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Impact of Cocoa Consumption on Inflammation Processes—A Critical Review of Randomized Controlled Trials

Faculty of Food, Nutrition and Hospitality Sciences Hochschule Niederrhein, University of Applied Sciences, Rheydter Str. 277, Mönchengladbach 41065, Germany
Department of Nutrition and Food Sciences, Nutritional Physiology, University of Bonn, Endenicher Allee 11-13, Bonn 53115, Germany
Author to whom correspondence should be addressed.
Nutrients 2016, 8(6), 321;
Received: 27 February 2016 / Revised: 9 May 2016 / Accepted: 20 May 2016 / Published: 26 May 2016
(This article belongs to the Special Issue Flavonoids, Inflammation and Immune System)
PDF [657 KB, uploaded 26 May 2016]


Background: Cocoa flavanols have strong anti-inflammatory properties in vitro. If these also occur in vivo, cocoa consumption may contribute to the prevention or treatment of diseases mediated by chronic inflammation. This critical review judged the evidence for such effects occurring after cocoa consumption. Methods: A literature search in Medline was performed for randomized controlled trials (RCTs) that investigated the effects of cocoa consumption on inflammatory biomarkers. Results: Thirty-three RCTs were included, along with 9 bolus and 24 regular consumption studies. Acute cocoa consumption decreased adhesion molecules and 4-series leukotrienes in serum, nuclear factor κB activation in leukocytes, and the expression of CD62P and CD11b on monocytes and neutrophils. In healthy subjects and in patients with cardiovascular diseases, most regular consumption trials did not find any changes except for a decreased number of endothelial microparticles, but several cellular and humoral inflammation markers decreased in patients suffering from type 2 diabetes and impaired fasting glucose. Conclusions: Little evidence exists that consumption of cocoa-rich food may reduce inflammation, probably by lowering the activation of monocytes and neutrophils. The efficacy seems to depend on the extent of the basal inflammatory burden. Further well-designed RCTs with inflammation as the primary outcome are needed, focusing on specific markers of leukocyte activation and considering endothelial microparticles as marker of vascular inflammation. View Full-Text
Keywords: cocoa; chocolate; inflammation; randomized controlled trials; evidence; critical review cocoa; chocolate; inflammation; randomized controlled trials; evidence; critical review

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Ellinger, S.; Stehle, P. Impact of Cocoa Consumption on Inflammation Processes—A Critical Review of Randomized Controlled Trials. Nutrients 2016, 8, 321.

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