Effects of Dark Chocolate and Almonds on Cardiovascular Risk Factors in Overweight and Obese Individuals: A Randomized Controlled-Feeding Trial

Yujin Lee, Claire E Berryman, Sheila G West, C-Y Oliver Chen, Jeffrey B Blumberg, Karen G Lapsley, Amy G Preston, Jennifer A Fleming, Penny M Kris-Etherton, Yujin Lee, Claire E Berryman, Sheila G West, C-Y Oliver Chen, Jeffrey B Blumberg, Karen G Lapsley, Amy G Preston, Jennifer A Fleming, Penny M Kris-Etherton

Abstract

Background: Consumption of almonds or dark chocolate and cocoa has favorable effects on markers of coronary heart disease; however, the combined effects have not been evaluated in a well-controlled feeding study. The aim of this study was to examine the individual and combined effects of consumption of dark chocolate and cocoa and almonds on markers of coronary heart disease risk.

Methods and results: A randomized controlled, 4-period, crossover, feeding trial was conducted in overweight and obese individuals aged 30 to 70 years. Forty-eight participants were randomized, and 31 participants completed the entire study. Each diet period was 4 weeks long, followed by a 2-week compliance break. Participants consumed each of 4 isocaloric, weight maintenance diets: (1) no treatment foods (average American diet), (2) 42.5 g/d of almonds (almond diet [ALD]), (3) 18 g/d of cocoa powder and 43 g/d of dark chocolate (chocolate diet [CHOC]), or (4) all 3 foods (CHOC+ALD). Compared with the average American diet, total cholesterol, non-high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol after the ALD were lower by 4%, 5%, and 7%, respectively (P<0.05). The CHOC+ALD decreased apolipoprotein B by 5% compared with the average American diet. For low-density lipoprotein subclasses, compared with the average American diet, the ALD showed a greater reduction in large buoyant low-density lipoprotein particles (-5.7±2.3 versus -0.3±2.3 mg/dL; P=0.04), whereas the CHOC+ALD had a greater decrease in small dense low-density lipoprotein particles (-12.0±2.8 versus -5.3±2.8 mg/dL; P=0.04). There were no significant differences between diets for measures of vascular health and oxidative stress.

Conclusions: Our results demonstrate that consumption of almonds alone or combined with dark chocolate under controlled-feeding conditions improves lipid profiles. Incorporating almonds, dark chocolate, and cocoa into a typical American diet without exceeding energy needs may reduce the risk of coronary heart disease.

Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01882881.

Keywords: almonds; cardiovascular disease risk factors; dark chocolate; flow‐mediated dilation; lipids and lipoproteins.

© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Figures

Figure 1
Figure 1
Flow of participants in the study. BMI indicates body mass index; DBP, diastolic blood pressure; LDL, low‐density lipoprotein; and SBP, systolic blood pressure.
Figure 2
Figure 2
Percentage change in serum lipids, lipoproteins, and apolipoproteins in response to 4 diets. Percentage change was calculated from the baseline value of each diet period. The bars represent least‐squares means for n=31. The error bars represent SEMs. Statistical significance was assessed using the PROC MIXED procedure in SAS; mean values with different lowercase letters are significantly different, P<0.05. AAD indicates average American diet; ALD, almond diet; ApoA1, apolipoprotein A1; ApoB, apolipoprotein B; CHOC, chocolate diet; CHOC+ALD, chocolate and almond diet; HDL, high‐density lipoprotein; HDL‐C, HDL cholesterol; IDL‐C, intermediate‐density lipoprotein cholesterol; LDL‐C, low‐density lipoprotein cholesterol; TC, total cholesterol; and VLDL‐C, very‐low‐density lipoprotein cholesterol.
Figure 3
Figure 3
Change from baseline in low‐density lipoprotein cholesterol (LDL‐C) subclasses in response to 4 diets. The bars represent least‐squares means for n=31. The error bars represent SEMs. Statistical significance was assessed using the PROC MIXED procedure in SAS; mean values with different lowercase letters are significantly different, P<0.05. AAD indicates average American diet; ALD, almond diet; CHOC, chocolate diet; CHOC+ALD, chocolate and almond diet; D‐LDL‐C, direct measurement of low‐density lipoprotein cholesterol; LDL1+2, large buoyant LDL‐C; and LDL3+4, small dense LDL‐C.
Figure 4
Figure 4
Change from baseline in high‐density lipoprotein cholesterol (HDL‐C) subclasses in response to 4 diets. The bars represent least‐squares means for n=31. The error bars represent SEMs. Statistical significance was assessed using the PROC MIXED procedure in SAS; no treatment effects occurred on HDL‐C subclasses, P>0.05. AAD indicates average American diet; ALD, almond diet; CHOC, chocolate diet; CHOC+ALD, chocolate and almond diet; HDL2, large HDL‐C particle; and HDL3, small HDL‐C particle.
Figure 5
Figure 5
Change from baseline in intermediate‐density lipoprotein (IDL), very‐low‐density lipoprotein (VLDL), VLDL 3, and triglyceride‐rich remnant (IDL+VLDL 3) in response to 4 diets. The bars represent least‐squares means for n=31. The error bars represent SEMs. Statistical significance was assessed using the PROC MIXED procedure in SAS; no treatment effects were seen in change in IDL, VLDL, VLDL 3, and triglyceride‐rich remnant, P>0.05. AAD indicates average American diet; ALD, almond diet; CHOC, chocolate diet; CHOC+ALD, chocolate and almond diet; IDL‐C, intermediate‐density lipoprotein cholesterol; VLDL‐C, very‐low‐density lipoprotein cholesterol; VLDL3, small remnant very‐low‐density lipoprotein cholesterol.

References

    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Despres JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jimenez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER III, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D , Yeh RW , Turner MB. Executive summary: heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133:447–454.
    1. Bao Y, Han J, Hu FB, Giovannucci EL, Stampfer MJ, Willett WC, Fuchs CS. Association of nut consumption with total and cause‐specific mortality. N Engl J Med. 2013;369:2001–2011.
    1. Hu FB, Stampfer MJ, Manson JE, Rimm EB, Colditz GA, Rosner BA, Speizer FE, Hennekens CH, Willett WC. Frequent nut consumption and risk of coronary heart disease in women: prospective cohort study. BMJ. 1998;317:1341–1345.
    1. Estruch R, Ros E, Salas‐Salvado J, Covas MI, Corella D, Aros F, Gomez‐Gracia E, Ruiz‐Gutierrez V, Fiol M, Lapetra J, Lamuela‐Raventos RM, Serra‐Majem L, Pinto X, Basora J, Munoz MA, Sorli JV, Martinez JA, Martinez‐Gonzalez MA. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368:1279–1290.
    1. US Department of Agriculture, Agricultural Research Service, Nutrient Data Laboratory . USDA National Nutrient Database for Standard Reference, Release 28. Accessed January 2, 2016.
    1. Musa‐Veloso K, Paulionis L, Poon T, Lee HY. The effects of almond consumption on fasting blood lipid levels: a systematic review and meta‐analysis of randomised controlled trials. J Nutr Sci. 2016;5:e34.
    1. Li SC, Liu YH, Liu JF, Chang WH, Chen CM, Chen CY. Almond consumption improved glycemic control and lipid profiles in patients with type 2 diabetes mellitus. Metabolism. 2011;60:474–479.
    1. Choudhury K, Clark J, Griffiths HR. An almond‐enriched diet increases plasma alpha‐tocopherol and improves vascular function but does not affect oxidative stress markers or lipid levels. Free Radic Res. 2014;48:599–606.
    1. Liu JF, Liu YH, Chen CM, Chang WH, Chen CY. The effect of almonds on inflammation and oxidative stress in Chinese patients with type 2 diabetes mellitus: a randomized crossover controlled feeding trial. Eur J Nutr. 2013;52:927–935.
    1. Jenkins DJ, Kendall CW, Marchie A, Josse AR, Nguyen TH, Faulkner DA, Lapsley KG, Blumberg J. Almonds reduce biomarkers of lipid peroxidation in older hyperlipidemic subjects. J Nutr. 2008;138:908–913.
    1. Keli SO, Hertog MG, Feskens EJ, Kromhout D. Dietary flavonoids, antioxidant vitamins, and incidence of stroke: the Zutphen study. Arch Intern Med. 1996;156:637–642.
    1. Hertog MG, Kromhout D, Aravanis C, Blackburn H, Buzina R, Fidanza F, Giampaoli S, Jansen A, Menotti A, Nedeljkovic S, Pekkarinen M, Simic BS, Toshima H, Feskens EJ, Hollman PC, Katan MB. Flavonoid intake and long‐term risk of coronary heart disease and cancer in the seven countries study. Arch Intern Med. 1995;155:381–386.
    1. Steinberg FM, Bearden MM, Keen CL. Cocoa and chocolate flavonoids: implications for cardiovascular health. J Am Diet Assoc. 2003;103:215–223.
    1. Ried K, Sullivan TR, Fakler P, Frank OR, Stocks NP. Effect of cocoa on blood pressure. Cochrane Database Syst Rev. 2012;4:Cd008893.
    1. Hooper L, Kay C, Abdelhamid A, Kroon PA, Cohn JS, Rimm EB, Cassidy A. Effects of chocolate, cocoa, and flavan‐3‐ols on cardiovascular health: a systematic review and meta‐analysis of randomized trials. Am J Clin Nutr. 2012;95:740–751.
    1. Harris JA, Benedict FG. A biometric study of human basal metabolism. Proc Natl Acad Sci U S A. 1918;4:370–373.
    1. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low‐density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499–502.
    1. Kulkarni KR. Cholesterol profile measurement by vertical auto profile method. Clin Lab Med. 2006;26:787–802.
    1. Kulkarni KRTH, Moore L, Jones S. A novel approach to measure apolipoprotein B/apolipoprotein AI ratio using the vertical auto profile method (poster). Diab Vasc Dis Res. 2007;4:266.
    1. Green LC, Wagner DA, Glogowski J, Skipper PL, Wishnok JS, Tannenbaum SR. Analysis of nitrate, nitrite, and [15n]nitrate in biological fluids. Anal Biochem. 1982;126:131–138.
    1. Chen CY, Milbury PE, Lapsley K, Blumberg JB. Flavonoids from almond skins are bioavailable and act synergistically with vitamins C and E to enhance hamster and human LDL resistance to oxidation. J Nutr. 2005;135:1366–1373.
    1. Sundram K, Nor RM. Analysis of tocotrienols in different sample matrixes by HPLC. Methods Mol Biol. 2002;186:221–232.
    1. Liang Y, Wei P, Duke RW, Reaven PD, Harman SM, Cutler RG, Heward CB. Quantification of 8‐iso‐prostaglandin‐F(2alpha) and 2,3‐dinor‐8‐iso‐prostaglandin‐F(2alpha) in human urine using liquid chromatography‐tandem mass spectrometry. Free Radic Biol Med. 2003;34:409–418.
    1. Grassi D, Necozione S, Lippi C, Croce G, Valeri L, Pasqualetti P, Desideri G, Blumberg JB, Ferri C. Cocoa reduces blood pressure and insulin resistance and improves endothelium‐dependent vasodilation in hypertensives. Hypertension. 2005;46:398–405.
    1. Berryman CE, West SG, Fleming JA, Bordi PL, Kris‐Etherton PM. Effects of daily almond consumption on cardiometabolic risk and abdominal adiposity in healthy adults with elevated LDL‐cholesterol: a randomized controlled trial. J Am Heart Assoc. 2015;4:e000993 DOI:
    1. Sabate J, Haddad E, Tanzman JS, Jambazian P, Rajaram S. Serum lipid response to the graduated enrichment of a Step I diet with almonds: a randomized feeding trial. Am J Clin Nutr. 2003;77:1379–1384.
    1. Wien M, Bleich D, Raghuwanshi M, Gould‐Forgerite S, Gomes J, Monahan‐Couch L, Oda K. Almond consumption and cardiovascular risk factors in adults with prediabetes. J Am Coll Nutr. 2010;29:189–197.
    1. Jenkins DJ, Kendall CW, Marchie A, Parker TL, Connelly PW, Qian W, Haight JS, Faulkner D, Vidgen E, Lapsley KG, Spiller GA. Dose response of almonds on coronary heart disease risk factors: blood lipids, oxidized low‐density lipoproteins, lipoprotein(a), homocysteine, and pulmonary nitric oxide: a randomized, controlled, crossover trial. Circulation. 2002;106:1327–1332.
    1. Kaldor JC, Magnusson RS, Colagiuri S. Government action on diabetes prevention: time to try something new. Med J Aust. 2015;202:578–580.
    1. Kris‐Etherton PM, Pearson TA, Wan Y, Hargrove RL, Moriarty K, Fishell V, Etherton TD. High‐monounsaturated fatty acid diets lower both plasma cholesterol and triacylglycerol concentrations. Am J Clin Nutr. 1999;70:1009–1015.
    1. Lin X, Zhang I, Li A, Manson JE, Sesso HD, Wang L, Liu S. Cocoa flavanol intake and biomarkers for cardiometabolic health: a systematic review and meta‐analysis of randomized controlled trials. J Nutr. 2016;146:2325–2333.
    1. Rajman I, Eacho PI, Chowienczyk PJ, Ritter JM. LDL particle size: an important drug target? Br J Clin Pharmacol. 1999;48:125–133.
    1. Toth PP, Patti AM, Nikolic D, Giglio RV, Castellino G, Biancucci T, Geraci F, David S, Montalto G, Rizvi A, Rizzo M. Bergamot reduces plasma lipids, atherogenic small dense LDL, and subclinical atherosclerosis in subjects with moderate hypercholesterolemia: a 6 months prospective study. Front Pharmacol. 2015;6:299.
    1. Parlesak A, Eckoldt J, Winkler K, Bode CJ, Schafer C. Intercorrelations of lipoprotein subfractions and their covariation with lifestyle factors in healthy men. J Clin Biochem Nutr. 2014;54:174–180.
    1. Davison K, Coates AM, Buckley JD, Howe PR. Effect of cocoa flavanols and exercise on cardiometabolic risk factors in overweight and obese subjects. Int J Obes (Lond). 2008;32:1289–1296.
    1. Grassi D, Desideri G, Necozione S, Lippi C, Casale R, Properzi G, Blumberg JB, Ferri C. Blood pressure is reduced and insulin sensitivity increased in glucose‐intolerant, hypertensive subjects after 15 days of consuming high‐polyphenol dark chocolate. J Nutr. 2008;138:1671–1676.
    1. Picon MJ, Murri M, Munoz A, Fernandez‐Garcia JC, Gomez‐Huelgas R, Tinahones FJ. Hemoglobin A1c versus oral glucose tolerance test in postpartum diabetes screening. Diabetes Care. 2012;35:1648–1653.
    1. Taubert D, Berkels R, Roesen R, Klaus W. Chocolate and blood pressure in elderly individuals with isolated systolic hypertension. JAMA. 2003;290:1029–1030.
    1. Balzer J, Rassaf T, Heiss C, Kleinbongard P, Lauer T, Merx M, Heussen N, Gross HB, Keen CL, Schroeter H, Kelm M. Sustained benefits in vascular function through flavanol‐containing cocoa in medicated diabetic patients a double‐masked, randomized, controlled trial. J Am Coll Cardiol. 2008;51:2141–2149.
    1. Hooper L, Kroon PA, Rimm EB, Cohn JS, Harvey I, Le Cornu KA, Ryder JJ, Hall WL, Cassidy A. Flavonoids, flavonoid‐rich foods, and cardiovascular risk: a meta‐analysis of randomized controlled trials. Am J Clin Nutr. 2008;88:38–50.
    1. West SG, McIntyre MD, Piotrowski MJ, Poupin N, Miller DL, Preston AG, Wagner P, Groves LF, Skulas‐Ray AC. Effects of dark chocolate and cocoa consumption on endothelial function and arterial stiffness in overweight adults. Br J Nutr. 2014;111:653–661.
    1. Chen CY, Holbrook M, Duess MA, Dohadwala MM, Hamburg NM, Asztalos BF, Milbury PE, Blumberg JB, Vita JA. Effect of almond consumption on vascular function in patients with coronary artery disease: a randomized, controlled, cross‐over trial. Nutr J. 2015;14:61.
    1. Rein D, Lotito S, Holt RR, Keen CL, Schmitz HH, Fraga CG. Epicatechin in human plasma: in vivo determination and effect of chocolate consumption on plasma oxidation status. J Nutr. 2000;130:2109s–2114s.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다