Could supplements containing cocoa extract-rich in cocoa flavanols-reduce inflammation and thus prevent age-related chronic diseases? In a new study, COcoa Supplement and Multivitamin Outcomes Study (COSMOS), researchers at Mass General Brigham and their colleagues examined changes in five age-related inflammatory markers in participants who took cocoa supplements daily for several years. They found that hsCRP – an inflammatory marker that may indicate an increased risk of cardiovascular disease – decreased in participants taking the cocoa extract supplement, suggesting that its anti-inflammatory potential may explain its heart-protective effects. Their findings were published in Age and Ageing.
Cocoa Extract Against Cardiovascular Disease
Dietary interventions are an increasingly attractive solution for slowing inflammatory aging processes, known as “inflammaging” (the chronic low-threshold inflammatory activity associated with aging). In earlier, smaller studies, cocoa extract was shown to reduce inflammatory biomarkers thanks to flavanols – small, bioactive compounds found not only in cocoa beans, but also in berries, grapes, tea and other plant foods. To bridge the gap between these studies and humans, the researchers launched the large-scale COSMOS study to investigate the effects of cocoa extract on cardiovascular disease and whether inflammaging can explain these effects.
“Our interest in cocoa extract and inflammaging began because of the cocoa-related reduction in cardiovascular disease,” said corresponding author Howard Sesso, ScD, MPH, associate director of the Division of Preventive Medicine and deputy epidemiologist at Brigham and Women’s Hospital, a founding member of the Mass General Brigham Health System. “We also appreciate the important overlap between healthy aging and cardiovascular health, where age-related inflammation can harden arteries and lead to cardiovascular disease. For this reason, we wanted to investigate whether a multi-year intake of cocoa extract compared to a placebo can modulate inflammatory aging – and the data suggest that it does.” Between 2014 and 2020, Brigham and Women’s Hospital led the COSMOS study, a large-scale, randomized, double-blind, placebo-controlled clinical trial with 21,442 participants over the age of 60, which found that taking cocoa extract reduced mortality from cardiovascular disease by 27%.
Potential Role in the Modulation of Inflammation in Old Age
In this new study, the researchers collected and analyzed blood samples from 598 COSMOS participants to measure several biomarkers of inflammation: three proinflammatory proteins (hsCRP, IL-6 and TNF-α), one anti-inflammatory protein (IL-10) and one immune-mediating protein (IFN-γ). When comparing the changes in these biomarkers measured at baseline and after 1 and 2 years, hsCRP levels decreased by 8.4% per year compared to placebo, while the other biomarkers remained relatively constant or increased slightly. “Interestingly, we also observed an increase in interferon-γ, an immune-related cytokine, which raises new questions for future research,” said lead author Yanbin Dong, MD/PhD, director of the Georgia Prevention Institute (GPI) and cardiologist/population geneticist at the Medical College of Georgia/Augusta University. While cocoa extract is not a substitute for a healthy lifestyle, these results are encouraging and underscore its potential role in modulating inflammation as we age.
The decrease in hsCRP may explain the cardioprotective effect observed in the larger COSMOS trial of cocoa extract supplements, in which participants experienced a reduction in deaths due to cardiovascular disease. The researchers said changes in the other inflammatory markers, including a small reduction in IL-6 observed in female but not male participants, warrant further investigation. The team will continue to evaluate the COSMOS study to determine whether the cocoa and multivitamin supplements can curb more serious inflammation as well as other important age-related health consequences.
Cocoa as Protection Against the Negative Effects of Fatty Foods on Mental Stress
Food choices in stressful situations can influence the effects of stress on cardiovascular health. For example, a study by the University of Birmingham found that high-fat foods can impair vascular function and brain oxygenation, while the flavanol compounds abundant in cocoa and green tea can protect vascular function in stressful everyday situations. The same research team also found that consuming flavanol-rich cocoa in combination with a high-fat meal can counteract some of the effects of high-fat foods and protect the vascular system from stress. Blood flow-mediated dilatation of the brachial artery was significantly higher 30 and 90 minutes after the stress period following consumption of high flavanol cocoa than following consumption of low flavanol cocoa. This shows that consuming foods with a high flavanol content can be a strategy to mitigate the effects of an unhealthy diet on the cardiovascular system.