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Flavonoid-Rich Cocoa Consumption Affects Multiple Cardiovascular Risk Factors in a Meta-Analysis of Short-Term Studies
Open accessAbstract
A growing body of evidence suggests that the consumption of foods rich in polyphenolic compounds, particularly cocoa, may have cardioprotective effects. No review, however, has yet examined the effect of flavonoid-rich cocoa (FRC) on all major cardiovascular risk factors or has examined potential dose-response relationships for these effects. A systematic review and meta-analysis of randomized, controlled trials was performed to evaluate the effect of FRC on cardiovascular risk factors and to assess a dose-response relationship. Inclusion and exclusion criteria as well as dependent and independent variables were determined a priori. Data were collected for: blood pressure, pulse, total cholesterol, HDL cholesterol, LDL cholesterol, TG, BMI, C-reactive protein, flow-mediated vascular dilation (FMD), fasting glucose, fasting insulin, serum isoprostane, and insulin sensitivity/resistance indices. Twenty-four papers, with 1106 participants, met the criteria for final analysis. In response to FRC consumption, systolic blood pressure decreased by 1.63 mm Hg (P = 0.033), LDL cholesterol decreased by 0.077 mmol/L (P = 0.038), and HDL cholesterol increased by 0.046 mmol/L (P = 0.037), whereas total cholesterol, TG, and C-reactive protein remained the same. Moreover, insulin resistance decreased (HOMA-IR: -0.94 points; P < 0.001), whereas FMD increased (1.53%; P < 0.001). A nonlinear dose-response relationship was found between FRC and FMD (P = 0.004), with maximum effect observed at a flavonoid dose of 500 mg/d; a similar relationship may exist with HDL cholesterol levels (P = 0.06). FRC consumption significantly improves blood pressure, insulin resistance, lipid profiles, and FMD. These short-term benefits warrant larger long-term investigations into the cardioprotective role of FRC.
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“A few short-term trials of other dietary sources (e.g., tea, red wine, grapes) or specific flavonoid extracts have not consistently improved BP, lipid levels, or endothelial function.295-297”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [295]
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“In laboratory studies and randomized trials, flavonoid-rich cocoa has small but measurable benefits on BP, endothelial function, insulin resistance, and blood lipids.295-297”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [295]
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Metadata
- Authors
- Shrime, M. G., Bauer, S. R., McDonald, A. C., Chowdhury, N. H., Coltart, C. E. M., & Ding, E. L.
- Affiliations
- Harvard University (US)
- Brigham and Women's Hospital (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Shrime, Mark G.
- Ding, Eric L.
- Venue
- The Journal of Nutrition
- Publisher
- Elsevier BV
- Published
- 2011-11
- Volume
- 141
- Issue
- 11
- Pages
- 1982-1988
- ISSN
- 0022-3166 (ISSN-L)
- OpenAlex
- W2149628027
- Cited by
- 234
- References
- 41
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 11 · 2023: 8 · 2022: 13 · 2021: 11 · 2020: 12 · 2019: 17 · 2018: 23 · 2017: 27 · 2016: 23 · 2015: 17 · 2014: 22 · 2013: 27 · 2012: 14
- FWCI
- 1.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Biochemistry (medical) › Phytochemicals and Antioxidant Activities
- Life Sciences › Agricultural and Biological Sciences › Food Science › Food Chemistry and Fat Analysis
- Health Sciences › Medicine › Pharmacology (medical) › Coffee research and impacts
- Keywords
- cocoa consumption, cardiovascular risk factors, blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, C-reactive protein, flow-mediated dilation, insulin resistance, HOMA-IR, dose-response relationship, polyphenols, cardioprotection, insulin sensitivity
- MeSH terms
- Cacao, Cardiovascular System, Dose-Response Relationship, Drug, Flavonoids, Humans, Risk Factors, Cross-Over Studies
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