Nutr Res Pract.  2014 Dec;8(6):695-704. 10.4162/nrp.2014.8.6.695.

Changes in body weight, blood pressure and selected metabolic biomarkers with an energy-restricted diet including twice daily sweet snacks and once daily sugar-free beverage

• Nickols-Richardson SM
• Piehowski
• Metzgar CJ
• Miller DL
• Preston AG

• KMID: 2313797
• DOI: http://doi.org/10.4162/nrp.2014.8.6.695

Abstract

BACKGROUND/OBJECTIVES
The type of sweet snack incorporated into an energy-restricted diet (ERD) may produce differential effects on metabolic improvements associated with body weight (BW) loss. This study compared effects of incorporating either twice daily energy-controlled dark chocolate snacks plus once daily sugar-free cocoa beverage (DC) to non-chocolate snacks plus sugar-free non-cocoa beverage (NC) into an ERD on BW loss and metabolic outcomes.
MATERIALS/METHODS
In an 18-week randomized comparative trial, 60 overweight/obese premenopausal women were assigned to DC (n = 30) or NC group (n = 30). Dietary intake was measured at baseline and week 18, and BW, anthropometrics, blood pressure (BP) and serum glucose, insulin and lipid concentrations were measured at baseline, and weeks 6, 12 and 18. Data were analyzed using repeated measures ANOVA.
RESULTS
Using intention-to-treat analysis, women in DC and NC groups reduced energy intake (both P < 0.001) and lost 4.4 +/- 0.6 kg and 5.0 +/- 0.9 kg (both P < 0.001), respectively. Both groups lowered systolic and diastolic BP [DC = 2.7 (P < 0.05), 2.7 (P < 0.01); NC = 3.4 (P < 0.01), 4.2 (P < 0.01) mmHg, respectively]. Glucose and insulin concentrations decreased by 0.72 mmol/L (P < 0.001) and 13.20 pmol/L (P < 0.01) in DC group and by 0.83 mmol/L (P < 0.001) and 13.20 pmol/L (P < 0.01), respectively, in NC group. Total cholesterol increased in NC group (P < 0.05), with no significant lipid changes in DC group. There were no significant differences in biomarker outcomes between groups.
CONCLUSIONS
Overweight/obese premenopausal women following an 18-week ERD that included either DC or NC sweet snack and sugar-free beverage lost equivalent amounts of BW and improved BP measurements and glucose and insulin concentrations.

Keyword

Cocoa; dark chocolate; dietary intervention; obesity; randomized comparative trial

MeSH Terms

Beverages*
Biomarkers*
Blood Glucose
Blood Pressure*
Body Weight*
Cacao
Cholesterol
Diet*
Energy Intake
Female
Glucose
Humans
Insulin
Obesity
Snacks*
Cholesterol
Glucose
Insulin

Figure

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  Fig. 1 Flow diagram of participant enrollment in a study of premenopausal women with overweight/obesity, designed to evaluate changes in body weight, blood pressure and selected metabolic biomarkers with an energy-restricted diet including twice daily dark chocolate snacks plus once daily sugar-free cocoa beverage or twice daily non-chocolate snacks plus once daily sugar-free non-cocoa beverage.

Reference

1. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012; 307:491–497.

2. Withrow D, Alter DA. The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obes Rev. 2011; 12:131–141.

3. Hankey CR. Session 3 (joint with the British Dietetic Association): management of obesity: weight-loss interventions in the treatment of obesity. Proc Nutr Soc. 2010; 69:34–38.

4. Wu T, Gao X, Chen M, van Dam RM. Long-term effectiveness of diet-plus-exercise interventions vs. diet-only interventions for weight loss: a meta-analysis. Obes Rev. 2009; 10:313–323.

5. Sears B, Lawren B. Enter the Zone: A Dietary Road Map. New York (NY): Harper Collins;1995.

6. Ornish D. Eat More, Weigh Less: Dr. Dean Ornish's Program for Losing Weight Safely While Eating Abundantly. New York (NY): Harper Collins;2001.

7. Atkins RC. Dr. Atkins' New Diet Revolution. New York (NY): Harper Collins;2002.

8. Agatston A. The South Beach Diet : The Delicious, Doctor-Designed, Foolproof Plan for Fast and Healthy Weight Loss. Emmaus (PA): Rodale;2003.

9. Piehowski KE, Preston AG, Miller DL, Nickols-Richardson SM. A reduced-calorie dietary pattern including a daily sweet snack promotes body weight reduction and body composition improvements in premenopausal women who are overweight and obese: a pilot study. J Am Diet Assoc. 2011; 111:1198–1203.

10. Rozin P, Levine E, Stoess C. Chocolate craving and liking. Appetite. 1991; 17:199–212.

11. Zellner DA, Garriga-Trillo A, Rohm E, Centeno S, Parker S. Food liking and craving: a cross-cultural approach. Appetite. 1999; 33:61–70.

12. Lewis JR, Prince RL, Zhu K, Devine A, Thompson PL, Hodgson JM. Habitual chocolate intake and vascular disease: a prospective study of clinical outcomes in older women. Arch Intern Med. 2010; 170:1857–1858.

13. O'Neil CE, Fulgoni VL 3rd, Nicklas TA. Candy consumption was not associated with body weight measures, risk factors for cardiovascular disease, or metabolic syndrome in US adults: NHANES 1999-2004. Nutr Res. 2011; 31:122–130.

14. Golomb BA, Koperski S, White HL. Association between more frequent chocolate consumption and lower body mass index. Arch Intern Med. 2012; 172:519–521.

15. Khawaja O, Gaziano JM, Djoussé L. Chocolate and coronary heart disease: a systematic review. Curr Atheroscler Rep. 2011; 13:447–452.

16. Grassi D, Lippi C, Necozione S, Desideri G, Ferri C. Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons. Am J Clin Nutr. 2005; 81:611–614.

17. Grassi D, Desideri G, Necozione S, Lippi C, Casale R, Properzi G, Blumberg JB, Ferri C. Blood pressure is reduced and insulin sensitivity increased in glucose-intolerant, hypertensive subjects after 15 days of consuming high-polyphenol dark chocolate. J Nutr. 2008; 138:1671–1676.

18. Taubert D, Roesen R, Lehmann C, Jung N, Schomig E. Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: a randomized controlled trial. JAMA. 2007; 298:49–60.

19. Allen RR, Carson L, Kwik-Uribe C, Evans EM, Erdman JW Jr. Daily consumption of a dark chocolate containing flavanols and added sterol esters affects cardiovascular risk factors in a normotensive population with elevated cholesterol. J Nutr. 2008; 138:725–731.

20. Almoosawi S, Fyfe L, Ho C, Al-Dujaili E. The effect of polyphenol-rich dark chocolate on fasting capillary whole blood glucose, total cholesterol, blood pressure and glucocorticoids in healthy overweight and obese subjects. Br J Nutr. 2010; 103:842–850.

21. Ried K, Sullivan TR, Fakler P, Frank OR, Stocks NP. Effect of cocoa on blood pressure. Cochrane Database Syst Rev. 2012; 8:CD008893.

22. Shrime MG, Bauer SR, McDonald AC, Chowdhury NH, Coltart CE, Ding EL. Flavonoid-rich cocoa consumption affects multiple cardiovascular risk factors in a meta-analysis of short-term studies. J Nutr. 2011; 141:1982–1988.

23. Davison K, Coates AM, Buckley JD, Howe PR. Effect of cocoa flavanols and exercise on cardiometabolic risk factors in overweight and obese subjects. Int J Obes (Lond). 2008; 32:1289–1296.

24. Hooper L, Kay C, Abdelhamid A, Kroon PA, Cohn JS, Rimm EB, Cassidy A. Effects of chocolate, cocoa, and flavan-3-ols on cardiovascular health: a systematic review and meta-analysis of randomized trials. Am J Clin Nutr. 2012; 95:740–751.

25. Mursu J, Voutilainen S, Nurmi T, Rissanen TH, Virtanen JK, Kaikkonen J, Nyyssönen K, Salonen JT. Dark chocolate consumption increases HDL cholesterol concentration and chocolate fatty acids may inhibit lipid peroxidation in healthy humans. Free Radic Biol Med. 2004; 37:1351–1359.

26. Jia L, Liu X, Bai YY, Li SH, Sun K, He C, Hui R. Short-term effect of cocoa product consumption on lipid profile: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2010; 92:218–225.

27. Corti R, Flammer AJ, Hollenberg NK, Lüscher TF. Cocoa and cardiovascular health. Circulation. 2009; 119:1433–1441.

28. Fernández-Murga L, Tarín JJ, García-Perez MA, Cano A. The impact of chocolate on cardiovascular health. Maturitas. 2011; 69:312–321.

29. Tey SL, Brown RC, Gray AR, Chisholm AW, Delahunty CM. Long-term consumption of high energy-dense snack foods on sensory-specific satiety and intake. Am J Clin Nutr. 2012; 95:1038–1047.

30. Farhat G, Drummond S, Fyfe L, Al-Dujaili EA. Dark chocolate: an obesity paradox or a culprit for weight gain? Phytother Res. 2014; 28:791–797.

31. Panel on Macronutrients. Panel on the Definition of Dietary Fiber. Subcommittee on Upper Reference Levels of Nutrients. Subcommittee on Interpretation and Uses of Dietary Reference Intakes. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Food and Nutrition Board. Institute of Medicine (US). Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids. Washington, D.C.: National Academies Press;2005.

32. Harris JA, Benedict FG. A Biometric Study of Basal Metabolism in Man. Washington, D.C.: Carnegie Institute of Washington;1919.

33. Hill JO, Peters JC. Environmental contributions to the obesity epidemic. Science. 1998; 280:1371–1374.

34. Stroebele N, Ogden LG, Hill JO. Do calorie-controlled portion sizes of snacks reduce energy intake? Appetite. 2009; 52:793–796.

35. Sciamanna CN, Kiernan M, Rolls BJ, Boan J, Stuckey H, Kephart D, Miller CK, Jensen G, Hartmann TJ, Loken E, Hwang KO, Williams RJ, Clark MA, Schubart JR, Nezu AM, Lehman E, Dellasega C. Practices associated with weight loss versus weight-loss maintenance results of a national survey. Am J Prev Med. 2011; 41:159–166.

36. Rolls BJ. Plenary lecture 1: dietary strategies for the prevention and treatment of obesity. Proc Nutr Soc. 2010; 69:70–79.

37. Sallis JF, Haskell WL, Wood PD, Fortmann SP, Rogers T, Blair SN, Paffenbarger RS Jr. Physical activity assessment methodology in the Five-City Project. Am J Epidemiol. 1985; 121:91–106.

38. Tsai MC, Chang CM, Huang TL. Changes in high-density lipoprotein and homeostasis model assessment of insulin resistance in medicated schizophrenic patients and healthy controls. Chang Gung Med J. 2010; 33:613–618.

39. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972; 18:499–502.

40. Greenberg JA, Buijsse B. Habitual chocolate consumption may increase body weight in a dose-response manner. PLoS One. 2013; 8:e70271.

41. Desch S, Kobler D, Schmidt J, Sonnabend M, Adams V, Sareban M, Eitel I, Bluher M, Schuler G, Thiele H. Low vs. higher-dose dark chocolate and blood pressure in cardiovascular high-risk patients. Am J Hypertens. 2010; 23:694–700.

42. Matsui N, Ito R, Nishimura E, Yoshikawa M, Kato M, Kamei M, Shibata H, Matsumoto I, Abe K, Hashizume S. Ingested cocoa can prevent high-fat diet-induced obesity by regulating the expression of genes for fatty acid metabolism. Nutrition. 2005; 21:594–601.

43. Min SY, Yang H, Seo SG, Shin SH, Chung MY, Kim J, Lee SJ, Lee HJ, Lee KW. Cocoa polyphenols suppress adipogenesis in vitro and obesity in vivo by targeting insulin receptor. Int J Obes (Lond). 2013; 37:584–592.

44. Tokede OA, Gaziano JM, Djoussé L. Effects of cocoa products/dark chocolate on serum lipids: a meta-analysis. Eur J Clin Nutr. 2011; 65:879–886.

45. Engler MB, Engler MM, Chen CY, Malloy MJ, Browne A, Chiu EY, Kwak HK, Milbury P, Paul SM, Blumberg J, Mietus-Snyder ML. Flavonoid-rich dark chocolate improves endothelial function and increases plasma epicatechin concentrations in healthy adults. J Am Coll Nutr. 2004; 23:197–204.

46. Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy WS Jr, Brehm BJ, Bucher HC. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006; 166:285–293.

47. Makris A, Foster GD. Dietary approaches to the treatment of obesity. Psychiatr Clin North Am. 2011; 34:813–827.

48. Schoeller DA. How accurate is self-reported dietary energy intake? Nutr Rev. 1990; 48:373–379.