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Protective effects of dark chocolate on endothelial function and diabetes

Grassi, Davide; Desideri, Giovambattista; Ferri, Claudio

Current Opinion in Clinical Nutrition and Metabolic Care: November 2013 - Volume 16 - Issue 6 - p 662–668
doi: 10.1097/MCO.0b013e3283659a51
FUNCTIONAL FOODS AND DIETARY SUPPLEMENTS: Edited by Nathalie M. Delzenne and Gerard E. Mullin

Purpose of review Relationship between cocoa consumption and cardiovascular disease, particularly focusing on clinical implications resulting from the beneficial effects of cocoa consumption on endothelial function and insulin resistance. This could be of clinical relevance and may suggest the mechanistic explanation for the reduced risk of cardiovascular events reported in the different studies after cocoa intake.

Recent findings Increasing evidence supports a protective effect of cocoa consumption against cardiovascular disease. Cocoa and flavonoids from cocoa have been described to improve endothelial function and insulin resistance. A proposed mechanism could be considered in the improvement of the endothelium-derived vasodilator nitric oxide by enhancing nitric oxide synthesis or by decreasing nitric oxide breakdown.

Summary The endothelium plays a pivotal role in the arterial homeostasis, and insulin resistance is the most important pathophysiological feature in various prediabetic and diabetic states. Reduced nitric oxide bioavailability with endothelial dysfunction is considered the earliest step in the pathogenesis of atherosclerosis. Further, insulin resistance could account, at least in part, for the endothelial dysfunction. Endothelial dysfunction has been considered an important and independent predictor of future development of cardiovascular risk and events. Cocoa and flavonoids from cocoa might positively modulate these mechanisms with a putative role in cardiovascular protection.

Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy

Correspondence to Davide Grassi, MD, PhD, MSc, University of L’Aquila Department of Life, Health and Environmental Sciences - Viale S. Salvatore, Delta 6 Medicina, 67100 Coppito, L’Aquila, Italy. Tel: +39 0862 434749; fax: +39 0862 434749; e-mail:

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins