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Cooke CB, Greatwood HC, McCullough D, Kirwan R, Duckworth LC, Sutton L, Gately PJ. The effect of discretionary snack consumption on overall energy intake, weight status, and diet quality: A systematic review. Obes Rev 2024; 25:e13693. [PMID: 38226404 DOI: 10.1111/obr.13693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/27/2023] [Accepted: 12/02/2023] [Indexed: 01/17/2024]
Abstract
The consumption frequency and portion size of discretionary snacks are thought to contribute to a greater food intake and risk of overweight or obesity in the developed world but evidence from epidemiological studies is inconclusive. To investigate this, we systematically evaluated evidence on the effects of discretionary snack consumption on weight status, energy intake, and diet quality. Articles involving discretionary snacks reported against the outcome measures of any primary, peer-reviewed study using human participants from free-living conditions for all age groups were included. A total of 14,780 titles were identified and 40 eligible publications were identified. Three key outcomes were reported: weight status (n = 35), energy intake (n = 11), and diet quality (n = 3). Increased discretionary snack consumption may contribute modestly to energy intake, however, there is a lack of consistent associations with increased weight/BMI. Although cross-sectional analyses offered conflicting findings, longitudinal studies in adults showed a consistent positive relationship between discretionary snack intake and increasing weight or body mass index. Given that experimental findings suggest reducing the size of discretionary snacks could lead to decreased consumption and subsequent energy intake, food policy makers and manufacturers may find it valuable to consider altering the portion and/or packaging size of discretionary snacks.
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Affiliation(s)
- Carlton B Cooke
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | | | | | - Richard Kirwan
- School of Sports and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | | | - Louise Sutton
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Paul J Gately
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
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2
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Condori D, Espichan F, Macassi ALS, Carbajal L, Rojas R. Study of the post-harvest processes of the peruvian chuncho cocoa using multivariate and multi-block analysis. Food Chem 2024; 431:137123. [PMID: 37573746 DOI: 10.1016/j.foodchem.2023.137123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/15/2023]
Abstract
A screening of 24 Chuncho cacao postharvest processes was carried out and three treatments were identified with the best levels of functional non-volatile metabolites and the best profile of volatile metabolites. The relationship between the sensory profile of flavor and aroma, volatile and non-volatile metabolites was investigated by multiblock analysis. The most prominent volatile metabolites were benzaldehyde (Bz), 2,3,5-trimethylpyrazine (TriMP), 2,3,5,6-tetramethylpyrazine (TetraMP), myrcene (Myr), limonene (LM), ethylphenyl acetate (EpHAc) and 2-phenylethyl acetate (pHEthAc), and functional nonvolatile metabolites were total flavonoids (Tflav), total polyphenols (TppH), catechins (Cat), epicatechin (EpCat), caffeine (Caf), and theobromine (TeoB). Sensory analysis by MFA (multiple factorial analysis) allowed checking the substrates of the metabolites and highlighting correlated flavor and aroma descriptors. Based on multiblock analysis, four new descriptors were identified for Bz, Myr, and LM, such as nut, astringent, bitter, and crude. For TetraMP the fruity flavor was identified and for TriMP it was identified as Malt flavor. For Cat, EpCat, Caf, TeoB, Tflav, and TppH, the descriptors bitter, astringent, floral, and fruity were identified. This study will allow Chuncho cocoa farmers and producers to have a cocoa paste production scheme with a high value of functional metabolites and sensory profile, and value this Peruvian accession.
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Affiliation(s)
| | | | | | - Luz Carbajal
- Universidad Peruana Cayetano Heredia (UPCH), Peru.
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Li J, Sesso HD, Kim E, Manson JE, Friedenberg G, Clar A, Copeland T, Shadyab AH, Wactawski-Wende J, Tinker L, Liu S. Cocoa Extract Supplementation and Risk of Type 2 Diabetes: The Cocoa Supplement and Multivitamin Outcomes Study (COSMOS) Randomized Clinical Trial. Diabetes Care 2023; 46:2278-2284. [PMID: 37816167 DOI: 10.2337/dc23-1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/22/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVE Observational studies have indicated that cocoa flavanol supplementation may be a promising strategy for type 2 diabetes (T2D) prevention. We aimed to directly evaluate its clinical efficacy in a large randomized clinical trial (RCT). RESEARCH DESIGN AND METHOD The Cocoa Supplement and Multivitamin Outcomes Study (COMSOS) was a 2 × 2 factorial RCT performed from June 2015 to December 2020 that tested cocoa extract and a multivitamin for the prevention of cardiovascular disease (CVD) and cancer. A total of 21,442 U.S. adults free of CVD and recent cancer, including 12,666 women aged ≥65 years and 8,776 men aged ≥60 years, were randomly assigned to receive cocoa extract [500 mg/day cocoa flavanols, including 80 mg (-)-epicatechin] or placebo. In this study, we included 18,381 participants without diabetes at enrollment and examined the effect of cocoa extract supplementation on incident self-reported T2D in intention-to-treat analyses. RESULTS During a median follow-up of 3.5 years, 801 incident T2D cases were reported. Compared with placebo, taking a cocoa extract supplement did not reduce T2D (adjusted hazard ratio 1.04, 95% CI 0.91-1.20, P = 0.58). Stratification analyses showed that the effect of cocoa extract supplementation was not significantly modified by sex, race, BMI, smoking, physical activity, dietary quality, flavanol status at baseline, or randomized multivitamin assignment. CONCLUSIONS Middle-aged and older adults taking a cocoa extract supplement for a median of 3.5 years did not reduce their risk of incident T2D. Further studies of cocoa extract supplementation beginning earlier in adulthood and in populations with different background diets are warranted.
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Affiliation(s)
- Jie Li
- Department of Epidemiology and Center for Global Cardiometabolic Health, School of Public Health, Brown University, Providence, RI
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Howard D Sesso
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Eunjung Kim
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Georgina Friedenberg
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Allison Clar
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Trisha Copeland
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | - Jean Wactawski-Wende
- School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - Lesley Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Simin Liu
- Department of Epidemiology and Center for Global Cardiometabolic Health, School of Public Health, Brown University, Providence, RI
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Medicine, The Warrant Alpert School of Medicine, Brown University, Providence, RI
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Kanno K, Kayashima Y, Tamura K, Miyara T, Baba K, Koganei M, Natsume M, Imai S. Fatty acid tryptamide from cacao elongates Drosophila melanogaster lifespan with sirtuin-dependent heat shock protein expression. Sci Rep 2022; 12:12080. [PMID: 35840713 PMCID: PMC9287426 DOI: 10.1038/s41598-022-16471-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
Life span is increasing in developed countries as Japan, and an aging society is becoming a problem. In fact, healthy lifespan is not extended, and it is desired to extend it by functional food. Cacao (Theobroma cacao) contains various active components and is considered a preventative agent against metabolic disease. In addition, it has long been thought that regular cacao intake extends a healthy lifespan. However, there is no direct evidence for this belief. The purpose of this study is to identify the cacao component that elongate the lifespan of D. melanogaster as a model organism and to elucidate its functional mechanism. The activation of sirtuins, a family of NAD+-dependent deacetylases, has been reported to extend the lifespans of various organisms. Heat shock factor 1 is known to be deacetylated by reaction with sirtuins, thereby inducing gene expression of various heat shock proteins by heat stress and effectively extending the lifespan of organisms. Therefore, we evaluated whether components in cacao activate sirtuins and extend the lifespan of D. melanogaster. In the process, we discovered the fatty acid tryptamide as a lifespan-elongating component of cacao. Therefore, we investigated whether the fatty acid tryptamide from cacao upregulates the genes of heat shock proteins. As a result, it was confirmed that the gene expression of multiple heat shock proteins was significantly increased. This suggests that fatty acid tryptamide may activate sirtuins, increase gene expression of heat shock proteins, and elongate the lifespan of D. melanogaster.
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Affiliation(s)
- Kiko Kanno
- School of Bioscience and Biotechnology, Tokyo University of Technology, 1404-1, Katakura, Hachioji, Tokyo, 192-0982, Japan
| | - Yasunari Kayashima
- Department of Food and Nutrition, Yamanashi Gakuin Junior College, 2-4-5 Sakaori, Kofu-shi, Yamanashi, 400-8575, Japan
| | - Kazuji Tamura
- Meiji.Co., Ltd., 1-29-1, Nanakuni, Hachioji, Tokyo, 192-0919, Japan
| | - Takako Miyara
- Meiji Seika Pharma Co., Ltd., 788, Kayama, Odawara, Kanagawa, 250-0852, Japan
| | - Kento Baba
- Meiji.Co., Ltd., 1-29-1, Nanakuni, Hachioji, Tokyo, 192-0919, Japan
| | - Megumi Koganei
- Meiji.Co., Ltd., 1-29-1, Nanakuni, Hachioji, Tokyo, 192-0919, Japan
| | - Midori Natsume
- Meiji.Co., Ltd., 1-29-1, Nanakuni, Hachioji, Tokyo, 192-0919, Japan
| | - Shinjiro Imai
- School of Bioscience and Biotechnology, Tokyo University of Technology, 1404-1, Katakura, Hachioji, Tokyo, 192-0982, Japan.
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5
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Chen X, Guan X, Tang Y, Deng J, Zhang X. Effects of cocoa products intake on cardiometabolic biomarkers of type 2 diabetes patients: a systematic review and meta-analysis based on both long-term and short-term randomised controlled trials. Int J Food Sci Nutr 2022; 73:571-587. [DOI: 10.1080/09637486.2022.2046711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Xiaoli Chen
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaoxian Guan
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yujun Tang
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Jinlan Deng
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaofeng Zhang
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
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6
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Martin MÁ, Ramos S. Impact of cocoa flavanols on human health. Food Chem Toxicol 2021; 151:112121. [PMID: 33722594 DOI: 10.1016/j.fct.2021.112121] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 01/18/2023]
Abstract
Cocoa is a source of flavanols, and these phenolic compounds exert beneficial effects on health and aging, and reduce the risk of suffering chronic diseases (cardiovascular diseases, metabolic disorders, cancer). An increasing body of evidence has emerged to suggest that cocoa flavanols potentially are important chemopreventive natural agents. This review summarizes human studies from the past two decades, providing data related to the effects derived from cocoa intake on health and disease. Most human studies have reported beneficial effects of cocoa consumption on health and chronic diseases; however, outcomes are not unequivocal. Review of human studies enable to identify different mechanisms of action for cocoa, although they are not fully understood at present. In addition, it remains unclear whether cocoa consumption should be recommended to healthy subjects or to patients and what is the appropriate dosage or duration of cocoa consumption. Elucidation of information regarding these crucial issues could lead to cocoa use as an approach for decreasing the risk of certain chronic diseases, as well as improving health and quality of life.
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Affiliation(s)
- María Ángeles Martin
- Department of Metabolism and Nutrition, Institute of Food Science and Technology and Nutrition (ICTAN-CSIC), José Antonio Novais 10, Ciudad Universitaria, 28040, Madrid, Spain; Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Sonia Ramos
- Department of Metabolism and Nutrition, Institute of Food Science and Technology and Nutrition (ICTAN-CSIC), José Antonio Novais 10, Ciudad Universitaria, 28040, Madrid, Spain.
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7
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Ho YL, Nguyen XMT, Yan JQ, Vassy JL, Gagnon DR, Gaziano JM, Wilson PWF, Cho K, Djoussé L. Chocolate consumption and risk of coronary artery disease: the Million Veteran Program. Am J Clin Nutr 2021; 113:1137-1144. [PMID: 34483344 PMCID: PMC8412179 DOI: 10.1093/ajcn/nqaa427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Although previous studies have suggested cocoa products may promote cardiovascular health in the general population, no public data are available from patients receiving care in a national integrated health care system. Objectives We tested the hypothesis that regular chocolate consumption is associated with a lower risk of coronary artery disease (CAD) events among participants of the Million Veteran Program (MVP). Secondary analysis examined if the main hypothesis was observed among participants with type 2 diabetes. Methods We analyzed data from MVP participants who completed the food frequency section of the MVP Lifestyle Survey and were free of CAD at the time of survey completion. CAD events during follow-up (International Statistical Classification of Diseases Ninth Revision codes 410-411 and 413-414, and Tenth Revision codes I20-I25 except I25.2) were assessed using electronic health records. We fitted a Cox proportional hazard model to estimate the RR of CAD. Results Of 188,447 MVP enrollees with survey data, mean ± SD age was 64 ± 12.0 y and 90% were men. For regular chocolate (28.3 g/serving) consumption of <1 serving/mo, 1-3 servings/mo, 1 serving/wk, 2-4 servings/wk, and ≥5 servings/wk, crude incidence rates (per 1000 person-years) for fatal and nonfatal CAD events or coronary procedures were 20.2, 17.5, 16.7, 17.1, and 16.9, respectively, during a mean follow-up of 3.2 y. After adjusting for age, sex, race, and lifestyle factors, the corresponding HRs (95% CIs) were 1.00 (ref), 0.92 (0.87, 0.96), 0.88 (0.83, 0.93), 0.89 (0.84, 0.95), and 0.89 (0.84, 0.96), respectively (P for linear trend < 0.0001). In a secondary analysis of 47,265 diabetics, we did not observe a decreasing trend in CAD mortality among those who consumed ≥1 serving of chocolate a month compared with those who consumed <1 serving/mo. Conclusions Regular chocolate consumption was associated with a lower risk of CAD among veterans, but was not associated with cardiovascular disease risk in veterans with type 2 diabetes.
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Affiliation(s)
- Yuk-Lam Ho
- Address correspondence to Y-LH (e-mail: )
| | - Xuan-Mai T Nguyen
- VA Boston Healthcare System, Boston, MA, USA,Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | | | - Jason L Vassy
- VA Boston Healthcare System, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - David R Gagnon
- VA Boston Healthcare System, Boston, MA, USA,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - J Michael Gaziano
- VA Boston Healthcare System, Boston, MA, USA,Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter W F Wilson
- Atlanta VA Medical Center, Atlanta, GA, USA,School of Medicine, Emory University, Atlanta, GA, USA,School of Public Health, Emory University, Atlanta, GA, USA
| | - Kelly Cho
- VA Boston Healthcare System, Boston, MA, USA,Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Luc Djoussé
- VA Boston Healthcare System, Boston, MA, USA,Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
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8
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Kim N, Jeon MS. Chocolate consumption and the prevalence of metabolic syndrome in the Korean adult population: an analysis based on the 2014-2016 Korea National Health and Nutrition Examination Survey. Nutr Res Pract 2020; 15:80-94. [PMID: 33542794 PMCID: PMC7838477 DOI: 10.4162/nrp.2021.15.1.80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/16/2020] [Accepted: 05/29/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND/OBJECTIVES Recent studies have reported chocolate consumption has beneficial effects on blood pressure, obesity, and dyslipidemia, which are components of metabolic syndrome (MetS). However, evidence regarding these relationships in Asia is limited. The aim of this study was to investigate relations between chocolate consumption and MetS in Korea. SUBJECTS/METHODS Study subjects were 6,982 adults aged 19-64 years free of major chronic diseases that participated in the 2014-2016 Korea National Health and Nutrition Examination Survey. Information on chocolate consumption was obtained using food frequency questionnaires. For primary analysis, subjects were divided into two groups: non-consumer (n = 3,741, 53.6%); consumer (n = 3,241, 46.4%). In order to investigate dose-response effects on MetS, chocolate consumers were divided into quartiles based on amounts consumed: Q1 (n = 789, 24.3%); Q2 (n = 837, 25.8%); Q3 (n = 863, 26.6%); Q4 (n = 752, 23.2%) in second analysis. RESULTS Chocolate consumers; 1) were more physically active(P < 0.0001); 2) less likely to smoke(P < 0.0001); 3) paid more attention to food nutrition labels (P < 0.0001), and 4) had healthier dietary patterns, that is, they consumed vegetables, fruits, and dairy products more frequently(P < 0.0001) than non-consumers. Furthermore, chocolate consumers had a 30% lower risk of MetS (odds ratio, 0.70; 95% confidence interval, 0.58-0.86; P = 0.0005). However, dose-response effects between chocolate intake and MetS was not found by secondary analysis after excluding non-consumers. CONCLUSIONS In conclusion, chocolate consumers had healthier lifestyles and dietary patterns and a lower prevalence of MetS than non-consumers, as determined by our primary analysis. Although dose-response effects were not found to be significant among chocolate consumers during secondary analysis, the patterns were partially similar. This cross-sectional finding shows chocolate consumption does not increase the risk of MetS. The prospective studies and intervention trials in Korea are needed to confirm this cross-sectional finding.
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Affiliation(s)
- NaRae Kim
- Department of Food and Nutrition, Chungnam National University, Daejeon 34134, Korea
| | - Min-Sun Jeon
- Department of Food and Nutrition, Chungnam National University, Daejeon 34134, Korea
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9
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Morze J, Schwedhelm C, Bencic A, Hoffmann G, Boeing H, Przybylowicz K, Schwingshackl L. Chocolate and risk of chronic disease: a systematic review and dose-response meta-analysis. Eur J Nutr 2020; 59:389-397. [PMID: 30805697 PMCID: PMC7000512 DOI: 10.1007/s00394-019-01914-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/23/2019] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
- Jakub Morze
- Department of Human Nutrition, University of Warmia and Mazury, ul. Sloneczna 45f, 10-718, Olsztyn, Poland
| | - Carolina Schwedhelm
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, 14458, Nuthetal, Germany
| | - Aleksander Bencic
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
| | - Georg Hoffmann
- Department of Nutritional Sciences, University of Vienna, Althanstraße 14, UZA II, 1090, Vienna, Austria
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
| | - Katarzyna Przybylowicz
- Department of Human Nutrition, University of Warmia and Mazury, ul. Sloneczna 45f, 10-718, Olsztyn, Poland
| | - Lukas Schwingshackl
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany.
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, 14458, Nuthetal, Germany.
- Institute for Evidence in Medicine, Medical Center, University of Freiburg, Breisacher Straße 153, 79110, Freiburg, Germany.
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10
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Montagna MT, Diella G, Triggiano F, Caponio GR, Giglio OD, Caggiano G, Ciaula AD, Portincasa P. Chocolate, "Food of the Gods": History, Science, and Human Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16244960. [PMID: 31817669 PMCID: PMC6950163 DOI: 10.3390/ijerph16244960] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 02/06/2023]
Abstract
Chocolate is well known for its fine flavor, and its history began in ancient times, when the Maya considered chocolate (a cocoa drink prepared with hot water) the "Food of the Gods". The food industry produces many different types of chocolate: in recent years, dark chocolate, in particular, has gained great popularity. Interest in chocolate has grown, owing to its physiological and potential health effects, such as regulation of blood pressure, insulin levels, vascular functions, oxidation processes, prebiotic effects, glucose homeostasis, and lipid metabolism. However, further translational and epidemiologic studies are needed to confirm available results and to evaluate other possible effects related to the consumption of cocoa and chocolate, verifying in humans the effects hitherto demonstrated only in vitro, and suggesting how best to consume (in terms of dose, mode, and time) chocolate in the daily diet.
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Affiliation(s)
- Maria Teresa Montagna
- Department of Biomedical Sciences and Human Oncology, Section of Hygiene, University of Bari Aldo Moro, Medical School, Piazza G. Cesare 11, 70124 Bari, Italy; (G.D.); (F.T.); (O.D.G.); (G.C.)
- Correspondence: (M.T.M.); (P.P.); Tel.: +39-080-547-8476 (M.T.M.); +39-080-547-8293 (P.P.)
| | - Giusy Diella
- Department of Biomedical Sciences and Human Oncology, Section of Hygiene, University of Bari Aldo Moro, Medical School, Piazza G. Cesare 11, 70124 Bari, Italy; (G.D.); (F.T.); (O.D.G.); (G.C.)
| | - Francesco Triggiano
- Department of Biomedical Sciences and Human Oncology, Section of Hygiene, University of Bari Aldo Moro, Medical School, Piazza G. Cesare 11, 70124 Bari, Italy; (G.D.); (F.T.); (O.D.G.); (G.C.)
| | - Giusy Rita Caponio
- Department of Biomedical Sciences and Human Oncology, Clinica Medica “A. Murri”, University of Bari Aldo Moro, Medical School, Piazza G. Cesare 11, 70124 Bari, Italy; (G.R.C.); (A.D.C.)
- Department of Soil, Plant and Food Science (DISSPA), University of Bari Aldo Moro, Via Amendola 165/a, 70126 Bari, Italy
| | - Osvalda De Giglio
- Department of Biomedical Sciences and Human Oncology, Section of Hygiene, University of Bari Aldo Moro, Medical School, Piazza G. Cesare 11, 70124 Bari, Italy; (G.D.); (F.T.); (O.D.G.); (G.C.)
| | - Giuseppina Caggiano
- Department of Biomedical Sciences and Human Oncology, Section of Hygiene, University of Bari Aldo Moro, Medical School, Piazza G. Cesare 11, 70124 Bari, Italy; (G.D.); (F.T.); (O.D.G.); (G.C.)
| | - Agostino Di Ciaula
- Department of Biomedical Sciences and Human Oncology, Clinica Medica “A. Murri”, University of Bari Aldo Moro, Medical School, Piazza G. Cesare 11, 70124 Bari, Italy; (G.R.C.); (A.D.C.)
| | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, Clinica Medica “A. Murri”, University of Bari Aldo Moro, Medical School, Piazza G. Cesare 11, 70124 Bari, Italy; (G.R.C.); (A.D.C.)
- Correspondence: (M.T.M.); (P.P.); Tel.: +39-080-547-8476 (M.T.M.); +39-080-547-8293 (P.P.)
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11
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Abstract
Cardiovascular diseases are the main cause of deaths in highly developed countries. Dietetic interventions that involve recommendations for consumption of products with a confirmed health-improving action are an important aspect of prevention of cardiovascular diseases. Cocoa is an alimentary product with significant cardioprotective potential due to its high content of bioactive compounds. The aim of the present study was to review the most recent literature concerning the effectiveness and mechanisms of action of compounds contained in cocoa with regard to selected cardiovascular risk factors and cardiometabolic markers. Study results indicate that cocoa consumption, especially in the form of dark chocolate with high flavonoid content, may be a good strategy to diminish cardiovascular risk due to its beneficial effect on platelet aggregation, decreasing blood pressure, diminishing dyslipidemia, and decreasing blood plasma glucose concentration. Many studies have shown that cocoa-derived flavonoids have antioxidant and anti-inflammatory activity and also play a significant role in preventing insulin resistance. However, in order to completely confirm the potential cardiovascular benefits, it is necessary to conduct larger and longer studies, also with regard to potential dangers associated with long-term consumption of large amounts of flavonoids and determination of a safe and effective dose. Key teaching points Cocoa consumption may be a good strategy in diminishing cardiovascular risk. Beneficial effects on platelet aggregation, blood pressure, dyslipidemia, glycemia, as well as antioxidant and anti-inflammatory activity are observed. There is a need to conduct larger and longer studies to determine a safe and effective dose of cocoa flavonoids.
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Affiliation(s)
- Kinga Zięba
- a SWPS University of Social Sciences and Humans , Chodakowska , Warsaw , Poland
| | - Magdalena Makarewicz-Wujec
- b Department of Clinical Pharmacy and Pharmaceutical Care, Medical University of Warsaw Banacha 1 , Warsaw , Poland
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Intake of cocoa products and risk of type-2 diabetes: the multiethnic cohort. Eur J Clin Nutr 2018; 73:671-678. [PMID: 29795238 DOI: 10.1038/s41430-018-0188-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/30/2018] [Accepted: 03/11/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND/OBJECTIVES As cocoa products may be protective against chronic disease due to their polyphenol content, the current study determined the association of chocolate consumption and flavanol intake with type-2 diabetes (T2D) incidence in the Multiethnic Cohort (MEC) Study. SUBJECTS/METHODS The analysis included 151,691 participants of Native Hawaiian, Japanese American, Latino, African American, and white ancestry with 8487 incident T2D cases after 7.8 ± 3.5 years of follow-up. T2D status was based on three self-reports and confirmed by at least one of three administrative data sources. Dietary intake was assessed using a validated quantitative food frequency questionnaire, and flavanols from cocoa products were estimated from self-reported consumption of chocolate candy and drinks. Cox hazard regression, adjusted for potential confounders was applied to estimate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS For chocolate candy, both the highest vs. lowest (≥10 vs. <1 g/day) consumption (HR = 0.90; 95% CI, 0.83-0.97; ptrend = 0.01) and the frequency (≥4/week vs. <1/month) of intake (HR = 0.81; 95% CI, 0.72-0.91; ptrend = 0.0002) were inversely associated with T2D. The estimated flavanol intake from cocoa products (≥3 vs. <1 mg/day) also showed an inverse association with T2D risk (HR = 0.93; 95% CI, 0.88-0.99; ptrend = 0.02). Significant interaction terms indicated that the inverse relation was limited to Japanese Americans, normal-weight individuals, and to those without comorbidities. CONCLUSIONS The current study confirms previous reports that participants with high intake of chocolate products and cocoa-derived flavanols experience a reduced risk of developing T2D even after controlling for sugar intake, diet quality, and other aspects of the diet.
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Effects of Cocoa Antioxidants in Type 2 Diabetes Mellitus. Antioxidants (Basel) 2017; 6:antiox6040084. [PMID: 29088075 PMCID: PMC5745494 DOI: 10.3390/antiox6040084] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/27/2017] [Accepted: 10/27/2017] [Indexed: 02/05/2023] Open
Abstract
Type 2 Diabetes mellitus (T2D) is the most common form of diabetes and one of the most common chronic diseases. Control of hyperglycaemia by hypoglycaemic drugs is insufficient in for patients and nutritional approaches are currently being explored. Natural dietary compounds such as flavonoids, abundant in fruits and vegetables, have received broad attention because of their potential capacity to act as anti-diabetic agents. Especially cocoa flavonoids have been proved to ameliorate important hallmarks of T2D. In this review, an update of the most relevant reports published during the last decade in cell culture, animal models and human studies is presented. Most results support an anti-diabetic effect of cocoa flavonoids by enhancing insulin secretion, improving insulin sensitivity in peripheral tissues, exerting a lipid-lowering effect and preventing the oxidative and inflammatory damages associated to the disease. While it could be suggested that daily consumption of flavanols from cocoa or dark chocolate would constitute a potential preventive tool useful for the nutritional management of T2D, this recommendation should be cautious since most of commercially available soluble cocoa products or chocolates contain low amount of flavanols and are rich in sugar and calories that may aggravate glycaemic control in T2D patients.
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Protective effects of tea, red wine and cocoa in diabetes. Evidences from human studies. Food Chem Toxicol 2017; 109:302-314. [PMID: 28893620 DOI: 10.1016/j.fct.2017.09.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 12/14/2022]
Abstract
Prevention of diabetes through the diet has recently received an increasing interest, and polyphenolic compounds, such as flavanols, have become important potential chemopreventive natural agents due to their proved benefits on health, with low toxicity and cost. Tea, red wine and cocoa are good sources of flavanols and these highly consumed foods might contribute to prevent diabetes. In this regard, there is increasing evidence for a protective effect of tea, red wine and cocoa consumption against this disorder. This review summarizes the available epidemiological and interventional human studies providing evidence for and against this effect. Overall observational data suggest a benefit, but results are still equivocal and likely confounded by lifestyle and background dietary factors. The weight of data indicate favourable effects on diabetes risk factors for tea, red wine and cocoa intake, and a number of plausible mechanisms have been elucidated in human studies. However, despite the growing evidence it remains uncertain whether tea, red wine and cocoa consumption should be recommended to the general population or to patients as a strategy to reduce the risk of diabetes.
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Chocolate Consumption and Risk of Coronary Heart Disease, Stroke, and Diabetes: A Meta-Analysis of Prospective Studies. Nutrients 2017; 9:nu9070688. [PMID: 28671591 PMCID: PMC5537803 DOI: 10.3390/nu9070688] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/18/2017] [Accepted: 06/28/2017] [Indexed: 12/12/2022] Open
Abstract
Although epidemiological studies have examined the role of chocolate in preventing cardiometabolic disease, the results remain inconsistent. Herein, we conducted a meta-analysis of prospective studies to determine the association between chocolate intake and risk of coronary heart disease (CHD), stroke, and diabetes. A systematical search in PubMed and Embase through March 2017, together with reference scrutiny of relevant literatures, was performed to identify eligible studies. Relative risks (RRs) and 95% confidence intervals (CIs) were pooled using random effect models. Fourteen prospective studies of primary prevention with 508,705 participants were finally included, with follow-up durations ranging from 5 to 16 years. The summary RRs for the highest versus lowest chocolate consumption were 0.90 (95% CI: 0.82–0.97; n = 6) for CHD, 0.84 (95% CI: 0.78–0.90; n = 7) for stroke, and 0.82 (95% CI: 0.70–0.96; n = 5) for diabetes. Dose–response meta-analysis suggested a nonlinear association of chocolate consumption with all outcomes. For both CHD and stroke, there was little additional risk reduction when consuming chocolate ≥3 servings/week (one serving was defined as 30 g of chocolate). For diabetes, the peak protective effect of chocolate emerged at 2 servings/week (RR: 0.75, 95% CI: 0.63–0.89), with no benefit observed when increasing consumption above 6 servings/week. In conclusion, chocolate intake is associated with decreased risks of CHD, stroke, and diabetes. Consuming chocolate in moderation (≤6 servings/week) may be optimal for preventing these disorders.
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Greenberg JA, Manson JE, Tinker L, Neuhouser ML, Garcia L, Vitolins MZ, Phillips LS. Chocolate intake and diabetes risk in postmenopausal American women. Eur J Clin Nutr 2017; 71:1088-1093. [DOI: 10.1038/ejcn.2017.36] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/20/2017] [Accepted: 02/25/2017] [Indexed: 01/01/2023]
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Martín MÁ, Ramos S. Health beneficial effects of cocoa phenolic compounds: a mini-review. Curr Opin Food Sci 2017. [DOI: 10.1016/j.cofs.2016.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Moreno-Ulloa A, Moreno-Ulloa J. Mortality reduction among persons with type 2 diabetes: (−)-Epicatechin as add-on therapy to metformin? Med Hypotheses 2016; 91:86-89. [DOI: 10.1016/j.mehy.2016.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 04/11/2016] [Indexed: 02/05/2023]
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Khawaja O, Petrone AB, Kanjwal Y, Gaziano JM, Djoussé L. Chocolate Consumption and Risk of Atrial Fibrillation (from the Physicians' Health Study). Am J Cardiol 2015; 116:563-6. [PMID: 26076989 DOI: 10.1016/j.amjcard.2015.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 05/14/2015] [Accepted: 05/14/2015] [Indexed: 02/05/2023]
Abstract
Chocolate consumption has been shown to protect against various cardiovascular end points; however, little is known about the association between chocolate consumption and incident atrial fibrillation (AF). Therefore, we prospectively examined the association between chocolate consumption and incident AF in a cohort of 18,819 US male physicians. Chocolate consumption was ascertained from 1999 to 2002 through a self-administered food frequency questionnaire. Incident AF was ascertained through yearly follow-up questionnaires. Cox regression was used to estimate relative risks of AF. The average age at baseline was 66 years (±9.1). During a mean follow-up of 9.0 years (±3.0), 2,092 cases of AF occurred. Using <1 per month of chocolate consumption as the reference group, multivariable adjusted hazard ratios (95% confidence interval) for AF were 1.04 (0.93 to 1.18), 1.10 (0.96 to 1.25), 1.14 (0.99 to 1.31), and 1.05 (0.89 to 1.25) for chocolate intake of 1 to 3 per month and 1, 2 to 4, and ≥5 per week (p for trend 0.25), respectively. In a secondary analysis, there was no evidence of effect modification by adiposity (p interaction = 0.71) or age (p interaction = 0.26). In conclusion, our data did not support an association between chocolate consumption and risk of AF in US male physicians.
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