Acute Cocoa Supplementation Increases Postprandial HDL Cholesterol and Insulin in Obese Adults with Type 2 Diabetes after Consumption of a High-Fat Breakfast

作者：Basu Arpita^*; Betts Nancy M; Leyva Misti J; Fu Dongxu; Aston Christopher E; Lyons Timothy J

来源：Journal of Nutrition, 2015, 145(10): 2325-2332.

DOI：10.3945/jn.115.215772

• type 2 diabetes
• postprandial metabolism
• dietary cocoa
• HDL cholesterol
• insulin

Background: Dietary cocoa is an important source of flavonoids and is associated with favorable cardiovascular disease effects, such as improvements in vascular function and lipid profiles, in nondiabetic adults. Type 2 diabetes (T2D) is associated with adverse effects on postprandial serum glucose, lipids, inflammation, and vascular function.
Objective: We examined the hypothesis that cocoa reduces metabolic stress in obese T2D adults after a high-fat fastfood style meal.
Methods: Adults with T2D [n= 18; age (mean +/- SE): 56 +/- 3 y; BMI (in kg/m(2)): 35.3 +/- 2.0; 14 women; 4 men] were randomly assigned to receive cocoa beverage (960 mg total polyphenols; 480 mg flavanols) or flavanol-free placebo (110 mg total polyphenols; <0.1 mg flavanols) with a high-fat fast-food style breakfast [766 kcal, 50 g fat (59% energy)] in a crossover trial. After an overnight fast (10-12 h), participants consumed the breakfast with cocoa or placebo, and blood sample collection [glucose, insulin, lipids, and high-sensitivity C-reactive protein (hsCRP)] and vascular measurements were conducted at 0.5, 1, 2, 4, and 6 h postprandially on each study day. Insulin resistance was evaluated by homeostasis model assessment.
Results: Over the 6-h study, and specifically at 1 and 4 h, cocoa increased HDL cholesterol vs. placebo (overall Delta: 1.5 +/- 0.8 mg/dL; P <= 0.01) but had no effect on total and LDL cholesterol, triglycerides, glucose, and hsCRP. Cocoa increased serum insulin concentrations overall (Delta: 5.2 +/- 3.2 mU/L; P < 0.05) and specifically at 4 h but had no overall effects on insulin resistance (except at 4 h, P< 0.05), systolic or diastolic blood pressure, or small artery elasticity. However, large artery elasticity was overall lower after cocoa vs. placebo (Delta: -1.6 +/- 0.7 mL/mm Hg; P < 0.05), with the difference significant only at 2 h.
Conclusion: Acute cocoa supplementation showed no clear overall benefit in T2D patients after a high-fat fast-food style meal challenge. Although HDL cholesterol and insulin remained higher throughout the 6-h postprandial period, an overall decrease in large artery elasticity was found after cocoa consumption. This trial was registered at clinicaltrials.gov as NCT01886989.

• 出版日期2015-10