Intake-dependent Effect of Cocoa Flavanol Absorption, Metabolism and Excretion in Humans

A randomized, double-masked and cross-over dietary intervention study in healthy young adult males to evaluate the concentration of F-derived metabolites in plasma and urine after single acute intakes of F-containing drinks on four different test days.

Study Overview

• Status: Completed
• Conditions: Healthy
• Intervention / Treatment: Other: 100 mg of Cocoa Flavanols/70 kg BW; Other: 200 mg of Cocoa Flavanols/70 kg BW; Other: 400 mg of Cocoa Flavanols/70 kg BW; Other: 1000 mg of Cocoa Flavanols/70 kg BW

Detailed Description

Flavanols (F) are plant-derived compounds commonly present in the human diet. Examples of F-containing foods and beverages are apples, chocolate, tea, wine, berries, pomegranate and nuts. The consumption of F-containing foods and beverages has been associated with improvements in cardiovascular health. In this context, there exists a great interest in describing the absorption, metabolism and excretion of F in humans, as it is thought that F-derived metabolites present in circulation are the mediators of F-beneficial effects in humans. Recently, we described a series of F-derived metabolites in circulation that are present after the consumption of a single acute intake amount of F in humans. A key question, however, is if the metabolites we observed after a single acute feeding are the same as those that occur in individuals who consume F-rich diets on a regular basis. Studies investigating the metabolism of numerous other xenobiotics have shown that the profile of metabolites can greatly vary over time, as well as with the amount of xenobiotic ingested. In this context, and considering that i) the amount of F-consumed from diet greatly varies among individuals, ii) recent epidemiology studies indicate that the vascular protective effects of F diets primarily occur when daily intake of F are relatively high; and iii) there is evidence of an intake amount-dependency on the vascular effects of F in dietary intervention studies; we submit it is important to assess whether or not there are F intake amount-dependent effects on the levels and profile of F-derived metabolites in humans. This study will provide new information concerning the F-derived metabolites that may be responsible for mediating F-beneficial effects in humans. We suggest the information that will be obtained from the outlined work will be particularly timely given ongoing discussion concerning the possible generation of dietary recommendations for F-rich foods.

• Study Type: Interventional
• Enrollment (Actual): 14
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • Davis, California, United States, 95616
      • UC Davis

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 25 years to 40 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Male

Description

Inclusion Criteria:

• No prescription medications
• BMI 18.5 - 29.9 kg/m2
• Weight ≥ 110 pounds
• previously consumed cocoa and peanut products, with no adverse reactions

Exclusion Criteria:

• Adults unable to consent
• Prisoners
• Non-English speaking*
• BMI ≥ 30 kg/m2
• Allergies to nuts, cocoa and chocolate products
• Active avoidance of coffee and caffeinated soft drinks
• Under current medical supervision
• A history of cardiovascular disease, stroke, renal, hepatic, or thyroid disease
• History of clinically significant depression, anxiety or other psychiatric condition
• History of Raynaud's disease
• History of difficult blood draws
• Indications of substance or alcohol abuse within the last 3 years
• Current use of herbal, plant or botanical supplements (multi-vitamin/mineral supplements are allowed)
• Blood Pressure > 140/90 mm Hg
• GI tract disorders, previous GI surgery (except appendectomy)
• Self-reported malabsorption (e.g. difficulty digesting or absorbing nutrients from food, potentially leading to bloating, cramping or gas)
• Diarrhea within the last month, or antibiotic intake within the last month
• Vegetarian, Vegan, food faddists, individuals using non-traditional diets, on a weight loss diet or individual following diets with significant deviations from the average diet
• Metabolic panel results or complete blood counts that are outside of the normal reference range and are considered clinically relevant by the study physician
• Screening LDL ≥ 190 mg/dl for those who have 0-1 major risk factors apart from LDL cholesterol (i.e. family history of premature coronary artery disease (male first degree relative < 55 years; CHD in female first degree relative < 65 years), cigarette smoker, HDL-C ≤ 40 mg/dL)
• Screening LDL ≥ 160 mg/dl for those who have 2 major risk factors apart from LDL cholesterol (i.e. family history of premature coronary artery disease (male first degree relative < 55 years; CHD in female first degree relative < 65 years), cigarette smoker, HDL-C ≤ 40 mg/dL).

(using NCEP calculator http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof)

• Screening LDL ≥ 130 mg/dl for those who have 2 major risk factors apart from LDL cholesterol (i.e. family history of premature coronary artery disease (male first degree relative < 55 years; CHD in female first degree relative < 65 years), cigarette smoker, HDL-C ≤ 40 mg/dL), and a Framingham 10-year Risk Score 10-20% (Framingham risk calculated using NCEP calculator http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof)
• Cold, flu, or upper respiratory condition at screening
• Currently participating in a clinical or dietary intervention study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Quadruple

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 100 mg of Cocoa Flavanols/70 kg BW; Fruit flavored non-dairy drink containing 100 cocoa flavanol/70 kg BW	Other: 100 mg of Cocoa Flavanols/70 kg BW; Fruit-flavored non-dairy drink containing 100 cocoa flavanols/70kg BW.
Experimental: 200 mg of Cocoa Flavanols/70 kg BW; Fruit flavored non-dairy drink containing 200 cocoa flavanol/70 kg BW	Other: 200 mg of Cocoa Flavanols/70 kg BW; Fruit-flavored non-dairy drink containing 200 cocoa flavanols/70kg BW.
Experimental: 400 mg of Cocoa Flavanols/70 kg BW; Fruit flavored non-dairy drink containing 400 cocoa flavanol/70 kg BW	Other: 400 mg of Cocoa Flavanols/70 kg BW; Fruit-flavored non-dairy drink containing 400 cocoa flavanols/70kg BW.
Experimental: 1000 mg of Cocoa Flavanols/70 kg BW; Fruit flavored non-dairy drink containing 1000 cocoa flavanol/70 kg BW	Other: 1000 mg of Cocoa Flavanols/70 kg BW; Fruit-flavored non-dairy drink containing 1000 cocoa flavanols/70kg BW.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in levels of gut microbiome derived metabolites in urine	Gut microbiome derived metabolites include conjugates of 5-(3',4'-dihydroxyphenyl)-g-valerolatone metabolites	Urine collected 12h previous to intervention and up to 24 h after intervention
Change in levels of gut microbiome derived metabolites in plasma	Gut microbiome derived metabolites include conjugates of 5-(3',4'-dihydroxyphenyl)-g-valerolatone	Plasma collected before (0h) and up to 6h post intervention
Change in levels of structurally related epicatechin metabolites in urine	Structurally related epicatechin metabolites include sulfated, glucuronidated and/or methylated metabolites of epicatechin	Urine collected 12h previous to intervention and up to 24 h after intervention
Change in levels of structurally related epicatechin metabolites in plasma	Structurally related epicatechin metabolites include sulfated, glucuronidated and/or methylated metabolites of epicatechin	Plasma collected before (0h) and up to 6h post intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Composite of pharmacokinetic (PK) parameters of metabolites Maximum Plasma Concentration (CMax)	PK parameters: Cmax: maximum observed concentration in plasma;	Before intervention (0h) and up to 24 h after intervention
Composite of pharmacokinetic (PK) parameters of metabolites Time to Maximum Plasma Concentration	tmax: time to maximum concentration in plasma;	Before intervention (0h) and up to 24 h after intervention
Composite of pharmacokinetic (PK) parameters of metabolites Area Under the Curve	AUC0-t: area under the plasma concentration-time curve from hour 0 to the last measurable concentration in plasma;	Before intervention (0h) and up to 24 h after intervention
Composite of pharmacokinetic (PK) parameters of metabolites Area Under the Curve extrapolated to infinity	AUC0-∞: area under the plasma concentration-time curve extrapolated to infinity;	Before intervention (0h) and up to 24 h after intervention
Composite of pharmacokinetic (PK) parameters of metabolites Elimination Rate Constant	λZ: apparent terminal elimination rate constant in plasma;	Before intervention (0h) and up to 24 h after intervention
Composite of pharmacokinetic (PK) parameters of metabolites Elimination Half-Life	t1/2: apparent terminal elimination half-life in plasma;	Before intervention (0h) and up to 24 h after intervention
Composite of pharmacokinetic (PK) parameters of metabolites Systemic Clearance	CL/F: systemic clearance;	Before intervention (0h) and up to 24 h after intervention
Composite of pharmacokinetic (PK) parameters of metabolites Renal Clearance	CLR: renal clearance;sampling interval and the total interval examined;	Before intervention (0h) and up to 24 h after intervention
Composite of pharmacokinetic (PK) parameters of metabolites cumulative Amount Excreted in Feces	Aef(0-t): Cumulative amount excreted in the feces over each sampling interval and the total interval examined.	Before intervention (0h) and up to 24 h after intervention
Composite of pharmacokinetic (PK) parameters of metabolites Volume of Distribution	Vd/F: apparent volume of distribution;	Before intervention (0h) and up to 24 h after intervention
Composite of pharmacokinetic (PK) parameters of metabolites cumulative Amount Excreted in Urine	Aeu(0-t): cumulative amount excreted in the urine over each	Before intervention (0h) and up to 24 h after intervention

Collaborators and Investigators

• Sponsor: University of California, Davis
• Collaborators: Mars, Inc.

Publications and helpful links

General Publications

• Heiss C, Kleinbongard P, Dejam A, Perre S, Schroeter H, Sies H, Kelm M. Acute consumption of flavanol-rich cocoa and the reversal of endothelial dysfunction in smokers. J Am Coll Cardiol. 2005 Oct 4;46(7):1276-83. doi: 10.1016/j.jacc.2005.06.055.
• Schroeter H, Heiss C, Spencer JP, Keen CL, Lupton JR, Schmitz HH. Recommending flavanols and procyanidins for cardiovascular health: current knowledge and future needs. Mol Aspects Med. 2010 Dec;31(6):546-57. doi: 10.1016/j.mam.2010.09.008. Epub 2010 Sep 18.
• Ottaviani JI, Momma TY, Kuhnle GK, Keen CL, Schroeter H. Structurally related (-)-epicatechin metabolites in humans: assessment using de novo chemically synthesized authentic standards. Free Radic Biol Med. 2012 Apr 15;52(8):1403-12. doi: 10.1016/j.freeradbiomed.2011.12.010. Epub 2011 Dec 23.
• Koster H, Halsema I, Scholtens E, Knippers M, Mulder GJ. Dose-dependent shifts in the sulfation and glucuronidation of phenolic compounds in the rat in vivo and in isolated hepatocytes. The role of saturation of phenolsulfotransferase. Biochem Pharmacol. 1981 Sep 15;30(18):2569-75. doi: 10.1016/0006-2952(81)90584-0. No abstract available.
• McCullough ML, Chevaux K, Jackson L, Preston M, Martinez G, Schmitz HH, Coletti C, Campos H, Hollenberg NK. Hypertension, the Kuna, and the epidemiology of flavanols. J Cardiovasc Pharmacol. 2006;47 Suppl 2:S103-9; discussion 119-21. doi: 10.1097/00005344-200606001-00003.

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2013
• Primary Completion (Actual): May 25, 2013
• Study Completion (Actual): May 25, 2013

Study Registration Dates

• First Submitted: June 19, 2017
• First Submitted That Met QC Criteria: June 26, 2017
• First Posted (Actual): June 28, 2017

Study Record Updates

• Last Update Posted (Actual): June 28, 2017
• Last Update Submitted That Met QC Criteria: June 26, 2017
• Last Verified: June 1, 2017

More Information

Terms related to this study

• Keywords: polyphenols; ADME; flavanol; cocoa flavanols
• Other Study ID Numbers: 429275

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Yes
• IPD Plan Description: Only researchers listed in the protocol and approved by the IRB will have access to IPD.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No