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Meta-Analysis
. 2024 Jun 18;16(12):1919.
doi: 10.3390/nu16121919.

Effects of Cocoa Consumption on Cardiometabolic Risk Markers: Meta-Analysis of Randomized Controlled Trials

Tainah O P Arisi  1 , Diego Silveira da Silva  1 , Elana Stein  1 , Camila Weschenfelder  1 , Patrícia Caetano de Oliveira  1 , Aline Marcadenti  1   2   3 , Alexandre Machado Lehnen  1 , Gustavo Waclawovsky  1
Affiliations
Meta-Analysis

Effects of Cocoa Consumption on Cardiometabolic Risk Markers: Meta-Analysis of Randomized Controlled Trials

Tainah O P Arisi et al. Nutrients. .

Abstract

Background: We conducted a systematic review and meta-analysis to examine the effect of dietary intake of cocoa on anthropometric measurements, lipid and glycemic profiles, and blood pressure levels in adults, with and without comorbidities.

Methods: The databases used were MEDLINE (PubMed), EMBASE, Web of Science, Cochrane, LILACS, and SciELO. The eligible studies were randomized clinical trials (RCTs) involving adults undergoing cocoa consumption (cocoa extract or ≥70% cocoa dark chocolate) for ≥4 weeks that evaluated at least one of the following markers: body weight, body mass index (BMI), waist/abdominal circumference, total cholesterol, LDL-c, triglycerides, HDL-c, blood glucose, glycated hemoglobin (HbA1c), and systolic and diastolic blood pressure (SBP/DBP).

Results: Thirty-one studies were included, totaling 1986 participants. Cocoa consumption showed no effects on body weight, BMI, waist circumference, triglycerides, HDL-c and HbA1c. Yet, there was a reduction in total cholesterol (-8.35 mg/dL, 95% CI -14.01; -2.69 mg/dL), LDL-c (-9.47 mg/dL, 95% CI -13.75; -5.20 mg/dL), fasting blood glucose (-4.91 mg/dL, 95% CI -8.29; -1.52 mg/dL), SBP (-2.52 mmHg, 95% CI -4.17; -0.88 mmHg), and DBP (-1.58 mmHg, 95% CI -2.54; -0.62 mmHg).

Conclusions: The consumption of cocoa showed protective effects on major cardiometabolic risk markers that have a clinical impact in terms of cardiovascular risk reduction.

Keywords: blood pressure; cocoa; dyslipidemia; fasting glucose; obesity; polyphenols.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of the study selection process.
Figure 2
Figure 2
Forest plot summarizing the results from the meta-analysis regarding the effects of cocoa consumption on anthropometric measurements versus control group. Panel (A): body weight: Ayoobi et al. 2017 [35]; Balzer et al. 2008 [53]; Desideri et al. 2012 [38]; Dicks et al. 2018 [32]; Giraldo et al. 2017 [50]; Ibero-Baraibar et al. 2014 [34]; León-Flores et al. 2020 [51]; Mastroiacovo et al. 2015 [39]; Munguia et al. 2019 [45]; Neufingerl et al 2013 [49]; Nickols-Richardson et al. 2014 [46]. panel (B): body mass index: Ayoobi et al. 2017 [35]; Baba et al. 2007 [37]; Balzer et al. 2008 [53]; Crews et al. 2008 [57]; Davison et al. 2008 [40]; Desideri et al. 2012 [38]; Dicks et al. 2018 [32]; Giraldo et al. 2017 [50]; León-Flores et al. 2020 [51]; Leyva-Soto et al. 2018 [58]; Mastroiacovo et al. 2015 [39]; Munguía et al. 2015 [44]; Nickols-Richardson et al. 2014 [46]; Nishiwaki et al. 2019 [41]; Pereira et al. 2019 [33]. panel (C): waist circumference: Ayoobi et al. 2017 [35]; Balzer et al. 2008 [53]; Davison et al. 2008 [40]; Dicks et al. 2018 [32]; Ibero-Baraibar et al. 2014 [34]; León-Flores et al. 2020 [51]; Munguia et al. 2019 [45]; Nickols-Richardson et al. 2014 [46]; Nishiwaki et al. 2019 [41]. panel (D): abdominal circumference: Giraldo et al. 2017 [50]; Leyva-Soto et al. 2018 [58]; Munguía et al. 2015 [44].
Figure 3
Figure 3
Forest plot summarizing the results from the meta-analysis regarding the effects of cocoa consumption on lipid profile versus control group. Panel (A): total cholesterol; panel (B): low-density lipoprotein cholesterol (LDL-c). Baba et al. 2007 [37]; Baba et al. 2007 [36]; Balzer et al. 2008 [53]; Crews et al. 2008 [57]; Desideri et al. 2012 [38]; Dicks et al. 2018 [32]; Giraldo et al. 2017 [50]; Ibero-Baraibar et al. 2014 [34]; Jafarirad et al. 2018 [52]; León-Flores et al. 2020 [51]; Leyva-Soto et al. 2018 [58]; Mastroiacovo et al. 2015 [39]; Munguia et al. 2019 [45]; Naghdipour-Biregani et al. 2014 [54]; Neufingerl et al 2013 [49]; Nickols-Richardson et al. 2014 [46]; Parsaeyan et al. 2014 [56]; Polagruto et al. 2006 [55]; Rodriguez-Mateos et al. 2018 [47]; Rostami et al. 2015 [42]; Sansone et al. 2015 [48]. panel (C): triglycerides; Baba et al. 2007 [37]; Baba et al. 2007 [36]; Balzer et al. 2008 [53]; Crews et al. 2008 [57]; Davison et al. 2008 [40]; Desideri et al. 2012 [38]; Dicks et al. 2018 [32]; Giraldo et al. 2017 [50]; Ibero-Baraibar et al. 2014 [34]; Jafarirad et al. 2018 [52]; León-Flores et al. 2020 [51]; Leyva-Soto et al. 2018 [58]; Mastroiacovo et al. 2015 [39]; Munguia et al. 2019 [45]; Naghdipour-Biregani et al. 2014 [54]; Neufingerl et al 2013 [49]; Nickols-Richardson et al. 2014 [46]; Parsaeyan et al. 2014 [56]; Polagruto et al. 2006 [55]; Rodriguez-Mateos et al. 2018 [47]; Rostami et al. 2015 [42]; and panel (D): high-density lipoprotein cholesterol (HDL-c). Panel (A,D): Baba et al. 2007 [37]; Baba et al. 2007 [36]; Balzer et al. 2008 [53]; Crews et al. 2008 [57]; Davison et al. 2008 [40]; Desideri et al. 2012 [38]; Dicks et al. 2018 [32]; Giraldo et al. 2017 [50]; Ibero-Baraibar et al. 2014 [34]; Jafarirad et al. 2018 [52]; León-Flores et al. 2020 [51]; Leyva-Soto et al. 2018 [58]; Mastroiacovo et al. 2015 [39]; Munguia et al. 2019 [45]; Naghdipour-Biregani et al. 2014 [54]; Neufingerl et al 2013 [49]; Nickols-Richardson et al. 2014 [46]; Parsaeyan et al. 2014 [56]; Polagruto et al. 2006 [55]; Rodriguez-Mateos et al. 2018 [47]; Rostami et al. 2015 [42]; Sansone et al. 2015 [48].
Figure 4
Figure 4
Forest plot summarizing the results from the meta-analysis regarding the effects of cocoa consumption on glycemic markers versus control group. Panel (A): fasting blood glucose, Baba et al. 2007 [37]; Balzer et al. 2008 [53]; Davison et al. 2008 [40]; Desideri et al. 2012 [38]; Dicks et al. 2018 [32]; Giraldo et al. 2017 [50]; Ibero-Baraibar et al. 2014 [34]; Jafarirad et al. 2018 [52]; León-Flores et al. 2020 [51]; Leyva-Soto et al. 2018 [58]; Mastroiacovo et al. 2015 [39]; Munguia et al. 2019 [45]; Nickols-Richardson et al. 2014 [46]; Nishiwaki et al. 2019 [41]; Rodriguez-Mateos et al. 2018 [47]; Rostami et al. 2015 [42]; panel (B): glycated hemoglobin. Balzer et al. 2008 [53]; Dicks et al. 2018 [32]; Jafarirad et al. 2018 [52]; Leyva-Soto et al. 2018 [58]; Rostami et al. 2015 [42].
Figure 5
Figure 5
Forest plot summarizing the results from the meta-analysis regarding the effects of cocoa consumption on blood pressure versus control group. Panel (A): systolic blood pressure. Ayoobi et al. 2017 [35]; Baba et al. 2007 [37]—26 g; Crews et al. 2008 [57]; Davison et al. 2008 [40]; Desch et al. 2010 [43]; Desideri et al. 2012 [38]; Dicks et al. 2018 [32]; Ibero-Baraibar et al. 2014 [34]; Leyva-Soto et al. 2018 [58]; Massee et al. 2015 [30]; Mastroiacovo et al. 2015 [39]; Mozaffari-Khosravi et al. 2016 [29]; Munguía et al. 2015 [44]; Neufingerl et al 2013 [49]; Nickols-Richardson et al. 2014 [46]; Nishiwaki et al. 2019 [41]; Ottaviani et al. 2015 [31]; Pereira et al. 2019 [33]; Rodriguez-Mateos et al. 2018 [47]; Rostami et al. 2015 [42]; Sansone et al. 2015 [48]; panel (B): diastolic blood pressure. Ayoobi et al. 2017 [35]; Baba et al. 2007 [37]—26 g; Crews et al. 2008 [57]; Davison et al. 2008 [40]; Desch et al. 2010 [43]; Desideri et al. 2012 [38]; Dicks et al. 2018 [32]; Ibero-Baraibar et al. 2014 [34]; Leyva-Soto et al. 2018 [58]; Massee et al. 2015 [30]; Mastroiacovo et al. 2015 [39]; Mozaffari-Khosravi et al. 2016 [29]; Munguía et al. 2015 [44]; Neufingerl et al 2013 [49].
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