effects of the flavonoids due to their antioxidant properties. To date, no systematic review has been performed to collate the evidence on the effects of flavonoid-rich fruits on hypertension in adults.

INCLUSION CRITERIA

This systematic review included randomized controlled trials (RCTs) that compared the administration of any type of flavonoid-rich fruit or equivalent supplement with a placebo or other intervention in adults with hypertension. Trials that measured blood pressure using objective outcome measures such as a manual mercury sphygmomanometer were included. Studies that did not specify the flavonoid component of the fruit or fruit supplement were excluded from the review. Secondary outcomes, including change in weight, blood glucose level, triglycerides and total blood cholesterol levels, were also assessed.

METHODS

A three-step search was undertaken, including a comprehensive search of the MEDLINE, Embase, Cochrane Trials (CENTRAL) and CINAHL databases, in September 2018. We also searched Dissertation Abstracts International, ProQuest Dissertations and Theses, MedNar and ClinicalTrials.gov to identify unpublished studies. The title and abstracts of the studies were reviewed by two independent reviewers against the inclusion/exclusion criteria. The methodological quality of the potential studies for inclusion were assessed using the critical appraisal checklist for randomized controlled trials as recommended by JBI. Data were pooled in a statistical meta-analysis model. Subgroup-analysis according to type of intervention and length of intervention period was performed. Where statistical pooling was not possible, the findings have been presented in a narrative form.

RESULTS

Fifteen randomized controlled trials involving 572 participants were included in the review. The subclasses of flavonoids assessed included: anthocyanins, naringin, narirutin and flavan-3-ols. The overall methodological quality of the trials was high. Six trials investigated the effect of the flavonoid intervention on blood pressure within four weeks. Meta-analysis of four of the trials demonstrated no effect of flavonoids on systolic or diastolic blood pressure when compared to placebo (systolic mean difference = -1.02, 95% confidence interval [CI] -3.12, 1.07; p = 0.34, I = 0%; diastolic mean difference = -0.90, 95% CI -2.10, 0.31; p = 0.15, I = 0%). Similarly, pooled results from two crossover RCTs with two-timed dosed interventions in a 24-hour period demonstrated no effect on a reduction in diastolic blood pressure (p = 0.38) but did reveal evidence of a reduction in systolic blood pressure (p = 0). Six trials assessed blood pressure following the flavonoid intervention at more than four weeks follow-up. Meta-analysis of five of the trials demonstrated evidence of no effect on either systolic blood pressure (mean difference = -0.95, 95%CI -3.58, 1.68; p = 0.478, I = 0%) or diastolic blood pressure (mean difference = 0.86, 95%CI -1.11, 2.82; p = 0.393, I = 0%).

CONCLUSIONS

The findings of this systematic review should be interpreted with caution, given that the results are obtained from single-center trials with small sample sizes. Flavonoids have no effect on systolic and diastolic blood pressure. Further robust RCTs using sample sizes based on power calculations are needed to provide evidence for the use of flavonoid-rich fruits for the management of hypertension.

Using digital health technology to evaluate the impact of chocolate on blood pressure: Results from the COCOA-BP study

Background

High blood pressure (BP) is a major risk factor for cardiovascular disease (CVD). Consumption of dark chocolate, which is high in flavonoids that may reduce CVD risk, is an attractive intervention to reduce to BP. Additionally, the use of mobile health (mHealth) technologies (eg, telehealth, smartphones, and wearable devices) can improve outcomes in patients with CVD.

Objective

The purpose of this study was to investigate the impact of dark chocolate intake on BP, subject use of mHealth, and integration of mHealth into a clinical trial.

Methods

The COCOA-BP (ChOcolate COnsumption And Blood Pressure) study was a prospective, single-center, pre-/postintervention study that enrolled 62 healthy volunteers. The study consisted of 3 phases: smartwatch/smart BP monitor familiarization and washout from chocolate (week 1); control (week 2); and intervention (weeks 3 and 4). During the intervention phase, subjects consumed 50 g of dark chocolate per day. The primary endpoint was change in resting systolic BP between the intervention and control phases. Additional endpoints included device accuracy and correlation with physical activity.

Results

Mean resting systolic BP was 116.4 mm Hg before chocolate intake among 62 participants (mean age 37 years; 61% female). After chocolate intake, mean resting systolic BP was 116.0 mm Hg (difference –0.4; P = .69). These findings suggest that 2 weeks of dark chocolate intake did not reduce resting systolic BP. There was poor agreement between mHealth device and standard (nurse-performed) measurements.

Conclusion

In this study, short-term dark chocolate intake did not seem to reduce BP. mHealth technology shows great potential for use in clinical studies, but challenges related to device accuracy and compliance need to be addressed.

Control of Reactive Oxygen Species for the Prevention of Parkinson's Disease: The Possible Application of Flavonoids

Oxidative stress reflects an imbalance between the production of reactive oxygen species (ROS) and antioxidant defense systems, and it can be associated with the pathogenesis and progression of neurodegenerative diseases such as multiple sclerosis, stroke, and Parkinson's disease (PD). The application of antioxidants, which can defend against oxidative stress, is able to detoxify the reactive intermediates and prevent neurodegeneration resulting from excessive ROS production. There are many reports showing that numerous flavonoids, a large group of natural phenolic compounds, can act as antioxidants and the application of flavonoids has beneficial effects in the adult brain. For instance, it is well known that the long-term consumption of the green tea-derived flavonoids catechin and epigallocatechin gallate (EGCG) can attenuate the onset of PD. Also, flavonoids such as ampelopsin and pinocembrin can inhibit mitochondrial dysfunction and neuronal death through the regulation of gene expression of the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway. Additionally, it is well established that many flavonoids exhibit anti-apoptosis and anti-inflammatory effects through cellular signaling pathways, such as those involving (ERK), glycogen synthase kinase-3β (GSK-3β), and (Akt), resulting in neuroprotection. In this review article, we have described the oxidative stress involved in PD and explained the therapeutic potential of flavonoids to protect the nigrostriatal DA system, which may be useful to prevent PD.

Association between chocolate consumption frequency and heart rate variability indices

BACKGROUND

Previous studies have shown favorable effects of chocolate products on the cardiovascular system and reported an inverse relationship between chocolate consumption and adverse cardiac events; however, relationships between chocolate eating habits and heart rate variability have not yet been studied. The purpose of the present research was to determine the relationship, if any, between chocolate consumption frequency and heart rate variability.

METHODS

A cross-sectional study was carried out in a group of 98 young females (19-21 years old). The study included the evaluation of chocolate eating habits by a questionnaire and heart rate variability parameters by Finometer and Powerlab as primary outcomes along with measuring anthropometry, blood pressure and fasting blood sugar levels as predictors to account for potential confounding.

RESULTS

Three chocolate eating patterns were distinguished: "No regular chocolate consumption (n:42), 2-4 servings/week (n:20), 5 or more servings/week (n:36)". An ANOVA test revealed insignificant differences (p > 0.05) in heart rate variability parameters (time domain: Heart rate, RRms, SDNN, RMSSD; frequency domain: LF, HF, LF/HF) and pressures (systolic, diastolic, pulse, mean arterial) among three groups of individuals having different chocolate eating habits. Relative frequency of chocolate intake did not correlate with any of the cardiovascular, time-domain or frequency-domain parameters of heart rate variability in study participants.

CONCLUSION

Based on our results, we conclude that relative frequency of chocolate eating may not affect autonomic regulation of the heart in young females. Also, it may have no correlation with any of the cardiovascular, time-domain or frequency-domain parameters of heart rate variability.

Chocolate and risk of chronic disease: a systematic review and dose-response meta-analysis

PURPOSE

Evidence for the association between chocolate intake and risk of chronic diseases is inconclusive. Therefore, we aimed to synthesize and evaluate the credibility of evidence on the dose-response association between chocolate consumption with risk of all-cause mortality, coronary heart disease (CHD), stroke, heart failure (HF), type 2 diabetes (T2D), colorectal cancer (CRC), and hypertension.

METHODS

Prospective studies were searched until July 2018 in PubMed, Embase, and Web of Science. Random-effects meta-analyses comparing highest versus lowest intake categories, linear, and non-linear dose-response analyses were conducted. The credibility of evidence was evaluated with the NutriGrade scoring-system.

RESULTS

Overall, 27 investigations were identified (n = 2 for all-cause mortality, n = 9 for CHD, n = 8 for stroke, n = 6 for HF, n = 6 for T2D, n = 2 for hypertension and CRC, respectively). No associations with HF (RR 0.99, 95% CI 0.94, 1.04) and T2D (RR 0.94, 95% CI 0.88, 1.01) per each 10 g/day increase in chocolate intake were observed in the linear dose-response meta-analyses. However, a small inverse association for each 10 g/daily increase could be shown for the risk of CHD (RR 0.96, 95% CI 0.93, 0.99), and stroke (RR 0.90, 95% CI 0.82, 0.98). The credibility of evidence was rated either very low (all-cause mortality, HF, T2D, CRC or hypertension) or low (CHD, stroke).

CONCLUSION

Chocolate consumption is not related to risk for several chronic diseases, but could have a small inverse association with CHD and stroke. Our findings are limited by very low or low credibility of evidence, highlighting important uncertainty for chocolate-disease associations.

Biogenic Amines, Phenolic, and Aroma-Related Compounds of Unroasted and Roasted Cocoa Beans with Different Origin

Biogenic amines (BAs), polyphenols, and aroma compounds were determined by chromatographic techniques in cocoa beans of different geographical origin, also considering the effect of roasting (95, 110, and 125 °C). In all samples, methylxantines (2.22–12.3 mg kg⁻¹) were the most abundant followed by procyanidins (0.69–9.39 mg kg⁻¹) and epicatechin (0.16–3.12 mg kg⁻¹), all reduced by heat treatments. Volatile organic compounds and BAs showed variable levels and distributions. Although showing the highest BAs total content (28.8 mg kg⁻¹), Criollo variety presented a good aroma profile, suggesting a possible processing without roasting. Heat treatments influenced the aroma compounds especially for Nicaragua sample, increasing more than two-fold desirable aldehydes and pyrazines formed during the Maillard cascade and the Strecker degradation. As the temperature increased, the concentration of BAs already present in raw samples increased as well, although never reaching hazardous levels.

Physiological Responses to Basic Tastes for Sensory Evaluation of Chocolate Using Biometric Techniques

Facial expressions are in reaction to basic tastes by the response to receptor stimulation. The objective of this study was to assess the autonomic nervous system responses to basic tastes in chocolates and to identify relationships between conscious and unconscious responses from participants. Panelists (n = 45) tasted five chocolates with either salt, citric acid, sugar, or monosodium glutamate, which generated four distinctive basic tastes plus bitter, using dark chocolate. An integrated camera system, coupled with the Bio-Sensory application, was used to capture infrared thermal images, videos, and sensory responses. Outputs were used to assess skin temperature (ST), facial expressions, and heart rate (HR) as physiological responses. Sensory responses and emotions elicited during the chocolate tasting were evaluated using the application. Results showed that the most liked was sweet chocolate (9.01), while the least liked was salty chocolate (3.61). There were significant differences for overall liking (p < 0.05) but none for HR (p = 0.75) and ST (p = 0.27). Sweet chocolate was inversely associated with angry, and salty chocolate positively associated with sad. Positive emotion-terms were associated with sweet samples and liking in self-reported responses. Findings of this study may be used to assess novel tastes of chocolate in the industry based on conscious and emotional responses more objectively.

Therapeutic potential of natural compounds in inflammation and chronic venous insufficiency

The term varicose vein refers to the twisted and swollen vein visible under the skin surface which occurs most commonly in the leg. Epidemiological studies report a varying percentage of incidences from 2 to 56% in men and <1-60% in women. Venous insufficiency is most often caused by the damage to the valves and walls of the veins. The mechanism of varicose vein formation is complex. It is, however, based on hypotensive blood vessels, hypoxia, and other mechanisms associated with inflammation. This work describes mechanisms related to the formation and development of the varicose vein. It discusses risk factors, pathogenesis of chronic venous disease, markers of the epithelial and leukocyte activation, state of hypoxia and inflammation, reactive oxygen species (ROS) generation, and oxidative stress. Additionally, this paper describes substances of plant origin used in the treatment of venous insufficiency. It also considers the structure of the molecules, their properties, and their mechanisms of action, the structure-activity relationship and chemical properties of flavonoids and other substances. The flavonoids include quercetin derivatives, micronized purified flavonoid fraction (Daflon), natural pine bark extract (Pycnogenol), and others such as triterpene saponine, extracts from Ruscus aculeatus and Centella asiatica, Ginkgo biloba extract, coumarin dereivatives that are used in chronic venous insufficiency. Flavonoids are natural substances found in plants, including fruits, vegetables, flowers, and others. They are important to the circulatory system and critical to blood vessels and the blood flow. Additionally, they have antioxidant, antiinflammatory properties.

Effects of Extra Virgin Olive Oil and Apples Enriched-Dark Chocolate on Endothelial Progenitor Cells in Patients with Cardiovascular Risk Factors: A Randomized Cross-Over Trial

Background: Endothelial dysfunction has been associated to cardiovascular outcomes in patients with cardiovascular risk factors. Circulating endothelial progenitor cells (EPCs) play an important physiological role for their reparative potential of vascular integrity, but are numerically reduced and functionally impaired in patients with cardiovascular risks. This study assesses the effects of Extra Virgin Olive Oil (EVOO) and apple-enriched dark chocolate intake on the blood levels of EPCs. Methods: Thirty volunteers with cardiovascular risk factors, enrolled in a randomised, crossover, four-weeks trial, received a solid dark chocolate bar (40 g/day) containing 10% EVOO or 2.5% dry apples. Urine samples were analyzed for endogenous metabolites. Circulating EPCs levels, clinical data and anthropometric examinations were collected. Results: 26 volunteers (M/F:14/12, 51 ± 9 years of age) completed the study. Comparison of pre-post intervention revealed a significant increase in EPCs levels associated with EVOO-dark chocolate consumption. Most biochemical parameters were not significantly modified by both chocolates. Conclusions: This study shows that a daily consumption of a non fattening dose of dark chocolate enriched with EVOO improves blood levels of EPCs, a well known surrogate biologic marker for endothelial function.

Longan (Dimocarpus longan) and lychee (Litchi chinensis): Functional ingredients in chocolate pralines

Fresh and half-dried fruits of lychee (Litchi Chinensis) and longan (Dimocarpus longan) were processed by air drying and implemented in diverse forms as fillings in order to produce chocolate pralines. Both dried fruits and chocolate pralines were characterized with total polyphenols, proanthocyanidins, flavan-3-ols and antioxidant capacity (2, 2-diphenyl-1-picrylhydrazyl, 2, 2-Azino-Bis-3-Ethylbenzothiazoline-6-Sulfonic acid) were determined by spectrophotometric and sensory analyses by quantitative descriptive analysis. Specific polyphenolic compounds were quantified using high-performance liquid chromatography coupled with photodiode array detector. The bioactive content and profile of chocolate pralines produced with the addition of longan and lychee were not significantly altered when compared to plain chocolate, but the sensory analysis revealed a preference for lychee-containing pralines, due to characteristic fruity sensory properties. Since longan and lychee fruits are still underutilized as raw materials and ingredients in food production, preservation by drying and incorporation into new products may enable their popularization and increase functional food production. PRACTICAL APPLICATIONS: Since both longan and lychee are still underutilized as raw materials and ingredients in food production, preservation by drying and incorporation into new products may enable their popularization and increase functional food production.

Effects of polyols on the quality characteristics of sucrose-free milk chocolate produced in a ball mill

Sucrose-free milk chocolates containing different types of bulk (isomalt, xylitol and maltitol) and high intensity (Stevia) sweeteners were produced by using a ball mill. The main quality characteristics of the formulated chocolates were evaluated and compared with those of the conventional sample containing sucrose. The Casson model was the best fitting model for the rheological data. Casson viscosity and Casson yield stress were significantly affected by the type of bulking agent in chocolates formulated with xylitol (p < 0.05). However xylitol notably improved the overall acceptability according to the sensory analysis results. Chocolates containing the sucrose replacers demonstrated lower T_onset values and higher enthalpy than the control sample. Sucrose-free chocolates illustrated a higher degree of particle agglomeration. Bulk sweeteners meanwhile seem to have high potential for milk chocolate production with low calorie values by using the ball mill technique. Industrial applications: the production of sucrose-free chocolates with conventional methods requires a lot of time and energy. Recently, using alternative methods for chocolate production has been raising interest in many small industries. This study proposed a ball mill method for the preparation of sucrose-free milk chocolates with physiochemical properties almost ranging in the standard limit defined for chocolate. Although using the ball mill method presents a more cost-effective technique for chocolate production and provides shorter processing times for small chocolate industries, it seems to be less efficient in evaporating moisture than the conventional processing. Challenges are still ahead for upgrading this alternative technique to be efficient in evaporating more moisture during operation ending in a high quality product.

Sucrose-free milk chocolates containing different types of bulk (isomalt, xylitol and maltitol) and high intensity (Stevia) sweeteners were produced by using a ball mill.

Potassium Channel Activation Is Involved in the Cardiovascular Effects Induced by Freeze Dried Syzygium jambolanum (Lam.) DC Fruit Juice

This work aimed to explore the cardiovascular effects induced by freeze-dried juice from Syzygium jambolanum (Lam.) DC fruits (JSJ). JSJ presented high polyphenol content and steroids. HPLC analysis revealed that 2,5-dihydroxybenzoic and caffeic acid were present in higher amounts in the JSJ extract. In rat, JSJ induces hypotension and vasodilatation in mesenteric arteries, with or without vascular endothelium. JSJ-mediated vasodilation response against contractions induced with KCl (60 mM) depolarizing solution was significantly lower than the responses induced by JSJ when evaluated against phenylephrine-induced contractions. To investigate the involvement of potassium channels we used Tyrode's solution with KCl (20 mM) or tetraethylammonium (1.0, 3.0, or 5.0 mM). In these conditions JSJ-induced effects were significantly attenuated. To investigate the potassium channel subtypes involved in the response, we used 4-aminopyridine, glibenclamide, BaCl2, and iberiotoxin. In the presence (simultaneous) of different potassium channel blockers we observed a significant attenuation of JSJ-induced effect. Inhibition was also observed when using BaCl2, glibenclamide, or 4-aminopyridine, separately. However, incubation with iberiotoxin did not promote changes in either maximum effect, or potency. We also evidenced a discrete participation of CaV channels in the JSJ-induced vasorelaxant effect. In addition, patch-clamp studies demonstrated that JSJ could activate potassium channels. In conclusion, JSJ promotes hypotension and vasorelaxation in rats, involving, at least, the activation of potassium channels.

Phenolic Compounds as Nutraceuticals or Functional Food Ingredients

BACKGROUND

Nowadays, the functional foods represent one the most promising, interesting and innovative areas in the food industry. Various components are being added to foods in order to render them functional.

METHODS

One example of these components are plant naturally occurring phenolic compounds, which are associated with a high antioxidant capacity and thus with benefits in relation to human health.

RESULTS

However, despite the huge number of scientific studies and patents on this topic and their natural presence in foods, namely in the ones from plant origin, there are still few marketable products enriched with these compounds. The commercialization of this type of functional products needs to go through various regulations, proving that they are safe and present the ascribed health benefits, conquering the target audience. In this review the growing interest of industry and consumers' appetence for functional foods and nutraceuticals is highlighted, focusing especially on phenolic compounds.

CONCLUSION

Although several published works show the multitude of bioactive properties of these compounds, ensuring their use as bioactive ingredients in food, they present inherent stability issues needing to be solved. However, considerable research is presently ongoing to overcome this problem, making viable the development of new products to be launched in the market.

Functional Food and Cardiovascular Disease Prevention and Treatment: A Review

Cardiovascular disease (CVD) is now the leading cause of death globally and is a growing health concern. Lifestyle factors, including nutrition, play an important role in the etiology and treatment of CVD. Functional foods based on their basic nutritional functions can decrease the risk of many chronic diseases and have some physiological benefits. They contain physiologically active components either from plant or animal sources, marketed with the claim of their ability to reduce heart disease risk, focusing primarily on established risk factors, which are hyperlipidemia, diabetes, metabolic syndrome, obesity/overweight, elevated lipoprotein A level, small dense low-density lipoprotein cholesterol (LDL-C), and elevated inflammatory marker levels. Functional foods are suspected to exert their cardioprotective effects mainly through blood lipid profile level and improve hypertension control, endothelial function, platelet aggregation, and antioxidant actions. Clinical and epidemiological observations indicate that vegetable and fruit fiber, nuts and seeds, sea foods, coffee, tea, and dark chocolate have cardioprotective potential in humans, as well whole-grain products containing intact grain kernels rich in fiber and trace nutrients. They are nutritionally more important because they contain phytoprotective substances that might work synergistically to reduce cardiovascular risk. This review will focus on the reciprocal interaction between functional foods and the potential link to cardiovascular health and the possible mechanisms of action.

Rheological behaviour of chocolate at different temperatures

The rheological behaviour of the chocolate at different temperatures was studied using a concentric cylinder viscometer with precision small samples adapter, temperature sensor and standard spindle. BIO chocolate (100% organic cocoa) has been used for the whole types of experiments. At the first, the range of temperature has been chosen 36 °C, 38 °C, 40 °C, 42 °C, and 44 °C. The shear deformation rate was established from the 0.1 s-1 up to 68 s-1. Rheological behaviour was non-Newtonian (plastic) with inconsiderable yield stress in all temperatures. The chocolate unambiguously demonstrated plastic behaviour and flow curves were fitted by the power law model (Herschel-Bulkley model), Bingham model, and Casson model with taking into account the coefficient of determination R2. The obtained results of rheological behaviour of chocolate can be best described as Casson fluid. Exactly coefficients of models can be used for modelling of flow velocity, volume flow, friction factor, Reynolds number, two dimensional and three dimensional velocity profiles and much more for flow in the real technical elements e.g. pipes, trough, tubes. Finally, temperature dependence of apparent viscosity of chocolate was also continuously measured in the range from 35 °C up to 62 °C. The apparent viscosity decreased in the temperature range. This decrease was fitted using power law equation. The knowledge of the plastic flow behaviour of chocolate is very important, because it is not quite common flow behaviour of foodstuffs.

Formulation of dark chocolate as a carrier to deliver eicosapentaenoic and docosahexaenoic acids: Effects on product quality

In this study, dark chocolate enriched with EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) was developed using various forms and origins. Quality characteristics such as physical, thermo-gravimetric, rheological, textural and sensory properties of chocolates were investigated. The highest EPA/DHA stability was determined in samples prepared by free-flowing powder and microencapsulated forms of omega-3 fatty acids (FA). The L^∗ and C^∗ values varied from 32.16-33.37 and 7.45-8.09, respectively for the all samples. Hardness values ranged between 6422 and 8367 N and the use of EPA/DHA in the triglyceride form caused softer chocolate whereas control sample was the hardest sample. Melting and rheological properties were not significantly affected by the studied EPA/DHA sources (P < 0.05). Microencapsulated EPA/DHA added chocolate was the most preferred source whereas sample with algae oil showed the lowest acceptability. According to the results, dark chocolate can be used for delivering omega-3 FA by considering their origin and physical form.

Cardioprotection and natural polyphenols: an update of clinical and experimental studies

Mechanisms involved in ischemia–reperfusion injury.

Intake of dietary fat and fat subtypes and risk of premenstrual syndrome in the Nurses' Health Study II

Approximately 8-20 % of reproductive-aged women experience premenstrual syndrome (PMS), substantially impacting quality of life. Women with PMS are encouraged to reduce fat intake to alleviate symptoms; however, its role in PMS development is unclear. We evaluated the association between dietary fat intake and PMS development among a subset of the prospective Nurses' Health Study II cohort. We compared 1257 women reporting clinician-diagnosed PMS, confirmed by premenstrual symptom questionnaire and 2463 matched controls with no or minimal premenstrual symptoms. Intakes of total fat, subtypes and fatty acids were assessed via FFQ. After adjustment for age, BMI, smoking, Ca and other factors, intakes of total fat, MUFA, PUFA and trans-fat measured 2-4 years before were not associated with PMS. High SFA intake was associated with lower PMS risk (relative risk (RR) quintile 5 (median=28·1 g/d) v. quintile 1 (median=15·1 g/d)=0·75; 95 % CI 0·58, 0·98; P trend=0·07). This association was largely attributable to stearic acid intake, with women in the highest quintile (median=7·4 g/d) having a RR of 0·75 v. those with the lowest intake (median=3·7 g/d) (95 % CI 0·57, 0·97; P trend=0·03). Individual PUFA and MUFA, including n-3 fatty acids, were not associated with risk. Overall, fat intake was not associated with higher PMS risk. High intake of stearic acid may be associated with a lower risk of developing PMS. Additional prospective research is needed to confirm this finding.

(-)-Epicatechin-induced relaxation of isolated human saphenous vein: Roles of K+ and Ca2+ channels

In this study, we aimed to investigate relaxant effect of flavanol (-)-epicatechin on the isolated human saphenous vein (HSV), as a part of its cardioprotective action, and to define the mechanisms underlying this vasorelaxation. (-)-Epicatechin induced a concentration-dependent relaxation of HSV pre-contracted by phenylephrine. Among K⁺ channel blockers, 4-aminopyridine, margatoxin, and iberiotoxin significantly inhibited relaxation of HSV, while glibenclamide considerably reduced effects of the high concentrations of (-)-epicatechin. Additionally, (-)-epicatechin relaxed contraction induced by 80 mM K⁺ , whereas in the presence of nifedipine produced partial relaxation of HSV rings pre-contracted by phenylephrine. In Ca²⁺ -free solution, (-)-epicatechin relaxed contraction induced by phenylephrine, but had no effect on contraction induced by caffeine. A sarcoplasmic reticulum Ca²⁺ -ATPase inhibitor, thapsigargin, significantly reduced relaxation of HSV produced by (-)-epicatechin. These results demonstrate that (-)-epicatechin produces endothelium-independent relaxation of isolated HSV rings. Vasorelaxation to (-)-epicatechin probably involves activation of 4-aminopyridine- and margatoxin-sensitive K_V channels, BK_Ca channels, and at least partly, K_ATP channels. In addition, not only the inhibition of extracellular Ca²⁺ influx, but regulation of the intracellular Ca²⁺ release, via inositol-trisphosphate receptors and reuptake into sarcoplasmic reticulum, via stimulation of Ca²⁺ -ATPase, as well, most likely participate in (-)-epicatechin-induced relaxation of HSV.

Sensory profiling and consumer acceptability of new dark cocoa bars containing Tuscan autochthonous food products

A new set of cocoa bars named Toscolata^® were developed containing top‐quality extra virgin olive oil, dried apples cultivars, and chestnut flour. The present work has been conducted to define the sensory profile of these products through tasting by trained experts and consumers to study the acceptability, preference, and quality perception. The four sensorial profiles of the bars differed in the level of persistence, bitterness, aromaticity, acidity, astringency, and tastiness. In particular, the sour attribute could be traced to the presence of dried apple. Bars containing apple and chestnut flour obtained higher acceptance ratings, compared to those with extra virgin olive oil. The bar with chestnut flour was preferred by consumers who considered it to be sweeter due to the presence of natural sugars, which lowered the bitter sensation of cocoa. These results showed that the selection of the preferred bar by consumers was mainly based on the level of bitterness and, in particular, elderly consumers expressed a strong preference for the sweetest product. As far as we know, this is the first study comparing the results of a panel of expert tasters with that of consumers in the tasting of dark chocolate.

Brachial and Cerebrovascular Functions Are Enhanced in Postmenopausal Women after Ingestion of Chocolate with a High Concentration of Cocoa

Background: Cocoa contains polyphenols that are thought to be beneficial for vascular health.Objective: We assessed the impact of chocolate containing distinct concentrations of cocoa on cerebrovascular function and cognition.Methods: Using a counterbalanced within-subject design, we compared the acute impact of consumption of energy-matched chocolate containing 80%, 35%, and 0% single-origin cacao on vascular endothelial function, cognition, and cerebrovascular function in 12 healthy postmenopausal women (mean ± SD age: 57.3 ± 5.3 y). Participants attended a familiarization session, followed by 3 experimental trials, each separated by 1 wk. Outcome measures included cerebral blood flow velocity (CBFv) responses, recorded before and during completion of a computerized cognitive assessment battery (CogState); brachial artery flow-mediated dilation (FMD); and hemodynamic responses (heart rate and blood pressure).Results: When CBFv data before and after chocolate intake were compared between conditions through the use of 2-factor ANOVA, an interaction effect (P = 0.003) and main effects for chocolate (P = 0.043) and time (P = 0.001) were evident. Post hoc analysis revealed that both milk chocolate (MC; 35% cocoa; P = 0.02) and dark chocolate (DC; 80% cocoa; P = 0.003) induced significantly lower cerebral blood flow responses during the cognitive tasks, after normalizing for changes in arterial pressure. DC consumption also increased brachial FMD compared with the baseline value before chocolate consumption (P = 0.002), whereas MC and white chocolate (0% cocoa) caused no change (P-interaction between conditions = 0.034).Conclusions: Consumption of chocolate containing high concentrations of cocoa enhanced vascular endothelial function, which was reflected by improvements in FMD. Cognitive function outcomes did not differ between conditions; however, cerebral blood flow responses during these cognitive tasks were lower in those consuming MC and DC. These findings suggest that chocolate containing high concentrations of cocoa may modify the relation between cerebral metabolism and blood flow responses in postmenopausal women. This trial was registered at www.ANZCTR.orgau as ACTRN12616000990426.

The role of polyphenols in modern nutrition

Polyphenols are found in plant‐based foods and beverages, notably apples, berries, citrus fruit, plums, broccoli, cocoa, tea and coffee and many others. There is substantial epidemiological evidence that a diet high in polyphenol‐rich fruit, vegetables, cocoa and beverages protects against developing cardiovascular disease and type 2 diabetes. The absorption and metabolism of these compounds have been well described and, for many, the gut microbiota play a critical role in absorption; taking into consideration the parent compound and the metabolites from colon bacteria catabolism, more than 80% of a dose can be absorbed and ultimately excreted in the urine. Common polyphenols in the diet are flavanols (cocoa, tea, apples, broad beans), flavanones (hesperidin in citrus fruit), hydroxycinnamates (coffee, many fruits), flavonols (quercetin in onions, apples and tea) and anthocyanins (berries). Many intervention studies, mechanistic in vitro data and epidemiological studies support a role for polyphenols against the development of chronic diseases. For example, flavanols decrease endothelial dysfunction, lower blood pressure and cholesterol, and modulate energy metabolism. Coffee and tea both reduce the risk of developing type 2 diabetes, through action of their constituent polyphenols. Despite extensive research, the exact mechanisms of action of polyphenols in the human body have not been decisively proven, but there is strong evidence that some targets such as nitric oxide metabolism, carbohydrate digestion and oxidative enzymes are important for health benefits. Consumption of polyphenols as healthy dietary components is consistent with the advice to eat five or more portions of fruit and vegetables per day, but it is currently difficult to recommend what ‘doses’ of specific polyphenols should be consumed to derive maximum benefit.

Food and Cardiac Health

Emerging influence of Cardiovascular Diseases (CVDs) and its impact on the society has raised much awareness for its prevention. Healthy food habits and physical exercise has drawn a lot of attention of the people from scientific as well as common world. The role of food-based bioactive compounds in reducing risk of CVDs has been established with various health benefits apart from the basic nutrition have been reported. The present chapter provides an overview of the role of different foods on cardiovascular health of humans. Biological effects of plant derived food products and their bioactive compounds in the context of relevance to cardiovascular health promotion are discussed in detail. The chapter also covers the effects of the consumption of functional food on the intermediate clinical markers of CVDs including cholesterolemia, hypertension, endothelial function and inflammation. The chapter will enable the better understanding of the current knowledge on the potential health benefits of different functional foods and bioactive compounds on cardiovascular health.

Chocolate intake and incidence of heart failure: Findings from the Cohort of Swedish Men

The objective of this study was to evaluate the association of chocolate consumption and heart failure (HF) in a large population of Swedish men.

METHODS

We conducted a prospective cohort study of 31,917 men 45-79 years old with no history of myocardial infarction, diabetes, or HF at baseline who were participants in the population-based Cohort of Swedish Men study. Chocolate consumption was assessed through a self-administrated food frequency questionnaire. Participants were followed for HF hospitalization or mortality from January 1, 1998, to December 31, 2011, using record linkage to the Swedish inpatient and cause-of-death registries.

RESULTS

During 14 years of follow-up, 2,157 men were hospitalized (n=1,901) or died from incident HF (n=256). Compared with subjects who reported no chocolate intake, the multivariable-adjusted rate ratio of HF was 0.88 (95% CI 0.78-0.99) for those consuming 1-3 servings per month, 0.83 (95% CI 0.72-0.94) for those consuming 1-2 servings per week, 0.82 (95% CI 0.68-0.99) for those consuming 3-6 servings per week, and 1.10 (95% CI 0.84-1.45) for those consuming ≥1 serving per day (P for quadratic trend=.001).

CONCLUSIONS

In this large prospective cohort study, there was a J-shaped relationship between chocolate consumption and HF incidence. Moderate chocolate consumption was associated with a lower rate of HF hospitalization or death, but the protective association was not observed among individuals consuming ≥1 serving per day. Journal Subject Codes: Etiology: Epidemiology, Heart failure: Congestive.

The absorption, distribution, metabolism and excretion of procyanidins

Procyanidins (PAs) are polyphenols in plant food that have many health benefits, including cancer prevention, cardiovascular protection and diabetes prevention. PAs have been known to have low oral bioavailability. In this review, we summarize the published results on the ADME (absorption, distribution, metabolism and excretion) of PAs in vivo and in vitro. After oral administration, in the stomach the decomposition of PAs is highly dependent on the pH value of gastric juice, which is also affected by food intake. In the small intestine, PA polymers and oligomers with DP > 4 are not directly absorbed in vivo, but minor PA monomers and dimers could be detected in the plasma. Methylated and glucuronidated PA dimers and monomers are the main metabolites of PAs in plasma. In the colon, PAs are catabolized by colonic microflora into a series of low molecular weight phenolic acids, such as phenyl valerolactone, phenylacetic acids and phenylpropionic acids. We reviewed the degradation of PAs in gastric digestion, the absorption of PAs in the small intestine and the metabolic pathway of PAs by colonic microflora. To clearly explain the in vivo pharmacokinetics of PAs, a systematic comparative analysis on previously published data on PAs was conducted.

Cocoa Flavanol Intake and Biomarkers for Cardiometabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Cocoa flavanols may improve cardiometabolic health. Evidence from small short-term randomized clinical trials (RCTs) remains inconsistent, and large long-term RCTs testing the efficacy of cocoa flavanols are still lacking.

OBJECTIVE

We performed a systematic review and meta-analysis of RCTs to quantify the effect of cocoa flavanol intake on cardiometabolic biomarkers.

METHODS

We searched PubMed, Web of Science, and the Cochrane Library for RCTs that evaluated the effects of cocoa flavanols on biomarkers relevant to vascular disease pathways among adults. Data were extracted following a standardized protocol. We used DerSimonian and Laird random-effect models to compute the weighted mean differences (WMDs) and 95% CIs. We also examined potential modification by intervention duration, design, age, sex, comorbidities, and the form and amount of cocoa flavanol intake.

RESULTS

We included 19 RCTs that comprised 1131 participants, and the number of studies for a specific biomarker varied. The amount of cocoa flavanols ranged from 166 to 2110 mg/d, and intervention duration ranged from 2 to 52 wk. Cocoa flavanol intake significantly improved insulin sensitivity and lipid profile. The WMDs between treatment and placebo were -0.10 mmol/L (95% CI: -0.16, -0.04 mmol/L) for total triglycerides, 0.06 mmol/L (95% CI: 0.02, 0.09 mmol/L) for HDL cholesterol, -2.33 μIU/mL (95% CI: -3.47, -1.19 μIU/mL) for fasting insulin, -0.93 (95% CI: -1.31, -0.55) for the homeostatic model assessment of insulin resistance, 0.03 (95% CI: 0.01, 0.05) for the quantitative insulin sensitivity check index, 2.54 (95% CI: 0.63, 4.44) for the insulin sensitivity index, -0.83 mg/dL (95% CI: -0.88, -0.77 mg/dL) for C-reactive protein, and 85.6 ng/mL (95% CI: 16.0, 155 ng/mL) for vascular cell adhesion molecule 1. No significant associations were found for other biomarkers. None of the modifiers seemed to qualitatively modify the effects of cocoa flavanol intake.

CONCLUSIONS

Our study suggests that cocoa flavanol intake has favorable effects on select cardiometabolic biomarkers among adults. These findings support the need for large long-term RCTs to assess whether cocoa flavanol intake reduces the risk of diabetes and cardiovascular events.

Evaluation of Antioxidant Interactions of Combined Model Systems of Phenolics in the Presence of Sugars

The aim of this study was to determine the antioxidant activity of model systems of phenolics (individual and combinations) without and with the addition of sugars (sucrose or trehalose). Also, the synergistic or antagonistic effects of the phenolics in all model systems were evaluated. The results for the antioxidant activity were obtained by three assays, ABTS+•, DPPH• and FRAP. ABTS+• and DPPH• assay showed that quercetin and gallic acid had the same antioxidant activity, higher than catechin. When the FRAP assay was applied, the order of increasing of antioxidant activity was quercetin < gallic acid < catechin. The highest synergistic effect was achieved in the model system of catechin, quercetin and gallic acid. Addition of sugars, sucrose and trehalose, influenced both antioxidant activity and synergistic effect of phenolics in the model systems. The highest synergistic effect in the model systems with sucrose addition was observed with catechin, quercetin and gallic acid, while in samples with trehalose, the highest synergistic effect was in combination with catechin and gallic acid. Interactions of phenolics and phenolics/sugars caused changes in antioxidant activity as well as synergistic effects.

Dark chocolate attenuates intracellular pro-inflammatory reactivity to acute psychosocial stress in men: A randomized controlled trial

Flavanol-rich dark chocolate consumption relates to lower risk of cardiovascular mortality, but underlying mechanisms are elusive. We investigated the effect of acute dark chocolate consumption on inflammatory measures before and after stress. Healthy men, aged 20-50years, were randomly assigned to a single intake of either 50g of flavanol-rich dark chocolate (n=31) or 50g of optically identical flavanol-free placebo-chocolate (n=34). Two hours after chocolate intake, both groups underwent the 15-min Trier Social Stress Test. We measured DNA-binding-activity of the pro-inflammatory transcription factor NF-κB (NF-κB-BA) in peripheral blood mononuclear cells, as well as plasma and whole blood mRNA levels of the pro-inflammatory cytokines IL-1β and IL-6, and the anti-inflammatory cytokine IL-10, prior to chocolate intake as well as before and several times after stress. We also repeatedly measured the flavanol epicatechin and the stress hormones epinephrine and cortisol in plasma and saliva, respectively. Compared to the placebo-chocolate-group, the dark-chocolate-group revealed a marginal increase in IL-10 mRNA prior to stress (p=0.065), and a significantly blunted stress reactivity of NF-κB-BA, IL-1β mRNA, and IL-6 mRNA (p's⩽0.036) with higher epicatechin levels relating to lower pro-inflammatory stress reactivity (p's⩽0.033). Stress hormone changes to stress were controlled. None of the other measures showed a significant chocolate effect (p's⩾0.19). Our findings indicate that acute flavanol-rich dark chocolate exerts anti-inflammatory effects both by increasing mRNA expression of the anti-inflammatory cytokine IL-10 and by attenuating the intracellular pro-inflammatory stress response. This mechanism may add to beneficial effects of dark chocolate on cardiovascular health.

Impact of Cocoa Consumption on Inflammation Processes-A Critical Review of Randomized Controlled Trials

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.

Daily chocolate consumption is inversely associated with insulin resistance and liver enzymes in the Observation of Cardiovascular Risk Factors in Luxembourg study

This study examined the association of chocolate consumption with insulin resistance and serum liver enzymes in a national sample of adults in Luxembourg. A random sample of 1153 individuals, aged 18–69 years, was recruited to participate in the cross-sectional Observation of Cardiovascular Risk Factors in Luxembourg study. Chocolate consumption (g/d) was obtained from a semi-quantitative FFQ. Blood glucose and insulin levels were used for the homoeostasis model assessment of insulin resistance (HOMA-IR). Hepatic biomarkers such as serum γ-glutamyl-transpeptidase (γ-GT), serum aspartate transaminase and serum alanine transaminase (ALT) (mg/l) were assessed using standard laboratory assays. Chocolate consumers (81·8 %) were more likely to be younger, physically active, affluent people with higher education levels and fewer chronic co-morbidities. After excluding subjects taking antidiabetic medications, higher chocolate consumption was associated with lower HOMA-IR (β=−0·16, P=0·004), serum insulin levels (β=−0·16, P=0·003) and γ-GT (β=−0·12, P=0·009) and ALT (β=−0·09, P=0·004), after adjustment for age, sex, education, lifestyle and dietary confounding factors, including intakes of fruits and vegetables, alcohol, polyphenol-rich coffee and tea. This study reports an independent inverse relationship between daily chocolate consumption and levels of insulin, HOMA-IR and liver enzymes in adults, suggesting that chocolate consumption may improve liver enzymes and protect against insulin resistance, a well-established risk factor for cardiometabolic disorders. Further observational prospective research and well-designed randomised-controlled studies are needed to confirm this cross-sectional relationship and to comprehend the role and mechanisms that different types of chocolate may play in insulin resistance and cardiometabolic disorders.

Cocoa agronomy, quality, nutritional, and health aspects

The history of cocoa and chocolate including the birth and the expansion of the chocolate industry was described. Recent developments in the industry and cocoa economy were briefly depicted. An overview of the classification of cacao as well as studies on phenotypic and genetic diversity was presented. Cocoa agronomic practices including traditional and modern propagation techniques were reviewed. Nutrition-related health benefits derived from cocoa consumption were listed and widely reviewed. The specific action of cocoa antioxidants was compared to those of teas and wines. Effects of adding milk to chocolate and chocolate drinks versus bioavailability of cocoa polyphenols were discussed. Finally, flavor, sensory, microbiological, and toxicological aspects of cocoa consumption were presented.

Macro- and Microelemental Composition and Toxicity of Unsweetened Natural Cocoa Powder in Sprague-Dawley Rats

Unsweetened natural cocoa powder (UNCP) is a pulverized high-grade powder of compressed solid blocks which remains after extraction. Little scientific data is available concerning its safety despite the presence of potential toxic elements. Elemental composition in UNCP was analyzed with ED-XRF spectroscopy. Single oral high dose toxicity study was conducted on adult male Sprague-Dawley rats (150 g) by the limit test method. One group received water and the test group 2000 mg/kg UNCP. All animals were observed for 14 days and then euthanized for haematological, biochemical, and histopathological examinations. Thirty-eight (38) elements were found in UNCP. There was an increase in HDL cholesterol (p < 0.05), reduction in LDL cholesterol (p > 0.05), alkaline phosphatase (p < 0.05), and creatinine levels, and slight increase in urea levels (p > 0.05). Haematological changes were not significant. Histopathological analysis showed no toxic effect on the heart, liver, kidney, lungs, testis, and spleen. Intestinal erosion was observed in the test group. UNCP appears to be relatively safe when taken as a single oral high dose of 2000 mg/kg b.w.t. in rats. Caution should however be exercised at high doses due to the high elemental content of copper and high possibility of intestinal lining erosion.