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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 randomized, 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.

Long term cocoa ingestion leads to an increased resistance against UV-induced erythema and a lowered transepidermal water loss. AIM OF THE STUDY: To investigate the acute effects of a single dose of cocoa rich in flavanols on dermal microcirculation. METHODS: In a crossover design study, 10 healthy women ingested a cocoa drink (100 ml) with high (329 mg) or low (27 mg) content of flavanols. The major flavanol monomer in both drinks was epicatechin, 61 mg in the high flavanol, and 6.6 mg in the low flavanol product per 100 ml. Dermal blood flow and oxygen saturation of hemoglobin were examined by laser Doppler flowmetry and spectroscopically at 1 mm skin depth at t = 0, 1, 2, 4, and 6 h. At the same time points, plasma levels of total epicatechin (free compound plus conjugates) were measured by means of HPLC. RESULTS: Subsequent to the intake of high flavanol cocoa, dermal blood flow was significantly increased by 1.7-fold at t = 2 h and oxygen saturation was elevated 1.8-fold. No statistically significant changes were found upon intake of low flavanol cocoa. Maximum plasma levels of total epicatechin were observed 1 h after ingestion of the high flavanol cocoa drink, 11.6 +/- 7.4 nmol/l at baseline, and 62.9 +/- 35.8 nmol/l at 1 h. No change of total epicatechin was found in the low flavanol group. CONCLUSION: Flavanol-rich cocoa consumption acutely increases dermal blood flow and oxygen saturation.

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 (168mg of flavanols) or CBC (,5mg of flavanols), as part of their normal diet. The consumption of FCMC was significantly associated with a decrease in diastolic blood pressure (25mmHg), mean blood pressure (25mmHg), plasma cholesterol (211%), LDLcholesterol (215%), malondialdehyde (212%), urate (211%) and lactate dehydrogenase (LDH) activity (211%), and an increase in vitamin E/cholesterol (þ12%). No relevant changes in these variables were associated with CBC consumption. No changes in the plasma levels of (2)-epicatechin were observed following analysis of fasting blood samples. 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 inFCMC is likely to have been one of the contributing factors to these
results.

Diets rich in flavonoids have been associated with reduced risk for cardiovascular disease. This may be due, in part, to flavonoid-induced alterations in eicosanoid synthesis. Our objective was to identify plant-derived beverages that alter synthesis of prostacyclin in cultured human aortic endothelial cells (HAEC), and to determine if these beverages could alter in vivo 6-keto-prostaglandin F(1alpha) (a stable metabolite of prostacyclin) synthesis and platelet function. HAEC were treated with nine commonly consumed beverages to determine their effects on prostacyclin synthesis under acute and chronic treatment regimens. Orange, purple grape, and pomegranate juices and coffee (6-9 mL/kg) were then provided to 28 fasted, healthy adult subjects (eight men and 20 women) on five separate days. Plasma samples were collected immediately following juice consumption (baseline), and at 2 and 6 hours post-consumption. On an acute basis, administration of HAEC with pomegranate juice increased media prostacyclin. Chronic exposure to purple grape and pomegranate juice increased aortic endothelial cell prostacyclin synthesis (38% and 61%, respectively; P <.05). The consumption of purple grape, pomegranate, and orange juice prolonged epinephrine/collagen-induced clotting time (P <.05). Purple grape juice increased plasma 6-keto-prostaglandin F(1alpha) (20%; P <.05) at 2 hours; pomegranate and orange juice did not significantly influence plasma prostacyclin concentrations. Consistent with the in vitro data, coffee consumption did not influence clotting time or plasma prostacyclin concentrations. These results indicate that the HAEC model system can provide a qualitative means to screen food and food-derived products for biologic activity related to cardiovascular health.

Epidemiologic studies have linked flavonoid-rich foods with a reduced risk of cardiovascular mortality. Some cocoas are flavonoid-rich and contain the monomeric flavanols (-)-epicatechin and (+)-catechin and oligomeric procyanidins formed from these monomeric units. Both the monomers and the oligomers have shown potential in favorably influencing cardiovascular health in in vitro and preliminary clinical studies. Although previous investigations have shown increasing concentrations of (-)-epicatechin in human plasma after cocoa consumption, no information is available in the published literature regarding the presence of procyanidins in human plasma. OBJECTIVE: This study sought to determine whether procyanidins can be detected and quantified in human plasma after acute consumption of a flavanol-rich cocoa. DESIGN: Peripheral blood was obtained from 5 healthy adult subjects before (baseline, 0 h) and 0.5, 2, and 6 h after consumption of 0.375 g cocoa/kg body wt as a beverage. Plasma samples were analyzed for monomers and procyanidins with the use of reversed-phase HPLC with coulometric electrochemical array detection and liquid chromatography-tandem mass spectrometry. RESULTS: Procyanidin dimer, (-)-epicatechin, and (+)-catechin were detected in the plasma of human subjects as early as 0.5 h (16 +/- 5 nmol/L, 2.61 +/- 0.46 micro mol/L, and 0.13 +/- 0.03 micro mol/L, respectively) after acute cocoa consumption and reached maximal concentrations by 2 h (41 +/- 4 nmol/L, 5.92 +/- 0.60 micro mol/L, and 0.16 +/- 0.03 micro mol/L, respectively). CONCLUSION: Dimeric procyanidins can be detected in human plasma as early as 30 min after the consumption of a flavanol-rich food such as cocoa.

BACKGROUND: Flavanols modulate platelet function in vitro, but less is known of their in vivo effects and how they compare to pharmacological platelet inhibitors. We investigated the effect of a flavanol-rich cocoa beverage (897 mg/ml) in combination with and in comparison to aspirin on platelet function and activation in healthy subjects. METHODS AND RESULTS: On separate test days in a crossover design, 16 healthy adults consumed aspirin (81 mg), cocoa (as a beverage), or aspirin plus cocoa. Platelet activation was measured by surface expression of P-selectin and PAC-1 binding to the activated conformation of the GPIIb/IIIa receptor (GPIIb/IIIa-act). Platelet function was measured on an analyzer (the PFA-100) that measures shear stress-induced platelet plug formation in response to collagen-epinephrine or collagen-ADP. Plasma epicatechin concentrations peaked approximately 2 h after subjects were given either the cocoa or aspirin plus cocoa. After 6 h, cocoa inhibited epinephrine-induced platelet function. Epinephrine-induced platelet function was inhibited 2 and 6 h after aspirin, and after aspirin plus cocoa. Epinephrine-stimulated P-selectin expression was inhibited by aspirin at 6 h, and after 2 and 6 h by aspirin plus cocoa. ADP-stimulated P-selectin expression was not affected by the treatments. Cocoa and aspirin, given separately, reduced epinephrine-stimulated GPIIb/IIIa-act expression at 2 and 6 h, respectively, and at 2 and 6 h when given together, suggesting an additive effective. ASA plus cocoa inhibited ADP-stimulated GPIIb/IIIa-act expression at 6 h. CONCLUSIONS: Flavanol-rich cocoa inhibited epinephrine-stimulated platelet activation and function. These effects were qualitatively similar to aspirin, but less profound. These results emphasize the need to further examine the effects of food flavonoids for platelet modulating effects.