Abstract

Objective

To examine the long-term effect of cocoa flavanols on inflammaging biomarkers in the COcoa Supplement and Multivitamin Outcomes Study (COSMOS).

Methods

COSMOS is a large, randomised, double-blind, placebo-controlled, 2 × 2 factorial trial testing the effects of a cocoa extract supplement (containing 500 mg cocoa flavanols/day, including 80 mg (−)-epicatechin) among women aged ≥65 years and men aged ≥60 years. This ancillary study measured five widely used serum inflammaging biomarkers, including three pro-inflammatory markers (high-sensitivity C-reactive protein [hsCRP], interleukin-6, tumour necrosis factor-α), one anti-inflammatory cytokine (interleukin-10) and one pleotropic cytokine (interferon-γ [IFN-γ]) in a random sample of 598 participants with biospecimens collected at baseline, Year 1, and Year 2.

Results

The mean age was 70.0 ± 5.6 years, and 49.8% were female. Cocoa extract supplementation significantly decreased hsCRP levels compared with placebo, with a between-group difference in yearly percentage change relative to baseline levels of −8.4% (95% CI, −14.1% to −2.3%; nominal P = .008; Holm-adjusted P value = .039). Moreover, cocoa extract increased IFN-γ with a 6.8% (95% CI, 1.5% to 12.2%, nominal P = .011; Holm-adjusted P value = .043) difference in yearly percentage change versus placebo. The effects of cocoa extract on other inflammatory markers were not significant (all adjusted P values >.05).

Conclusion

Cocoa extract supplementation significantly decreased hsCRP, supporting a role in modulating the chronic inflammaging process as a potential mechanism underlying its cardio-protective effects, including a 27% reduction in cardiovascular disease death in the COSMOS trial. The biological effect of increased IFN-γ by cocoa extract warrants further exploration.

Key Quotes:

Taking cocoa extract supplementation lowered C-reactive protein, a key marker of body-wide inflammation, by 70 percent after two years.

While the placebo group’s CRP levels rose by about 5 percent per year, the cocoa group’s dipped by about 3 percent—a change that wasn’t significant on its own. However, when the two groups were compared across two years, cocoa significantly prevented the usual age-related inflammaging, keeping inflammation steady. These results came from a standardized 500 milligram cocoa flavanol supplement (including 80 milligrams epicatechin).

Evidently CRP rises about 5% annually with age.

Cocoa is high in flavanols which counter inflammation and boost nitric oxide production which relaxes blood vessels, lowers oxidative stress, and helps reduce inflammation in vessel walls. A review of dark chocolate shows that effects are strongest with higher doses exceeding 450mg per day. Authors state the darker the better and to aim for 70% cocoa or higher and to be careful not to overdo chocolate in food as it is calorie dense.  All it takes is a square or two…..not the whole bar!

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