title: Cardiovascular effects of flavanol-rich chocolate in patients with heart failure. Effects of dark chocolate and cocoa consumption on endothelial function and arterial stiffness in overweight adults. Cocoa Reduces Blood Pressure and Insulin Resistance and Improves Endothelium-Dependent Vasodilation in Hypertensives Realistic intake of a flavanol-rich soluble cocoa product increases HDL-cholesterol without inducing anthropometric changes in healthy and moderately hypercholesterolemic subjects. Effect of cocoa bran on low-density lipoprotein oxidation and fecal bulking. Flavanol-rich chocolate acutely improves arterial function and working memory performance counteracting the effects of sleep deprivation in healthy individuals Dietary Cocoa Butter or Refined Olive Oil Does Not Alter Postprandial hsCRP and IL-6 Concentrations in Healthy Women The effect of polyphenol-rich dark chocolate on fasting capillary whole blood glucose, total cholesterol, blood pressure and glucocorticoids in healthy overweight and obese subjects. Postprandial Effects of Breakfast Glycemic Index on Vascular Function among Young Healthy Adults: A Crossover Clinical Trial Daily consumption of a dark chocolate containing flavanols and added sterol esters affects cardiovascular risk factors in a normotensive population with elevated cholesterol. Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons. Continuous intake of polyphenolic compounds containing cocoa powder reduces LDL oxidative susceptibility and has beneficial effects on plasma HDL-cholesterol concentrations in humans. A double-blind, placebo-controlled, randomized trial of the effects of dark chocolate and cocoa on variables associated with neuropsychological functioning and cardiovascular health: clinical findings from a sample of healthy, cognitively intact older adults. Dietary flavanols and procyanidin oligomers from cocoa (Theobroma cacao) inhibit platelet function. Effect of cocoa powder on the modulation of inflammatory biomarkers in patients at high risk of cardiovascular disease. Improved endurance capacity following chocolate milk consumption compared with 2 commercially available sport drinks. Flavonoid-Rich Dark Chocolate Improves Endothelial Function and Increases Plasma Epicatechin Concentrations in Healthy Adults Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment: The Cocoa, Cognition, and Aging (CoCoA) Study Dark chocolate or tomato extract for prehypertension: a randomised controlled trial High cocoa polyphenol rich chocolate may reduce the burden of the symptoms in chronic fatigue syndrome Regular Consumption of a Flavanol-rich Chocolate can Improve Oxidant Stress in Young Soccer Players Chocolate milk as a post-exercise recovery aid. Low vs. higher-dose dark chocolate and blood pressure in cardiovascular high-risk patients. Cocoa consumption for 2 wk enhances insulin-mediated vasodilatation without improving blood pressure or insulin resistance in essential hypertension. Characterisation of Hypertensive Patients with Improved Endothelial Function after Dark Chocolate Consumption Chocolate consumption in relation to blood pressure and risk of cardiovascular disease in German adults. Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: a randomized controlled trial. Effects of regularly consuming dietary fibre rich soluble cocoa products on bowel habits in healthy subjects: a free-living, two-stage, randomized, crossover, single-blind intervention Blood pressure and endothelial function in healthy, pregnant women after acute and daily consumption of flavanol-rich chocolate: a pilot, randomized controlled trial Habitual Chocolate Consumption May Increase Body Weight in a Dose-Response Manner Central Arterial Hemodynamic Effects of Dark Chocolate Ingestion in Young Healthy People: A Randomized and Controlled Trial Long-term consumption of high energy-dense snack foods on sensory-specific satiety and intake. Effect of cocoa and theobromine consumption on serum HDL-cholesterol concentrations: a randomized controlled trial. Dietary cocoa ameliorates obesity-related inflammation in high fat-fed mice Effect of dark chocolate on nitric oxide serum levels and blood pressure in prehypertension subjects. Natural antioxidant ice cream acutely reduces oxidative stress and improves vascular function and physical performance in healthy individuals. Cocoa Flavanol Supplementation Influences Skin Conditions of Photo-Aged Women: A 24-Week Double-Blind, Randomized, Controlled Trial. Sustained benefits in vascular function through flavanol-containing cocoa in medicated diabetic patients a double-masked, randomized, controlled trial. Regular consumption of cocoa powder with milk increases HDL cholesterol and reduces oxidized LDL levels in subjects at high-risk of cardiovascular disease. Oxidised LDL levels decreases after the consumption of ready-to-eat meals supplemented with cocoa extract within a hypocaloric diet. A reduced-calorie dietary pattern including a daily sweet snack promotes body weight reduction and body composition improvements in premenopausal women who are overweight and obese: a pilot study. Effects of sugar-sweetened and sugar-free cocoa on endothelial function in overweight adults. Dietary Flavonoids Added to Pharmacological Antihypertensive Therapy are Effective in Improving Blood Pressure Multifaceted nutritional intervention among nursing-home residents has a positive influence on nutrition and function. Appetite suppression through smelling of dark chocolate correlates with changes in ghrelin in young women Prebiotic evaluation of cocoa-derived flavanols in healthy humans by using a randomized, controlled, double-blind, crossover intervention study.
abstract: AIMS Flavanol-rich chocolate ( FRC ) is beneficial for vascular and platelet function by increasing nitric oxide bioavailability and decreasing oxidative stress . Congestive heart failure ( CHF ) is characterized by impaired endothelial and increased platelet reactivity . As statins are ineffective in CHF , alternative therapies are a clinical need . We therefore investigated whether FRC might improve cardiovascular function in patients with CHF . METHODS AND RESULTS Twenty patients with CHF were enrolled in a double-blind , r and omized placebo-controlled trial , comparing the effect of commercially available FRC with cocoa-liquor-free control chocolate ( CC ) on endothelial and platelet function in the short term ( 2 h after ingestion of a chocolate bar ) and long term ( 4 weeks , two chocolate bars/day ) . Endothelial function was assessed non-invasively by flow-mediated vasodilatation of the brachial artery . Flow-mediated vasodilatation significantly improved from 4.98 ± 1.95 to 5.98 ± 2.32 % ( P = 0.045 and 0.02 for between-group changes ) 2h after intake of FRC to 6.86 ± 1.76 % after 4 weeks of daily intake ( P = 0.03 and 0.004 for between groups ) . No effect on endothelial-independent vasodilatation was observed . Platelet adhesion significantly decreased from 3.9 ± 1.3 to 3.0 ± 1.3 % ( P = 0.03 and 0.05 for between groups ) 2 h after FRC , an effect that was not sustained at 2 and 4 weeks . Cocoa-liquor-free CC had no effect , either on endothelial function or on platelet function . Blood pressure and heart rate did not change in either group . CONCLUSION Flavanol-rich chocolate acutely improves vascular function in patients with CHF . A sustained effect was seen after daily consumption over a 4-week period , even after 12 h abstinence . These beneficial effects were paralleled by an inhibition of platelet function in the presence of FRC only The consumption of cocoa and dark chocolate is associated with a lower risk of CVD , and improvements in endothelial function may mediate this relationship . Less is known about the effects of cocoa/chocolate on the augmentation index ( AI ) , a measure of vascular stiffness and vascular tone in the peripheral arterioles . We enrolled thirty middle-aged , overweight adults in a r and omised , placebo-controlled , 4-week , cross-over study . During the active treatment ( cocoa ) period , the participants consumed 37 g/d of dark chocolate and a sugar-free cocoa beverage ( total cocoa = 22 g/d , total flavanols ( TF ) = 814 mg/d ) . Colour-matched controls included a low-flavanol chocolate bar and a cocoa-free beverage with no added sugar ( TF = 3 mg/d ) . Treatments were matched for total fat , saturated fat , carbohydrates and protein . The cocoa treatment significantly increased the basal diameter and peak diameter of the brachial artery by 6 % ( + 2 mm ) and basal blood flow volume by 22 % . Substantial decreases in the AI , a measure of arterial stiffness , were observed in only women . Flow-mediated dilation and the reactive hyperaemia index remained unchanged . The consumption of cocoa had no effect on fasting blood measures , while the control treatment increased fasting insulin concentration and insulin resistance ( P= 0·01 ) . Fasting blood pressure ( BP ) remained unchanged , although the acute consumption of cocoa  increased resting BP by 4 mmHg . In summary , the high-flavanol cocoa and dark chocolate treatment was associated with enhanced vasodilation in both conduit and resistance arteries and was accompanied by significant reductions in arterial stiffness in women Consumption of flavanol-rich dark chocolate ( DC ) has been shown to decrease blood pressure ( BP ) and insulin resistance in healthy subjects , suggesting similar benefits in patients with essential hypertension ( EH ) . Therefore , we tested the effect of DC on 24-hour ambulatory BP , flow-mediated dilation ( FMD ) , and oral glucose tolerance tests ( OGTTs ) in patients with EH . After a 7-day chocolate-free run-in phase , 20 never-treated , grade I patients with EH ( 10 males ; 43.7±7.8 years ) were r and omized to receive either 100 g per day DC ( containing 88 mg flavanols ) or 90 g per day flavanol-free white chocolate ( WC ) in an isocaloric manner for 15 days . After a second 7-day chocolate-free period , patients were crossed over to the other  treatment . Noninvasive 24-hour ambulatory BP , FMD , OGTT , serum cholesterol , and markers of vascular inflammation were evaluated at the end of each treatment . The homeostasis model assessment of insulin resistance ( HOMA-IR ) , quantitative insulin sensitivity check index ( QUICKI ) , and insulin sensitivity index ( ISI ) were calculated from OGTT values . Ambulatory BP decreased  after DC ( 24-hour systolic BP −11.9±7.7 mm Hg , P<0.0001 ; 24-hour diastolic BP −8.5±5.0 mm Hg , P<0.0001 ) but not WC . DC but not WC decreased HOMA-IR ( P<0.0001 ) , but it improved QUICKI , ISI , and FMD . DC also decreased serum LDL cholesterol ( from 3.4±0.5 to 3.0±0.6 mmol/L ; P<0.05 ) . In  summary , DC  decreased BP and serum LDL cholesterol , improved FMD , and ameliorated insulin sensitivity in hypertensives . These results suggest that , while balancing total calorie intake , flavanols from cocoa products may provide some cardiovascular benefit if included as part of a healthy diet for patients with EH To assess whether antioxidant , anti-inflammatory and other cardio-protective effects attributed to cocoa are achieved when regularly consuming moderate amounts of a flavanol-rich soluble cocoa product , a non-r and omized , controlled , crossover , free-living study was carried out in healthy ( n = 24 ; 25.9 ± 5.6 years ) and moderately hypercholesterolemic ( 200 - 240 mg dL(-1 ) ; n = 20 ; 30.0 ± 10.3 years ) volunteers . Participants consumed two servings per day ( 7.5 g per serving ) of a soluble cocoa product ( providing 45.3 mg flavanols per day ) in milk , which was compared with consuming only milk during a 4 week period . The effects on systolic and diastolic blood pressure and heart rate were determined , as well as on serum lipid and lipoprotein profiles , interleukins (IL)-1β , IL-6 , IL-8 , IL-10 , tumor necrosis factor-α ( TNF-α ) , monocyte chemoattractant protein-1 ( MCP-1 ) , vascular ( VCAM-1 ) and intercellular cell adhesion molecules ( ICAM-1 ) , serum malondialdehyde ( MDA ) , carbonyl groups ( CG ) , ferric reducing/antioxidant power ( FRAP ) , oxygen radical absorbance capacity ( ORAC ) , and free radical scavenging capacity ( ABTS ) . During the study , the volunteers ' diets and physical activity were also evaluated , as well as any changes in weight , skin folds , circumferences and related anthropometric parameters . Cocoa and certain polyphenol-rich fruits and vegetables and their derivatives were restricted . After consuming the cocoa product positive effects were observed such as an increase in serum HDL-C ( p < 0.001 ) and dietary fiber intake ( p = 0.050 ) , whereas IL-10 decreased ( p = 0.022 ) . Other cardiovascular-related biomarkers and anthropometric parameters were unaffected . We have therefore concluded that regular consumption of this cocoa product in a Spanish-Mediterranean diet may protect against cardiovascular disease in healthy and hypercholesterolemic subjects without producing any weight gain or other anthropometric changes BACKGROUND Legumes have reported benefits in terms of reduced risk for coronary heart disease and of colonic health . A novel legume fiber , cocoa bran , also may have favorable health effects on serum lipid levels , low-density lipoprotein ( LDL ) cholesterol oxidation , and fecal bulk . METHODS Twenty-five healthy normolipidemic subjects ( 13 men and 12 women ) ( mean + /- SEM age , 37 + /- 2 years ; mean + /- SEM body mass index [ calculated as weight in kilograms divided by the square of height in meters ] , 24.6 + /- 0.7 ) ate cocoa-bran and chocolate-flavored low-fiber breakfast cereals for 2-week periods , with 2-week washout , in a double-blind crossover study . The cocoa-bran cereal provided 25.0 g/d of total dietary fiber ( TDF ) . The low-fiber cereal ( 5.6 g/d TDF ) was of similar appearance and energy value . Fasting blood sample s were obtained at the start and end of each period , and 4-day fecal collection s were made from days 11 through 14 . RESULTS High-density lipoprotein ( HDL ) cholesterol level was higher ( 7.6 % + /- 2.9 % ; P = .02 ) and the LDL/HDL cholesterol ratio was lower ( 6.7 % + /- 2.3 % ; P = .007 ) for cocoa-bran compared with low-fiber cereal at 2 weeks . No effect was seen on LDL cholesterol oxidation . Mean fecal output was significantly higher for cocoa-bran than for low-fiber cereal ( 56 + /- 14 g/d ; P<.001 ) and equal to the increase seen in the same subjects with wheat fiber in a previous study . CONCLUSIONS A chocolate-flavored cocoa-bran cereal increased fecal bulk similarly to wheat bran and was associated with a reduction in the LDL/HDL cholesterol ratio . In view of the low-fat , high-fiber nature of the material , these results suggest a possible role for this novel fiber source in the diets of normal , hyperlipidemic , and constipated subjects Background : Sleep deprivation is a risk factor for cardiovascular disease . Cocoa flavonoids exert cardiovascular benefits and neuroprotection . Whether chocolate consumption may mitigate detrimental effects of sleep loss on cognitive performance and cardiovascular parameters has never been studied . Aim : We investigated the effects of flavanol-rich chocolate consumption on cognitive skills and cardiovascular parameters after sleep deprivation . Methods : Thirty-two healthy participants underwent two baseline sessions after one night of undisturbed sleep and two experimental sessions after one night of total sleep deprivation . Two hours before each testing session , participants were r and omly assigned to consume high or poor flavanol chocolate bars . During the tests were evaluated , the Psychomotor Vigilance Task and a working memory task , office SBP and DBP , flow-mediated dilation and pulse-wave velocity . Results : Sleep deprivation increased SBP/DBP . SBP/DBP and pulse pressure were lower after flavanol-rich treatment respect to flavanol-poor treatment ( SBP : 116.9 ± 1.6 vs. 120.8 ± 1.9 mmHg , respectively , P = 0.00005 ; DBP : 70.5 ± 1.2 vs. 72.3 ± 1.2 mmHg , respectively , P = 0.01 ; pulse pressure : 46.4 ± 1.3 vs. 48.4 ± 1.5 mmHg , P = 0.004 ) . Sleep deprivation impaired flow-mediated dilation ( 5.5 ± 0.5 vs. 6.5 ± 0.6 % , P = 0.02 ) , flavanol-rich , but not flavanol-poor chocolate counteracted this alteration ( flavanol-rich/flavanol-poor chocolate : 7.0 ± 0.6 vs. 5.0 ± 0.4 % , P = 0.000001 ) . Flavanol-rich chocolate mitigated the pulse-wave velocity increase ( P = 0.001 ) . Flavanol-rich chocolate preserved working memory accuracy in women after sleep deprivation . Flow-mediated dilation correlated with working memory performance accuracy in the sleep condition ( P = 0.04 ) . Conclusion : Flavanol-rich chocolate counteracted vascular impairment after sleep deprivation and restored working memory performance . Improvement in cognitive performance could be because of the effects of cocoa flavonoids on blood pressure and peripheral and central blood flow Contrary to other long chain saturated fatty acids ( SFA ) , fats high in stearic acid do not raise plasma cholesterol concentrations , however , a slight elevation in inflammatory markers , plasma fibrinogen and interleukin-6 ( IL-6 ) , has been observed in the fasting state . The effect of stearic acid on inflammation in the postpr and ial state has not yet been reported . We conducted a single blind crossover , r and omized , postpr and ial study to compare the effects of a fat load of cocoa butter high in stearic acid and olive oil in ten healthy women . The test meals contained 1 g of fat per kg body weight ( mean 62 g ) . Blood sample s were collected at 0 ( fasting ) , 4 and 6 h. Both diets result ed in a significant increase in serum triacylglycerol ( TAG ) concentration over time ( P = 0.003 ) and a decrease in serum IL-6 concentration after 4 h followed by an increase to post absorptive values after 6 h ( P < 0.001 ) ; whereas serum high sensitivity C-reactive protein ( hsCRP ) concentration was not affected . There was no difference between diets in effects on serum TAG , hsCRP and IL-6 concentrations and no association between postpr and ial lipemia and inflammatory markers . High intake of dietary fats increase postpr and ial serum TAG , however , may not affect inflammatory markers postpr and ially . Thus , fat rich in stearic acid does not seem to increase postpr and ial inflammation Numerous studies indicate that polyphenol-rich chocolate reduces fasting blood glucose , blood pressure ( BP ) and total cholesterol in healthy individuals and hypertensives with or without glucose intolerance . The aim of the present study was to investigate the effect of two doses of polyphenol-rich dark chocolate ( DC ) on fasting capillary whole blood glucose , total cholesterol and BP and to examine whether improvements in these parameters are associated with changes in adrenocorticoid excretion in overweight and obese individuals . The study used a r and omised , single-blind , cross-over design where fourteen overweight and obese subjects were r and omised to either take 20 g DC with 500 mg polyphenols then 20 g DC with 1000 mg polyphenols or vice-versa . Participants followed each diet for 2 weeks separated by a 1-week washout period . It was observed that the 500 mg polyphenol dose was equally effective in reducing fasting blood glucose levels , systolic BP ( SBP ) and diastolic BP ( DBP ) as the 1000 mg polyphenol dose suggesting that a saturation effect might occur with increasing dose of polyphenols . There was also a trend towards a reduction in urinary free cortisone levels with both groups although it did not reach statistical significance . No changes in anthropometrical measurements were seen . We suggest that more research is required to investigate the mechanism(s ) by which polyphenol-rich foods influence health This study aim ed to evaluate the postpr and ial effects of high and low glycemic index ( GI ) breakfasts on vascular function . It was a crossover trial that included 40 young healthy adults ( 50 % women ) , aged 20–40 years , who were recruited at primary care setting s. They consumed three experimental breakfasts in r and omized order , each one separated by a 1-week washout period : ( 1 ) control conditions ( only water ) ; ( 2 ) low GI ( LGI ) breakfast ( 29.4 GI and 1489 KJ energy ) ; and ( 3 ) high GI ( HGI ) breakfast ( 64.0 GI and 1318 KJ energy ) . Blood sample s were collected at 60 and 120 min after each breakfast to determine glucose and insulin levels . Vascular parameters were measured at 15 min intervals . Augmentation index ( AIx ) was studied as a primary outcome . Secondary outcomes comprised glucose , insulin , heart rate ( HR ) and pulse pressures ( PPs ) . We found a trend toward increased AIx , HR and PPs for the HGI versus the LGI breakfast . A significant interaction between the type of breakfast consumed and all measured parameters was identified ( p < 0.05 ) except for central PP . Stratifying data by sex , this interaction remained significant for AIx and augmentation pressure only in males ( p < 0.05 ) . In conclusion , breakfast GI could affect postpr and ial vascular responses in young healthy adults Previous studies with plant sterols ( PS ) and cocoa flavanols ( CF ) provide support for their dietary use in maintaining cardiovascular health . This double-blind , placebo-controlled , cross-over study evaluated the efficacy of daily consumption of a cocoa flavanol-containing dark chocolate bar with added PS on serum lipids , blood pressure , and other circulating cardiovascular health markers in a population with elevated serum cholesterol . We recruited 49 adults ( 32 women , 17 men ) with serum total cholesterol concentrations of 5.20 - 7.28 mmol/L and blood pressure of < or = 159/99 mm Hg . Following a 2-wk lead-in utilizing the AHA style diet , participants were r and omized into 2 groups and instructed to consume 2 cocoa flavanol-containing dark chocolate bars per day with ( 1.1 g sterol esters per bar ) or without PS . Each 419-kJ bar was nutrient-matched and contained approximately 180 mg CF . Participants consumed 1 bar 2 times per day for 4 wk then switched to the other bar for an additional 4 wk . Serum lipids and other cardiovascular markers were measured at baseline and after 4 and 8 wk . Blood pressure was measured every 2 wk . Regular consumption of the PS-containing chocolate bar result ed in reductions of 2.0 and 5.3 % in serum total and LDL cholesterol ( P < 0.05 ) , respectively . Consumption of CF also reduced systolic blood pressure at 8 wk ( -5.8 mm Hg ; P < 0.05 ) . Results indicate that regular consumption of chocolate bars containing PS and CF as part of a low-fat diet may support cardiovascular health by lowering cholesterol and improving blood pressure BACKGROUND Numerous studies indicate that flavanols may exert significant vascular protection because of their antioxidant properties and increased nitric oxide bioavailability . In turn , nitric oxide bioavailability deeply influences insulin-stimulated glucose uptake and vascular tone . Thus , flavanols may also exert positive metabolic and pressor effects . OBJECTIVE The objective was to compare the effects of either dark or white chocolate bars on blood pressure and glucose and insulin responses to an oral-glucose-tolerance test in healthy subjects . DESIGN After a 7-d cocoa-free run-in phase , 15 healthy subjects were r and omly assigned to receive for 15 d either 100 g dark chocolate bars , which contained approximately 500 mg polyphenols , or 90 g white chocolate bars , which presumably contained no polyphenols . Successively , subjects entered a further cocoa-free washout phase of 7 d and then were crossed over to the other condition . Oral-glucose-tolerance tests were performed at the end of each period to calculate the homeostasis model assessment of insulin resistance ( HOMA-IR ) and the quantitative insulin sensitivity check index ( QUICKI ) ; blood pressure was measured daily . RESULTS HOMA-IR was significantly lower after dark than after white chocolate ingestion ( 0.94 + /- 0.42 compared with 1.72 + /- 0.62 ; P < 0.001 ) , and QUICKI was significantly higher after dark than after white chocolate ingestion ( 0.398 + /- 0.039 compared with 0356 + /- 0.023 ; P = 0.001 ) . Although within normal values , systolic blood pressure was lower after dark than after white chocolate ingestion ( 107.5 + /- 8.6 compared with 113.9 + /- 8.4 mm Hg ; P < 0.05 ) . CONCLUSION Dark , but not white , chocolate decreases blood pressure and improves insulin sensitivity in healthy persons BACKGROUND Cocoa powder is rich in polyphenols such as catechins and procyanidins and has been shown in various models to inhibit LDL oxidation and atherogenesis . OBJECTIVE We examined whether long-term intake of cocoa powder alters plasma lipid profiles in normocholesterolemic and mildly hypercholesterolemic human subjects . DESIGN Twenty-five subjects were r and omly assigned to ingest either 12 g sugar/d ( control group ) or 26 g cocoa powder and 12 g sugar/d ( cocoa group ) for 12 wk . Blood sample s were collected before the study and 12 wk after intake of the test drinks . Plasma lipids , LDL oxidative susceptibility , and urinary oxidative stress markers were measured . RESULTS At 12 wk , we measured a 9 % prolongation from baseline levels in the lag time of LDL oxidation in the cocoa group . This prolongation in the cocoa group was significantly greater than the reduction measured in the control group ( -13 % ) . A significantly greater increase in plasma HDL cholesterol ( 24 % ) was observed in the cocoa group than in the control group ( 5 % ) . A negative correlation was observed between plasma concentrations of HDL cholesterol and oxidized LDL . At 12 wk , there was a 24 % reduction in dityrosine from baseline concentrations in the cocoa group . This reduction in the cocoa group was significantly greater than the reduction in the control group ( -1 % ) . CONCLUSION It is possible that increases in HDL-cholesterol concentrations may contribute to the suppression of LDL oxidation and that polyphenolic substances derived from cocoa powder may contribute to an elevation in HDL cholesterol BACKGROUND In recent years , there has been increased interest in the potential health-related benefits of antioxidant- and phytochemical-rich dark chocolate and cocoa . OBJECTIVE The objective of the study was to examine the short-term ( 6 wk ) effects of dark chocolate and cocoa on variables associated with neuropsychological functioning and cardiovascular health in healthy older adults . DESIGN A double-blind , placebo-controlled , fixed-dose , parallel-group clinical trial was used . Participants ( n = 101 ) were r and omly assigned to receive a 37-g dark chocolate bar and 8 ounces ( 237 mL ) of an artificially sweetened cocoa beverage or similar placebo products each day for 6 wk . RESULTS No significant group ( dark chocolate and cocoa or placebo)-by-trial ( baseline , midpoint , and end-of-treatment assessment s ) interactions were found for the neuropsychological , hematological , or blood pressure variables examined . In contrast , the midpoint and end-of-treatment mean pulse rate assessment s in the dark chocolate and cocoa group were significantly higher than those at baseline and significantly higher than the midpoint and end-of-treatment rates in the control group . Results of a follow-up question naire item on the treatment products that participants believed they had consumed during the trial showed that more than half of the participants in both groups correctly identified the products that they had ingested during the experiment . CONCLUSIONS This investigation failed to support the predicted beneficial effects of short-term dark chocolate and cocoa consumption on any of the neuropsychological or cardiovascular health-related variables included in this research . Consumption of dark chocolate and cocoa was , however , associated with significantly higher pulse rates at 3- and 6-wk treatment assessment BACKGROUND Flavonoids may be partly responsible for some health benefits , including antiinflammatory action and a decreased tendency for the blood to clot . An acute dose of flavanols and oligomeric procyanidins from cocoa powder inhibits platelet activation and function over 6 h in humans . OBJECTIVE This study sought to evaluate whether 28 d of supplementation with cocoa flavanols and related procyanidin oligomers would modulate human platelet reactivity and primary hemostasis and reduce oxidative markers in vivo . DESIGN Thirty-two healthy subjects were assigned to consume active ( 234 mg cocoa flavanols and procyanidins/d ) or placebo ( < or = 6 mg cocoa flavanols and procyanidins/d ) tablets in a blinded parallel- design ed study . Platelet function was determined by measuring platelet aggregation , ATP release , and expression of activation-dependent platelet antigens by using flow cytometry . Plasma was analyzed for oxidation markers and antioxidant status . RESULTS Plasma concentrations of epicatechin and catechin in the active group increased by 81 % and 28 % , respectively , during the intervention period . The active group had significantly lower P selectin expression and significantly lower ADP-induced aggregation and collagen-induced aggregation than did the placebo group . Plasma ascorbic acid concentrations were significantly higher in the active than in the placebo group ( P < 0.05 ) , whereas plasma oxidation markers and antioxidant status did not change in either group . CONCLUSIONS Cocoa flavanol and procyanidin supplementation for 28 d significantly increased plasma epicatechin and catechin concentrations and significantly decreased platelet function . These data support the results of acute studies that used higher doses of cocoa flavanols and procyanidins BACKGROUND Epidemiologic studies have suggested that flavonoid intake plays a critical role in the prevention of coronary heart disease . Because atherosclerosis is considered a low- grade inflammatory disease , some feeding trials have analyzed the effects of cocoa ( an important source of flavonoids ) on inflammatory biomarkers , but the results have been controversial . OBJECTIVE The objective was to evaluate the effects of chronic cocoa consumption on cellular and serum biomarkers related to atherosclerosis in high-risk patients . DESIGN Forty-two high-risk volunteers ( 19 men and 23 women ; mean + /- SD age : 69.7 + /- 11.5 y ) were included in a r and omized crossover feeding trial . All subjects received 40 g cocoa powder with 500 mL skim milk/d ( C+M ) or only 500 mL skim milk/d ( M ) for 4 wk . Before and after each intervention period , cellular and serum inflammatory biomarkers related to atherosclerosis were evaluated . RESULTS Adherence to the dietary protocol was excellent . No significant changes in the expression of adhesion molecules on T lymphocyte surfaces were found between the C+M and M groups . However , in monocytes , the expression of VLA-4 , CD40 , and CD36 was significantly lower ( P = 0.005 , 0.028 , and 0.001 , respectively ) after C+M intake than after M intake . In addition , serum concentrations of the soluble endothelium-derived adhesion molecules P-selectin and intercellular adhesion molecule-1 were significantly lower ( both P = 0.007 ) after C+M intake than after M intake . CONCLUSIONS These results suggest that the intake of cocoa polyphenols may modulate inflammatory mediators in patients at high risk of cardiovascular disease . These antiinflammatory effects may contribute to the overall benefits of cocoa consumption against atherosclerosis . This trial was registered in the Current Controlled Trials at London , International St and ard R and omized Controlled Trial Number , at controlled-trials.com as IS RCT N75176807 This study examined the effects of 3 recovery drinks on endurance performance following glycogen-depleting exercise . Nine trained male cyclists performed 3 experimental trials , in a r and omized counter-balanced order , consisting of a glycogen-depleting trial , a 4-h recovery period , and a cycle to exhaustion at 70 % power at maximal oxygen uptake . At 0 and 2 h into the recovery period , participants consumed chocolate milk ( CM ) , a carbohydrate replacement drink ( CR ) , or a fluid replacement drink ( FR ) . Participants cycled 51 % and 43 % longer after ingesting CM ( 32 + /- 11 min ) than after ingesting CR ( 21 + /- 8 min ) or FR ( 23 + /- 8 min ) . CM is an effective recovery aid after prolonged endurance exercise for subsequent exercise at low-moderate intensities Background : Dark chocolate derived from the plant ( Theobroma cacao ) is a rich source of flavonoids . Cardioprotective effects including antioxidant properties , inhibition of platelet activity , and activation of endothelial nitric oxide synthase have been ascribed to the cocoa flavonoids . Objective : To investigate the effects of flavonoid-rich dark chocolate on endothelial function , measures of oxidative stress , blood lipids , and blood pressure in healthy adult subjects . Design : The study was a r and omized , double-blind , placebo-controlled design conducted over a 2 week period in 21 healthy adult subjects . Subjects were r and omly assigned to daily intake of high-flavonoid ( 213 mg procyanidins , 46 mg epicatechin ) or low-flavonoid dark chocolate bars ( 46 g , 1.6 oz ) . Results : High-flavonoid chocolate consumption improved endothelium-dependent flow-mediated dilation ( FMD ) of the brachial artery ( mean change = 1.3 ± 0.7 % ) as compared to low-flavonoid chocolate consumption ( mean change = −0.96 ± 0.5 % ) ( p = 0.024 ) . No significant differences were noted in the resistance to LDL oxidation , total antioxidant capacity , 8-isoprostanes , blood pressure , lipid parameters , body weight or body mass index ( BMI ) between the two groups . Plasma epicatechin concentrations were markedly increased at 2 weeks in the high-flavonoid group ( 204.4 ± 18.5 nmol/L , p ≤ 0.001 ) but not in the low-flavonoid group ( 17.5 ± 9 nmol/L , p = 0.99 ) . Conclusion : Flavonoid-rich dark chocolate  improves endothelial function and is associated with an increase in plasma epicatechin concentrations in healthy adults . No changes in oxidative stress measures , lipid profiles , blood pressure , body weight or BMI were seen Flavanol consumption is favorably associated with cognitive function . We tested the hypothesis that dietary flavanols might improve cognitive function in subjects with mild cognitive impairment . We conducted a double-blind , parallel arm study in 90 elderly individuals with mild cognitive impairment r and omized to consume once daily for 8 weeks a drink containing ≈990 mg ( high flavanols ) , ≈520 mg ( intermediate flavanols ) , or ≈45 mg ( low flavanols ) of cocoa flavanols per day . Cognitive function was assessed by Mini Mental State Examination , Trail Making Test A and B , and verbal fluency test . At the end of the follow-up period , Mini Mental State Examination was similar in the 3 treatment groups ( P=0.13 ) . The time required to complete Trail Making Test A and Trail Making Test B was significantly ( P<0.05 ) lower in subjects assigned to high flavanols ( 38.10±10.94 and 104.10±28.73 seconds , respectively ) and intermediate flavanols ( 40.20±11.35 and 115.97±28.35 seconds , respectively ) in comparison with those assigned to low flavanols ( 52.60±17.97 and 139.23±43.02 seconds , respectively ) . Similarly , verbal fluency test score was significantly ( P<0.05 ) better in subjects assigned to high flavanols in comparison with those assigned to low flavanols ( 27.50±6.75 versus 22.30±8.09 words per 60 seconds ) . Insulin resistance , blood pressure , and lipid peroxidation also decreased among subjects in the high-flavanol and intermediate-flavanol groups . Changes of insulin resistance explained ≈40 % of composite z score variability through the study period ( partial r2=0.4013 ; P<0.0001 ) . To the best of our knowledge , this is the first dietary intervention study demonstrating that the regular consumption of cocoa flavanols might be effective in improving cognitive function in elderly subjects with mild cognitive impairment . This effect appears mediated in part by an improvement in insulin sensitivity Background Flavanol-rich chocolate and lycopene-rich tomato extract have attracted interest as potential alternative treatment options for hypertension , a known risk factor for cardiovascular morbidity and mortality . Treatment of prehypertension ( SBP 120–139/DBP 80–89 mmHg ) may forestall progression to hypertension . However , there has been only limited research into non-pharmacological treatment options for prehypertension . We investigated the effect of dark chocolate or tomato extract on blood pressure , and their acceptability as an ongoing treatment option in a prehypertensive population . Methods Our trial consisted of two phases : a r and omised controlled three-group-parallel trial over 12 weeks ( phase 1 ) followed by a crossover of the two active treatment arms over an additional 12-week period ( phase 2 ) . Group 1 received a 50 g daily dose of dark chocolate with 70 % cocoa containing 750 mg polyphenols , group 2 were allocated one tomato extract capsule containing 15 mg lycopene per day , and group 3 received one placebo capsule daily over 8 weeks followed by a 4-week washout period . In phase 2 the active treatment groups were crossed over to receive the alternative treatment . Median blood pressure , weight , and abdominal circumference were measured 4-weekly , and other characteristics including physical activity , general health , energy , mood , and acceptability of treatment were assessed by question naire at 0 , 8 and 20 weeks . We analysed changes over time using a linear mixed model , and one time point differences using Kruskal-Wallis , Fisher's-Exact , or t-tests . Results Thirty-six prehypertensive healthy adult volunteers completed the 6-month trial . Blood pressure changes over time within groups and between groups were not significant and independent of treatment . Weight and other characteristics did not change significantly during the trial . However , a marked difference in acceptability between the two treatment forms ( chocolate or capsule ) was revealed ( p < 0.0001 ) . Half of the participants allocated to the chocolate treatment found it hard to eat 50 g of dark chocolate every day and 20 % considered it an unacceptable long-term treatment option , whereas all participants found it easy and acceptable to take a capsule each day for blood pressure . Conclusion Our study did not find a blood pressure lowering effect of dark chocolate or tomato extract in a prehypertensive population . Practicability of chocolate as a long-term treatment option may be limited . Trial registration http://www.anzctr.org.au Identifier : Background Chocolate is rich in flavonoids that have been shown to be of benefit in disparate conditions including cardiovascular disease and cancer . The effect of polyphenol rich chocolate in subjects with chronic fatigue syndrome ( CFS ) has not been studied previously . Methods We conducted a double blinded , r and omised , clinical pilot crossover study comparing high cocoa liquor/polyphenol rich chocolate ( HCL/PR ) in comparison to simulated iso-calorific chocolate ( cocoa liquor free/low polyphenols(CLF/LP ) ) on fatigue and residual function in subjects with chronic fatigue syndrome . Subjects with CFS having severe fatigue of at least 10 out of 11 on the Chalder Fatigue Scale were enrolled . Subjects had either 8 weeks of intervention in the form of HCL/PR or CLF/LP , with a 2 week wash out period followed by 8 weeks of intervention with the other chocolate . Results Ten subjects were enrolled in the study . The Chalder Fatigue Scale score improved significantly after 8 weeks of the HCL/PR chocolate arm [ median ( range ) Exact Sig . ( 2-tailed ) ] [ 33 ( 25 - 38 ) vs. 21.5 ( 6 - 35 ) 0.01 ] , but that deteriorated significantly when subjects were given simulated iso-calorific chocolate ( CLF/CP ) [ 28.5 ( 17 - 20 ) vs. 34.5 ( 13 - 26 ) 0.03 ] . The residual function , as assessed by the London H and icap scale , also improved significantly after the HCL/PR arm [ 0.49 ( 0.33 - 0.62 ) vs. 0.64 ( 0.44 - 0.83 ) 0.01 ] and deteriorated after iso-calorific chocolate [ 00.44 ( 0.43 - 0.68 ) vs. 0.36 ( 0.33 - 0.62)0.03 ] . Likewise the Hospital Anxiety and Depression score also improved after the HCL/PR arm , but deteriorated after CLF/CP . Mean weight remained unchanged throughout the trial . Conclusion This study suggests that HCL/PR chocolate may improve symptoms in subjects with chronic fatigue syndrome The consumption of a diet rich in certain flavonoids , including the flavanol sub-class , has been associated with a reduced risk for vascular disease . We evaluated the effects of the regular consumption ( 14 d ) of a flavanol-containing milk chocolate ( FCMC ) or cocoa butter chocolate ( CBC ) on variables related to vascular disease risk , oxidative stress and physical activity . Twenty-eight free-living , young ( 18–20 years old ) male soccer players consumed daily 105 g of FCMC ( 168 mg of flavanols ) or CBC ( < 5 mg of flavanols ) , as part of their normal diet . The consumption of FCMC was significantly associated with a decrease in diastolic blood pressure ( -5 mm Hg ) , mean blood pressure ( -5 mm Hg ) , plasma cholesterol ( -11 % ) , LDL-cholesterol ( -15 % ) , malondialdehyde ( -12 % ) , urate ( -11 % ) and lactate dehydrogenase ( LDH ) activity ( -11 % ) , and an increase in vitamin E/cholesterol ( + 12 % ) . No relevant changes in these variables were associated with CBC consumption . No changes in the plasma levels of (-)-epicatechin were observed following analysis of fasting blood sample s. In conclusion , FCMC consumption was associated with changes in several variables often associated with cardiovascular health and oxidant stress . The presence of significant quantities of flavanols in FCMC is likely to have been one of the contributing factors to these results Nine male , endurance-trained cyclists performed an interval workout followed by 4 h of recovery , and a subsequent endurance trial to exhaustion at 70 % VO2max , on three separate days . Immediately following the first exercise bout and 2 h of recovery , subjects drank isovolumic amounts of chocolate milk , fluid replacement drink ( FR ) , or carbohydrate replacement drink ( CR ) , in a single-blind , r and omized design . Carbohydrate content was equivalent for chocolate milk and CR . Time to exhaustion ( TTE ) , average heart rate ( HR ) , rating of perceived exertion ( RPE ) , and total work ( WT ) for the endurance exercise were compared between trials . TTE and WT were significantly greater for chocolate milk and FR trials compared to CR trial . The results of this study suggest that chocolate milk is an effective recovery aid between two exhausting exercise bouts BACKGROUND Dark chocolate may have blood pressure-lowering properties . We conducted a prospect i ve r and omized open-label blinded end-point design trial to study a potential dose dependency of the presumed antihypertensive effect of dark chocolate by directly comparing low vs. higher doses of dark chocolate over the course of 3 months . METHODS We enrolled a total of 102 patients with prehypertension/stage 1 hypertension and established cardiovascular end-organ damage or diabetes mellitus . Patients were r and omly assigned to receive either 6 or 25 g/day of flavanol-rich dark chocolate for 3 months . The difference in 24-h mean blood pressure between groups was defined as the primary outcome measure . RESULTS Significant reductions in mean ambulatory 24-h blood pressure were observed between baseline and follow-up in both groups ( 6 g/day : -2.3 mm Hg , 95 % confidence interval -4.1 to -0.4 ; 25 g/day : -1.9 mm Hg , 95 % confidence interval -3.6 to -0.2 ) . There were no significant differences in blood pressure changes between groups . In the higher-dose group , a slight increase in body weight was noted ( 0.8 kg , 95 % confidence interval 0.06 to 1.6 ) . CONCLUSIONS The findings are consistent with the hypothesis that dark chocolate may be associated with a reduction in blood pressure ( BP ) . However , due to the lack of a control group , confounding may be possible and the results should be interpreted with caution BACKGROUND Essential hypertension is characterized by reciprocal relations between endothelial dysfunction and insulin resistance . Cocoa flavanols stimulate production of the vasodilator nitric oxide from vascular endothelium . OBJECTIVE The objective was to test the hypothesis that consumption of cocoa may simultaneously lower blood pressure , improve endothelial dysfunction , and ameliorate insulin resistance in subjects with essential hypertension . DESIGN We conducted a r and omized , placebo-controlled , double-blind , crossover trial of a flavanol-rich cocoa drink ( 150 mL twice a day , approximately 900 mg flavanols/d ) in individuals with essential hypertension ( n = 20 ) . Antihypertensive medications were discontinued before study enrollment . After a 7-d cocoa-free run-in period , cocoa or flavanol-poor placebo ( approximately 28 mg flavanols/d ) treatment for 2 wk was followed by a 1-wk washout and then crossover to the other treatment arm . Blood pressure was measured thrice weekly . At baseline and after each treatment period , we assessed insulin sensitivity ( hyperinsulinemic-isoglycemic glucose clamp ) and insulin-stimulated changes in brachial artery diameter and forearm skeletal muscle capillary recruitment ( Doppler ultrasound with or without microbubble contrast ) . RESULTS Cocoa treatment for 2 wk increased insulin-stimulated changes in brachial artery diameter when compared with placebo [ median percentage increase from baseline ( 25th-75th percentile ) : 8.3 ( 4.2 - 11.3 ) compared with 5.9 ( -0.3 to 9.6 ) ; P < 0.04 ] . Nevertheless , cocoa treatment did not significantly reduce blood pressure or improve insulin resistance and had no significant effects on skeletal muscle capillary recruitment , circulating plasma concentrations of adipocytokines , or endothelial adhesion molecules . CONCLUSIONS Daily consumption of flavanol-rich cocoa for 2 wk is not sufficient to reduce blood pressure or improve insulin resistance in human subjects with essential hypertension . This trial was registered at clinical trials.gov as NCT00099476 Recent findings indicate an inverse relationship between cardiovascular disease and consumption of flavonoids . We aim ed to identify clinical and vascular parameters of treated hypertensive who present beneficial effects of dark chocolate for one-week period on vascular function . Twenty-one hypertensive subjects , aged 40–65 years , were included in a prospect i ve study with measurement of blood pressure ( BP ) , brachial flow-mediated dilatation ( FMD ) , peripheral arterial tonometry , and central hemodynamic parameters . These tests were repeated after seven days of eating dark chocolate 75 g/day . Patients were divided according to the response in FMD : responders ( n = 12 ) and nonresponders ( n = 9 ) . The responder group presented lower age ( 54 ± 7 versus 61 ± 6 years , P = 0.037 ) , Framingham risk score ( FRS ) ( 2.5 ± 1.8 versus 8.1 ± 5.1 % , P = 0.017 ) , values of peripheral ( 55 ± 9 versus 63 ± 5 mmHg , P = 0.041 ) , and central pulse pressure ( PP ) ( 44 ± 10 versus 54 ± 6 mmHg , P = 0.021 ) . FMD response showed negative correlation with FRS ( r = −0.60 , P = 0.014 ) , baseline FMD ( r = −0.54 , P = 0.011 ) , baseline reactive hyperemia index ( RHI ; r = −0.56 , P = 0.008 ) , and central PP ( r = −0.43 , P = 0.05 ) . However , after linear regression analysis , only FRS and baseline RHI were associated with FMD response . In conclusion , one-week dark chocolate intake significantly improved endothelial function and reduced  BP in younger hypertensive with impaired endothelial function in spite of lower cardiovascular risk AIMS To investigate the association of chocolate consumption with measured blood pressure ( BP ) and the incidence of cardiovascular disease ( CVD ) . METHODS AND RESULTS Dietary intake , including chocolate , and BP were assessed at baseline ( 1994 - 98 ) in 19 357 participants ( aged 35 - 65 years ) free of myocardial infa rct ion ( MI ) and stroke and not using antihypertensive medication of the Potsdam arm of the European Prospect i ve Investigation into Cancer and Nutrition . Incident cases of MI ( n = 166 ) and stroke ( n = 136 ) were identified after a mean follow-up of approximately 8 years . Mean systolic BP was 1.0 mmHg [ 95 % confidence interval ( CI ) -1.6 to -0.4 mmHg ] and mean diastolic BP 0.9 mmHg ( 95 % CI -1.3 to -0.5 mmHg ) lower in the top quartile compared with the bottom quartile of chocolate consumption . The relative risk of the combined outcome of MI and stroke for top vs. bottom quartiles was 0.61 ( 95 % CI 0.44 - 0.87 ; P linear trend = 0.014 ) . Baseline BP explained 12 % of this lower risk ( 95 % CI 3 - 36 % ) . The inverse association was stronger for stroke than for MI . CONCLUSION Chocolate consumption appears to lower CVD risk , in part through reducing BP . The inverse association may be stronger for stroke than for MI . Further research is needed , in particular r and omized trials CONTEXT Regular intake of cocoa-containing foods is linked to lower cardiovascular mortality in observational studies . Short-term interventions of at most 2 weeks indicate that high doses of cocoa can improve endothelial function and reduce blood pressure ( BP ) due to the action of the cocoa polyphenols , but the clinical effect of low habitual cocoa intake on BP and the underlying BP-lowering mechanisms are unclear . OBJECTIVE To determine effects of low doses of polyphenol-rich dark chocolate on BP . DESIGN , SETTING , AND PARTICIPANTS R and omized , controlled , investigator-blinded , parallel-group trial involving 44 adults aged 56 through 73 years ( 24 women , 20 men ) with untreated upper-range prehypertension or stage 1 hypertension without concomitant risk factors . The trial was conducted at a primary care clinic in Germany between January 2005 and December 2006 . INTERVENTION Participants were r and omly assigned to receive for 18 weeks either 6.3 g ( 30 kcal ) per day of dark chocolate containing 30 mg of polyphenols or matching polyphenol-free white chocolate . MAIN OUTCOME MEASURES Primary outcome measure was the change in BP after 18 weeks . Secondary outcome measures were changes in plasma markers of vasodilative nitric oxide ( S-nitrosoglutathione ) and oxidative stress ( 8-isoprostane ) , and bioavailability of cocoa polyphenols . RESULTS From baseline to 18 weeks , dark chocolate intake reduced mean ( SD ) systolic BP by -2.9 ( 1.6 ) mm Hg ( P < .001 ) and diastolic BP by -1.9 ( 1.0 ) mm Hg ( P < .001 ) without changes in body weight , plasma levels of lipids , glucose , and 8-isoprostane . Hypertension prevalence declined from 86 % to 68 % . The BP decrease was accompanied by a sustained increase of S-nitrosoglutathione by 0.23 ( 0.12 ) nmol/L ( P < .001 ) , and a dark chocolate dose result ed in the appearance of cocoa phenols in plasma . White chocolate intake caused no changes in BP or plasma biomarkers . CONCLUSIONS Data in this relatively small sample of otherwise healthy individuals with above-optimal BP indicate that inclusion of small amounts of polyphenol-rich dark chocolate as part of a usual diet efficiently reduced BP and improved formation of vasodilative nitric oxide . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00421499 Background Dietary fibre is both preventive and therapeutic for bowel functional diseases .  Soluble cocoa products are good sources of dietary fibre that may be supplemented with this dietary component . This study assessed the effects of regularly consuming two soluble cocoa products ( A and B ) with different non-starch polysaccharides levels ( NSP , 15.1 and 22.0 % w/w , respectively ) on bowel habits using subjective intestinal function and symptom question naires , a daily diary and a faecal marker in healthy individuals . Methods A free-living , two-stage , r and omized , crossover , single-blind intervention was carried out in 44 healthy men and women , between 18 - 55 y old , who had not taken dietary supplements , laxatives , or antibiotics six months before the start of the study . In the four-week-long intervention stages , separated by a three-week-wash-out stage , two servings of A and B , that provided 2.26 vs. 6.60 g/day of NSP respectively , were taken . In each stage , volunteers ' diet was recorded using a 72-h food intake report . Results Regularly consuming cocoa A and B increased fibre intake , although only cocoa B significantly increased fibre intake ( p < 0.001 ) with respect to the non-cocoa stage . No changes in body weight were observed in either of the 4 week interventions . With cocoa product B , the number of daily bowel movements increased ( p = 0.002 ) , the frequency of having a bowel movement once a day increased ( p = 0.009 ) , the time to have a bowel movement was lower ( p = 0.016 ) as well as the feeling of constipation ( p = 0.046 ) without inducing adverse gastrointestinal symptoms , only flatulence increased ( p = 0.019 ) . Conclusions Regular consumption of the cocoa products increases dietary fibre intake to recommended levels and product B improves bowel habits . The use of both objective and subjective assessment s to evaluate the effects of food on bowel habits is recommended Background Several r and omized clinical trials ( RCTs ) indicate that flavanol-rich chocolate has beneficial effects on flow-mediated dilation ( FMD ) and blood pressure ( BP ) . However , no RCTs have evaluated these outcomes in pregnant women . The objective of this 2-group , parallel , double-blind RCT was to examine the effects of flavanol-rich chocolate on FMD and BP in pregnant women with normal BP . Methods Forty-four healthy , pregnant women were r and omized to the  high-flavanol ( n = 23 ) or low-flavanol ( n = 21 ) chocolate consumption  for 12 weeks . At r and omization ( 0 , 60 , 120 and 180 min after a single 40-g dose of chocolate ) , 6 and 12 weeks after daily 20-g chocolate intake , we evaluated plasma concentrations of flavanols and theobromine , as well as the FMD and BP . Results Plasma epicatechin was significantly increased ( p < 0.001 ) 180 min after the consumption of 40-g high-flavanol chocolate compared to low-flavanol chocolate . Theobromine concentrations were significantly higher 180 min and 12 weeks after the intake of experimental chocolate or low-flavanol chocolate ( p < 0.001 ) . FMD was not different between the 2 groups at all pre-defined time periods . No other significant within-group or between-group changes were observed . Conclusion These results confirm the feasibility of a large-scale RCT comparing daily consumption of flavanol-rich chocolate to an equivalent placebo during pregnancy and demonstrate higher plasma epicatechin and theobromine concentration in the intervention group after acute ingestionTrial registration Clinical Trials.gov Identifier : Objective Habitual chocolate intake was recently found to be associated with lower body weight in three cross-sectional epidemiological studies . Our objective was to assess whether these cross-sectional results hold up in a more rigorous prospect i ve analysis . Methods We used data from the Atherosclerosis Risk in Communities cohort . Usual dietary intake was assessed by question naire at baseline ( 1987–98 ) , and after six years . Participants reported usual chocolate intake as the frequency of eating a 1-oz ( ∼28 g ) serving . Body weight and height were measured at the two visits . Missing data were replaced by multiple imputation . Linear mixed-effects models were used to evaluate cross-sectional and prospect i ve associations between  chocolate intake and adiposity . Results Data were from 15,732 and 12,830 participants at the first and second visit , respectively . More frequent chocolate consumption was associated with a significantly greater prospect i ve weight gain over time , in a dose-response manner . For instance , compared to participants who ate a chocolate serving less often than monthly , those who ate it 1–4 times a month and at least weekly experienced an increase in Body Mass Index ( kg/m2 ) of 0.26 ( 95 % CI 0.08 , 0.44 ) and 0.39 ( 0.23 , 0.55 ) , respectively , during the six-year study period . In cross-sectional analyses the frequency of chocolate consumption was inversely associated with body weight . This inverse association was attenuated after excluding participants with preexisting obesity-related illness . Compared to participants without such illness , those with it had higher BMI and reported less frequent chocolate intake , lower caloric intake , and diets richer in fruits and vegetables . They tended to make these dietary changes after becoming ill . Conclusions Our prospect i ve analysis found that a chocolate habit was associated with long-term weight gain , in a dose-response manner . Our cross-sectional finding that chocolate intake was associated with lower body weight did not apply to participants without preexisting serious illness Introduction . The aim of this study was to assess the vascular benefits of dark chocolate in healthy and young individuals . Methods . A r and omized and controlled trial was carried out involving 60 healthy volunteers , r and omized into two groups :  control group ( CG ; n = 30 ) and  intervention group ( IG ; n = 30 ) . The IG ingested a daily dosage of 10 g of dark chocolate ( > 75 % cocoa ) for a month . Blood pressure ( BP ) , flow-mediated dilation ( FMD ) , arterial stiffness index ( ASI ) , aortic pulse wave velocity ( PWV ) , and pulse wave analysis ( PWA ) were assessed at baseline and one week after the one-month intervention period . Results . Arterial function improved after intervention in the IG , with PWV decreasing from 6.13 ± 0.41 m/s to 5.83 ± 0.53 m/s ( P = 0.02 ) , with no significant differences observed in the CG . A significant decrease in ASI ( 0.16 ± 0.01 to 0.13 ± 0.01 ; P < 0.001 ) and AiX ( −15.88 ± 10.75 to −22.57 ± 11.16 ; P = 0.07 ) was also depicted for the IG . Endothelial function improved in the IG , with the FMD increasing 9.31 % after the 1-month intervention ( P < 0.001 ) , with no significant variation in the CG . Conclusion . The daily ingestion of 10 g dark chocolate ( > 75 % cocoa ) during a month significantly improves vascular function in young and healthy individuals BACKGROUND The sensory attributes of foods may have an important influence on intake because of sensory-specific satiety ( SSS ) . Foods with high SSS may aid in body weight maintenance as a result of termination of consumption before metabolic satiety . No studies have investigated whether long-term exposure to a food might change SSS or how this affects food intake . OBJECTIVE The objective was to compare the effects of daily consumption of 3 energy-dense snack foods ( hazelnuts , chocolate , and potato chips ) for 12 wk on SSS and ad libitum intake during a tasting session . DESIGN One hundred eighteen participants took part in this r and omized , controlled , parallel study with 4 arms : control group ( no additional food ) or ∼1100 kJ/d for each snack . SSS , food intake , and body composition were measured at baseline and at week 12 . RESULTS Daily consumption of snacks for 12 wk result ed in a statistically significant reduction in SSS in all 3 snack groups ( P = 0.015 ) . However , no such changes were seen in the control group ( P = 0.608 ) . Ad libitum energy intake increased over the study during the tasting sessions for the snack food across all groups , including the control group ( P = 0.039 ) . Inverse associations were found between baseline SSS and BMI ( P = 0.039 ) , percentage body fat ( P = 0.013 ) , and fat mass ( P = 0.004 ) . CONCLUSION Habitual consumption of a high energy-dense snack food results in a decrease in SSS , which could lead to a higher energy intake of the snack . This trial was registered at www.anzctr.org.au as ACTRN12609000265279 BACKGROUND Evidence from clinical studies has suggested that cocoa may increase high-density lipoprotein (HDL)-cholesterol concentrations . However , it is unclear whether this effect is attributable to flavonoids or theobromine , both of which are major cocoa components . OBJECTIVES We investigated whether pure theobromine increases serum HDL cholesterol and whether there is an interaction effect between theobromine and cocoa . DESIGN The study had a 2-center , double-blind , r and omized , placebo-controlled , full factorial parallel design . After a 2-wk run-in period , 152 healthy men and women ( aged 40 - 70 y ) were r and omly allocated to consume one 200-mL drink/d for 4 wk that contained 1 ) cocoa , which naturally provided 150 mg theobromine and 325 mg flavonoids [ cocoa intervention ( CC ) ] , 2 ) 850 mg pure theobromine [ theobromine intervention ( TB ) ] , 3 ) cocoa and added theobromine , which provided 1000 mg theobromine and 325 mg flavonoids [ theobromine and cocoa intervention ( TB+CC ) ] , or 4 ) neither cocoa nor theobromine ( placebo ) . Blood lipids and apolipoproteins were measured at the start and end of interventions . RESULTS In a 2-factor analysis , there was a significant main effect of the TB ( P < 0.0001 ) but not CC ( P = 0.1288 ) on HDL cholesterol but no significant interaction ( P = 0.3735 ) . The TB increased HDL-cholesterol concentrations by 0.16 mmol/L ( P < 0.0001 ) . Furthermore , there was a significant main effect of the TB on increasing apolipoprotein A-I ( P < 0.0001 ) and decreasing apolipoprotein B and LDL-cholesterol concentrations ( P < 0.02 ) . CONCLUSIONS Theobromine independently increased serum HDL-cholesterol concentrations by 0.16 mmol/L. The lack of significant cocoa and interaction effects suggested that theobromine may be the main ingredient responsible for the HDL cholesterol-raising effect . This trial was registered at clinical trials.gov as NCT01481389 Purpose To investigate the effect of cocoa powder supplementation on obesity-related inflammation in high fat (HF)-fed obese mice . Methods Male C57BL/6J ( n = 126 ) were fed with either low-fat ( LF , 10 % kcal from fat ) or HF ( 60 % kcal from fat ) diet for 18 weeks . After 8 weeks , mice from HF group were r and omized to HF diet or HF diet supplemented with 8 % cocoa powder ( HF – HFC group ) for 10 weeks . Blood and tissue sample s were collected for biochemical analyses . Results Cocoa powder supplementation significantly reduced the rate of body weight gain ( 15.8 % ) and increased fecal lipid content ( 55.2 % ) compared to HF-fed control mice . Further , cocoa supplementation attenuated insulin resistance , as indicated by improved HOMA-IR , and reduced the severity of obesity-related fatty liver disease ( decreased plasma alanine aminotransferase and liver triglyceride ) compared to HF group . Cocoa supplementation also significantly decreased plasma levels of the pro-inflammatory mediators interleukin-6 ( IL-6 , 30.4 % ) , monocyte chemoattractant protein-1 ( MCP-1 , 25.2 % ) , and increased adiponectin ( 33.7 % ) compared to HF-fed mice . Expression of pro-inflammatory genes ( Il6 , Il12b , Nos2 , and Emr1 ) in the stromal vascular fraction ( SVF ) of the epididymal white adipose tissue ( WAT ) was significantly reduced ( 37–56 % ) in the cocoa-supplemented mice . Conclusions Dietary supplementation with cocoa ameliorates obesity-related inflammation , insulin resistance , and fatty liver disease in HF-fed obese mice , principally through the down-regulation of pro-inflammatory gene expression in WAT . These effects appear to be mediated in part by a modulation of dietary fat absorption and inhibition of macrophage infiltration in WAT AIM to investigate the effect of consumption of dark chocolate 30 g/day for fifteen days on  Nitric oxide ( NO ) serum levels and blood pressure in male and female employees with prehypertension . METHODS the study was a parallel r and omized clinical trial . A total of thirty-two subjects was divided into two groups using block r and omization . Sixteen subjects received 30 g/day dark chocolate and dietary counseling ( treatment group ) and the other 16 subjects received white chocolate 25 g/day and dietary counseling ( control group ) for fifteen days . Data collected in this study consisted of age , physical activity , body massa index , intake of energy , intake of sodium , and intake of polyphenol , NO serum levels and blood pressure . The measurement of NO serum levels was done in pre- and after- treatment , while blood pressure was assessed in pre- , during- and after- treatment . Statistical analysis was performed using independent t-test for normal distribution data and Mann-Whitney test for not normal distribution data , with the level of significancy of 5 % . RESULTS after 15 days treatment , NO serum level between treatment and control groups were significantly different 7.70 ± 3.84 vs 1.92(-0.79 ± 17.78 ) ( p=0.001 ) . Both groups had decreased systolic and diastolic blood pressure . Systolic blood pressure was different significantly between groups after treatment 120.64 ± 8.47 vs 131.19 ± 7.45 ( p=0.001 ) , while diastolic blood pressure was not significant 74.14 ± 6.30 vs 77.44 ± 10.29 ( p=0.308 ) . CONCLUSION in prehypertension subjects  , dark chocolate 30 g/day increased NOx serum levels and decreased systolic blood pressure after 15 days of treatment OBJECTIVE The formation of reactive oxygen species ( ROS ) contributes to the pathogenesis and progression of several diseases . Polyphenols have been shown to be beneficial against ROS . The aim of this study was to evaluate the effects of a natural antioxidant ice cream on oxidative stress , vascular function , and physical performance . METHODS In this controlled , single-blind , crossover study , 14 healthy individuals were r and omized to consume 100 g of either antioxidant ice cream containing dark cocoa powder and hazelnut and green tea extracts or milk chocolate ice cream ( control ice cream ) . Participants were studied at baseline and 2 h after ingesting ice cream . Serum polyphenols , antioxidant status ( ferric-reducing ability of plasma [ FRAP ] ) , nitric oxide ( NOx ) bioavailability , markers of oxidative stress ( determination of reactive oxygen metabolites [ d-ROMs ] and hydrogen peroxide [ H2O2 ] ) , endothelium function ( flow-mediated dilation [ FMD ] and reactive hyperemia index [ RHI ] ) , and exercise tolerance ( stress test ) were assessed , and the double product was measured . RESULTS Serum polyphenols ( P < 0.001 ) , NOx ( P < 0.001 ) , FRAP ( P < 0.005 ) , FMD ( P < 0.001 ) , and RHI ( P < 0.05 ) increased significantly , oxidative stress decreased ( d-Roms , P < 0.001 ; H2O2 , P < 0.001 ) , and the double product ( P < 0.001 ) was improved only after antioxidant ice cream ingestion . No changes were found after control ice cream ingestion . CONCLUSIONS To our knowledge , this is the first study to demonstrate that a natural ice cream rich in polyphenols acutely improved vascular function and physical performance in healthy individuals through a reduction in oxidative stress BACKGROUND The consumption of dietary antioxidants is considered to be a good strategy against photo-aging . However , the results of previous clinical trials that investigated the effects of oral consumption of high-flavanol cocoa products on skin photo-aging have been contradictory . OBJECTIVE The aim of this study was to investigate whether high-flavanol cocoa supplementation would improve the moderately photo-aged facial skin of female participants , by assessing skin wrinkles and elasticity . METHODS We performed a 24-wk , r and omized , double-blind , placebo-controlled study to evaluate the effects of oral supplementation of cocoa flavanols on cutaneous photo-aging .  All participants were moderately photo-aged Korean women with visible facial wrinkles ( age range : 43 - 86 y ) . Participants were r and omly assigned to receive a placebo beverage or cocoa beverage that contained 320 mg total cocoa flavanols/d . We measured wrinkles , skin elasticity , and hydration at baseline and at 12 and 24 wk . The primary endpoint was the mean percentage change in the average roughness value ( Rz ) at 24 wk . RESULTS At 24 wk , the mean percentage change in Rz ( primary endpoint ) was significantly lower in the cocoa group than in the placebo group ( -8.7 percentage points ; 95 % CI : -16.1 , -1.3 percentage points ; P = 0.023 ) . The mean percentage changes in gross elasticity , as determined by a cutometer , also differed between the groups at 12 wk ( 9.1 percentage points ; 95 % CI : 1.5 , 16.7 percentage points ; P = 0.020 ) and 24 wk ( 8.6 percentage points ; 95 % CI : 1.0 , 16.2 percentage points ; P = 0.027 ) . However , there were no significant differences in skin hydration and barrier integrity between the 2 groups . CONCLUSIONS In moderately photo-aged women , regular cocoa flavanol consumption had positive effects on facial wrinkles and elasticity .  Cocoa flavanol supplementation may contribute to the prevention of the progression of photo-aging . This trial was registered at clinical trials.gov as NCT02060097 OBJECTIVES Our goal was to test feasibility and efficacy of a dietary intervention based on daily intake of flavanol-containing cocoa for improving vascular function of medicated diabetic patients . BACKGROUND Even in fully medicated diabetic patients , overall prognosis is unfavorable due to deteriorated cardiovascular function . Based on epidemiological data , diets rich in flavanols are associated with a reduced cardiovascular risk . METHODS In a feasibility study with 10 diabetic patients , we assessed vascular function as flow-mediated dilation ( FMD ) of the brachial artery , plasma levels of flavanol metabolites , and tolerability after an acute , single-dose ingestion of cocoa , containing increasing concentrations of flavanols ( 75 , 371 , and 963 mg ) . In a subsequent efficacy study , changes in vascular function in 41 medicated diabetic patients were assessed after a 30-day , thrice-daily dietary intervention with either flavanol-rich cocoa ( 321 mg flavanols per dose ) or a nutrient-matched control ( 25 mg flavanols per dose ) . Both studies were undertaken in a r and omized , double-masked fashion . Primary and secondary outcome measures included changes in FMD and plasma flavanol metabolites , respectively . RESULTS A single ingestion of flavanol-containing cocoa was dose-dependently associated with significant acute increases in circulating flavanols and FMD ( at 2 h : from 3.7 + /- 0.2 % to 5.5 + /- 0.4 % , p < 0.001 ) . A 30-day , thrice-daily consumption of flavanol-containing cocoa increased baseline FMD by 30 % ( p < 0.0001 ) , while acute increases of FMD upon ingestion of flavanol-containing cocoa continued to be manifest throughout the study . Treatment was well tolerated without evidence of tachyphylaxia . Endothelium-independent responses , blood pressure , heart rate , and glycemic control were unaffected . CONCLUSIONS Diets rich in flavanols reverse vascular dysfunction in diabetes , highlighting therapeutic potentials in cardiovascular disease BACKGROUND AND AIMS Epidemiological studies suggest that regular consumption of cocoa-containing products may confer cardiovascular protection , reducing the risk of coronary heart disease ( CHD ) . However , studies on the effects of cocoa on different cardiovascular risk factors are still scarce . The aim of this study was too evaluate the effects of chronic cocoa consumption on lipid profile , oxidized low-density lipoprotein ( oxLDL ) particles and plasma antioxidant vitamin concentrations in high-risk patients . METHODS AND RESULTS Forty-two high-risk volunteers ( 19 men and 23 women , mean age 69.7 ± 11.5 years ) were included in a r and omized , crossover feeding trial . All received 40 g of cocoa powder with 500 mL of skimmed milk/day(C + M ) or only 500 mL/day of skimmed milk ( M ) for 4 weeks in a r and om order . Before and after each intervention period , plasma lipids , oxLDL and antioxidant vitamin concentrations were measured , as well as urinary cocoa polyphenols metabolites derived from phase II and microbial metabolisms . Compared to M , C + M intervention increases HDLc [ 2.67 mg/dL ( 95 % confidence intervals , CI , 0.58 - 4.73 ; P = 0.008 ) ] and decreases oxLDL levels [ -12.3 U/L ( CI,-19.3 to -5.2;P = 0.001 ) ] . No changes between intervention groups were observed in vitamins B1 , B6 , B12 , C and E , or folic acid concentrations . In addition , subjects who showed higher increments in urinary cocoa polyphenol metabolites exhibited significant increases in HDLc and significant decreases in oxLDL levels ( P < 0.05 ; all ) . CONCLUSIONS Consumption of cocoa power with milk modulates the lipid profile  in high-risk subjects for CHD . In addition , the relationship observed between the urinary excretion of cocoa polyphenol metabolites and plasma HDLc and oxLDL levels suggests a beneficial role for cocoa polyphenols in lipid metabolism BACKGROUND AND AIMS Cocoa flavanols are recognised by their favourable antioxidant and vascular effects . This study investigates the influence on health of the daily consumption of ready-to-eat meals supplemented with cocoa extract within a hypocaloric diet , on middle-aged overweight/obese subjects . METHODS AND RESULTS Fifty healthy male and female middle-aged volunteers [ 57.26 ± 5.24 years and body mass index ( BMI ) 30.59 ± 2.33 kg/m(2 ) ] were recruited to participate in a 4 week r and omised , parallel and double-blind study . After following 3 days on a low-polyphenol diet , 25 volunteers received meals supplemented with 1.4 g of cocoa extract ( 645.3 mg of polyphenols ) and the other 25 participants received control meals , within a 15 % energy restriction diet . On the 4th week of intervention individuals in both dietary groups improved ( p < 0.05 ) anthropometric , body composition , blood pressure and blood biochemical measurements . Oxidised LDL cholesterol ( oxLDL ) , showed a higher reduction ( p = 0.030 ) in the cocoa group . Moreover , myeloperoxidase ( MPO ) levels decreased only in the cocoa supplemented group ( p = 0.007 ) . Intercellular Adhesion Molecule-1 ( sICAM-1 ) decreased significantly in both groups , while Vascular Cell Adhesion Molecule-1 ( sVCAM-1 ) did not present differences after the 4 weeks of intervention . Interestingly , cocoa intake showed a different effect by gender , presenting more beneficial effects in men . CONCLUSIONS The consumption of cocoa extract as part of ready-to-eat meals and within a hypocaloric diet improved oxidative status ( oxLDL ) in middle-aged subjects , being most remarkable in males . REGISTRATION NUMBER Registered at www . clinical trials.gov ( NCT01596309 ) Reduced-calorie diets are difficult to follow because they often require elimination of certain foods , leading to poor compliance and limited success . However , a low-calorie , nutrient-dense diet has the potential to accommo date a daily snack without exceeding energy requirements , even during weight loss . This pilot study evaluated the effects of a reduced-calorie diet including either a daily dark chocolate snack or a non-chocolate snack on anthropometric and body composition measurements . In a r and omized clinical trial , 26 overweight and obese ( body mass index ≥25 to ≤43 ) premenopausal women were assigned to a reduced-calorie diet that included either a daily dark chocolate snack or non-chocolate snack ( n=13 per group ) for 18 weeks . At baseline and end of study , body weight and waist and hip circumferences were measured along with fat mass , lean mass , and body fat percentage by dual-energy x-ray absorptiometry . Energy and macronutrient intakes were estimated from 4-day food records . Within- and between-group changes from baseline were analyzed using paired t tests and independent t tests , respectively . Women in both snack groups reduced estimated daily energy intake ( P<0.001 ) . Women in both the dark chocolate snack and non-chocolate snack groups , respectively , experienced decreases ( P<0.001 ) in body weight ( -5.1 vs -5.1 kg ) , hip circumference ( -5.8 vs -5.4 cm ) , waist circumference ( -5.7 vs -3.5 cm ) , fat mass ( -3.9 vs -3.6 kg ) , and body fat percentage ( -3.4 % vs -3.1 % ) , with no change in lean mass . Improvements in anthropometric and body composition measurements among overweight and obese premenopausal women can be achieved with a reduced-calorie diet including either a daily dark chocolate snack or non-chocolate snack BACKGROUND Studies of cocoa suggest an array of cardiovascular benefits ; however , the effects of daily intake of sugar-free and sugar-sweetened cocoa beverages on endothelial function ( EF ) have yet to be established . METHODS 44 adults ( BMI 25 - 35 kg/m2 ) participated in a r and omized , controlled , crossover trial . Participants were r and omly assigned to a treatment sequence : sugar-free cocoa beverage , sugar-sweetened cocoa beverage , and sugar-sweetened cocoa-free placebo . Treatments were administered daily for 6 weeks , with a 4-week washout period . RESULTS Cocoa ingestion improved EF measured as flow-mediated dilation ( FMD ) compared to placebo ( sugar-free cocoa : change , 2.4 % [ 95 % CI , 1.5 to 3.2 ] vs. -0.8 % [ 95 % CI , -1.9 to 0.3 ] ; difference , 3.2 % [ 95 % CI , 1.8 to 4.6 ] ; p<0.001 and sugar-sweetened cocoa : change , 1.5 % [ 95 % CI , 0.6 to 2.4 ] vs. -0.8 % [ 95 % CI , -1.9 to 0.3 ] ; difference , 2.3 % [ 95 % CI , 0.9 to 3.7 ] ; p=0.002 ) . The magnitude of improvement in FMD after consumption of sugar-free versus sugar-sweetened cocoa was greater , but not significantly . Other biomarkers of cardiac risk did not change appreciably from baseline . BMI remained stable throughout the study . CONCLUSIONS Daily cocoa ingestion improves EF independently of other biomarkers of cardiac risk , and does not cause weight gain . Sugar-free preparations may further augment endothelial function Epidemiological studies have suggested that the daily intake of flavonoids is associated with a decreased risk of developing cardiovascular disease . Our purpose was to evaluate the effect of the addition of dietary flavonoids ( DF ) to antihypertensive treatment ( AHT ) , based on telmisartan ( Tms ) or captopril ( Cpr ) , on blood pressure ( BP ) , body mass index ( BMI ) , waist/hip ratio , leptin , lipid profile and inflammation in hypertensive young patients . An open‐label , r and omized , controlled trial was performed among 79 patients aged 20–55 years with grade I or grade II systemic arterial hypertension . The subjects were assigned to one of four groups for AHT plus DF during 6 months : Cpr ( n = 14 ) , Cpr + DF ( n = 19 ) , Tms ( n = 25 ) and Tms + DF ( n = 21 ) . DF consisted of dark chocolate , dehydrated red apple and green tea in an infusion to obtain a daily dose of 425.8 ± 13.9 mg epicatechin equivalents . The BP and anthropometric parameters were measured every 2 weeks . Lipid profile , leptin and hsCRP were determined by st and ard methods . The combination AHT‐DF produced an additional and significant reduction in ( i ) SBP/DBP of −5/−4 mmHg , being −7/−5 for Cpr + DF and −4/−3 for Tms + DF ; ( ii ) triglyceride levels ( −30.6 % ) versus AHT alone ( −9.6 % ) ; and ( iii ) leptin : Cpr + DF versus Tms + DF ( p < 0.005 ) . Finally , C‐reactive protein plasma levels were reduced significantly in all groups independently of the applied treatment . We conclude that the addition of flavonoids to pharmacological antihypertensive therapy shows additional benefits on BP , lipid profile , leptin , obesity and inflammation OBJECTIVE We tested the hypothesis that a multifaceted 11-wk intervention comprising nutrition , group exercise , and oral care would have a significant influence on nutrition and function in elderly ( > or=65 y ) nursing-home residents . METHODS The study was an 11-wk r and omized controlled intervention study with nutrition ( chocolate and homemade oral supplements ) , group exercise twice a week ( 45 - 60 min , moderate intensity ) , and oral care intervention one to two times a week , with the aim of improving nutritional status and function in elderly nursing-home residents . A follow-up visit was made 4 mo after the end of the intervention . Assessment s were weight , body mass index , dietary intake , h and grip strength , Senior Fitness Test , Berg 's Balance Scale , and the prevalence of plaque . RESULTS A total of 121 subjects ( 61 % ) accepted the invitation and 62 were r and omized to the intervention group . Six of these dropped out during the 11 wk . At the 4-mo follow-up there were 15 deaths in the intervention group and 8 in the control group . The nutrition and exercise were well tolerated . After 11 wk the change in percentage of weight ( P = 0.005 ) , percentage of body mass index ( P = 0.003 ) , energy intake ( P = 0.084 ) , protein intake ( P = 0.012 ) , and Berg 's Balance Scale ( P = 0.004 ) was higher in the intervention group than in the control group . In addition , the percentage of subjects whose functional tests improved was higher in the intervention group . Both groups lost the same percentage of weight after the intervention ( P = 0.908 ) . The total percentage of weight loss from baseline to follow-up was higher in the control group ( P = 0.019 ) . Oral care was not well accepted and the prevalence of plaque did not change . CONCLUSION It is possible to improve nutrition and function in elderly nursing-home residents by means of a multifaceted intervention consisting of chocolate , homemade supplements , group exercise , and oral care Cephalic effects on appetite are mediated by vagal tone and altered gastrointestinal hormones . The objective of this study is to explore the relationship between appetite and levels of gastrointestinal hormones after smelling chocolate and after melt- and -swallow 30 g chocolate ( 1.059 oz , 85 % cocoa , 12.5 g of sugar per 100 g product ) . Twelve female residents ( BMI between 18 and 25 kg/m(2 ) ) all participated in two 60-minute study sessions . In the first session , all 12 women  ate chocolate ; for the second session , they were r and omized either to smell chocolate ( n=6 ) or to serve as a control ( no eating or smelling ; n=6 ) . At the start of the sessions , levels of insulin , glucagon-like peptide-1 ( GLP-1 ) and cholecystokinin ( CCK ) , but not glucose , correlated with appetite scored on a visual analogue scale ( VAS ) . In contrast , ghrelin levels correlated inversely with scored appetite . Chocolate eating and smelling both induced a similar appetite suppression with a disappearance of correlations between VAS scores and insulin , GLP-1 and CCK levels . However , while the correlation between VAS score and ghrelin disappeared completely after chocolate eating , it reversed after chocolate smelling , that is , olfactory stimulation with dark chocolate ( 85 % ) result ed in a satiation response that correlated inversely with ghrelin levels BACKGROUND The absorption of cocoa flavanols in the small intestine is limited , and the majority of the flavanols reach the large intestine where they may be metabolized by resident microbiota . OBJECTIVE We assessed the prebiotic potential of cocoa flavanols in a r and omized , double-blind , crossover , controlled intervention study . DESIGN Twenty-two healthy human volunteers were r and omly assigned to either a high-cocoa flavanol ( HCF ) group ( 494 mg cocoa flavanols/d ) or a low-cocoa flavanol ( LCF ) group ( 23 mg cocoa flavanols/d ) for 4 wk . This was followed by a 4-wk washout period before volunteers crossed to the alternant arm . Fecal sample s were recovered before and after each intervention , and bacterial numbers were measured by fluorescence in situ hybridization . A number of other biochemical and physiologic markers were measured . RESULTS Compared with the consumption of the LCF drink , the daily consumption of the HCF drink for 4 wk significantly increased the bifidobacterial ( P < 0.01 ) and lactobacilli ( P < 0.001 ) population s but significantly decreased clostridia counts ( P < 0.001 ) . These microbial changes were paralleled by significant reductions in plasma triacylglycerol ( P < 0.05 ) and C-reactive protein ( P < 0.05 ) concentrations . Furthermore , changes in C-reactive protein concentrations were linked to changes in lactobacilli counts ( P < 0.05 , R(2 ) = -0.33 for the model ) . These in vivo changes were closely paralleled by cocoa flavanol-induced bacterial changes in mixed-batch culture experiments . CONCLUSION This study shows , for the first time to our knowledge , that consumption of cocoa flavanols can significantly affect the growth of select gut microflora in humans , which suggests the potential prebiotic benefits associated with the dietary inclusion of flavanol-rich foods . This trial was registered at clinical trials.gov as NCT01091922
target: Conclusion : Cocoa/DC supplementation does not reduce anthropometric measures significantly .
  However subgroup analysis regarding dose ( ≥ 30 g/day ) and duration ( between 4 to 8 weeks ) revealed significant reduction of body weight and BMI
background: ABSTRACT Background : Cocoa and dark chocolate ( DC ) have been reported to be effective for health promotion ; however the exact effect of cocoa/DC on anthropometric measures have not been yet defined .