Effects of cocoa consumption on biochemical parameters, body composition and DNA damage in patients with resistant hypertension: a pilot study
DOI:
https://doi.org/10.34119/bjhrv7n4-105Keywords:
arterial hypertension, DNA damage, cocoa, polyphenolsAbstract
Introduction and objectives: Resistant Hypertension (RH) has a prevalence of 10 to 30%, and its pathophysiology has been related to a hyperactivity of the Renin-Angiotensin-Aldosterone System, excess circulating aldosterone, activation of the sympathetic nervous system, arterial stiffness and vascular remodeling. Cocoa has interesting repercussions on cardiovascular health, improving biochemical parameters, body composition, and possibly protecting against DNA damage. This work aimed to investigate the effect of cocoa powder consumption on DNA damage, biochemical parameters and body composition in patients with RH. Methods: Randomized, double-blind, placebo-controlled clinical trial. The IG (n=6) received 30g/day of cocoa powder. The CG (n=6) received 30g/day of maltodextrin. Biochemical analyzes and anthropometric measurements were performed at baseline (T0), at 30 days (T30) and 60 days (T60). At T0 and T60, bioimpedance and DNA damage analyzes were performed using the Comet Assay. Descriptive statistical analysis was performed using the GraphPad Prism software. When applicable, a two-way ANOVA test was performed. Results presented as mean and standard error/deviation. Significant difference when p ≤0.05. Results: There was a tendency to decrease HbA1c (p =0.0531) in the IG (5.325±0.306) in relation to the CG (6.520±0.386), at T30. We observed a trend towards attenuation of DNA damage, in class 1, of the IG (T0 21.75 – T60 10.50), and this is shown to be the opposite in the CG (T0 7.17 - T60 14.33). Conclusion(s): Cocoa supplementation in individuals with RH was beneficial in reducing HbA1c levels. Cocoa appears to add some DNA damage class 1 protection in individuals with RH.
References
Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; American heart association; world heart federation; international atherosclerosis society; and international association for the study of obesity. Circulation. 2009;120(16):1640–5.
Almoosawi S, Fyfe L, Ho C, et al. 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. British journal of nutrition. 2010;103(6):842–50.
Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obesity reviews. 2012;13(3):275–86.
Barroso WKS, Rodrigues CIS, Bortolotto LA, et al. Brazilian guidelines of hypertension–2020. Arquivos brasileiros de cardiologia. 2021;116:516–658.
Basu A, Sanchez K, Leyva MJ, et al. Green tea supplementation affects body weight, lipids, and lipid peroxidation in obese subjects with metabolic syndrome. Journal of the American College of Nutrition. 2010;29(1):31–40.
Brand S, Amann K, Schupp N. Angiotensin II-induced hypertension dose-dependently leads to oxidative stress and DNA damage in mouse kidneys and hearts. Journal of Hypertension. 2013;31(2):333–44.
Browning LM, Hsieh SD, Ashwell M. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0· 5 could be a suitable global boundary value. Nutrition research reviews. 2010;23(2):247–69.
Cai A, Calhoun DA. Resistant hypertension: an update of experimental and clinical findings. Hypertension. 2017;70(1):5–9.
Castro-Barquero S, Lamuela-Raventós RM, Doménech M, et al. Relationship between Mediterranean dietary polyphenol intake and obesity. Nutrients. 2018;10(10):1523.
Cordero-Herrera I, Martín MÁ, Goya L, et al. Cocoa flavonoids attenuate high glucose-induced insulin signalling blockade and modulate glucose uptake and production in human HepG2 cells. Food and Chemical Toxicology. 2014;64:10–9.
Cryer MJ, Horani T, DiPette DJ. Diabetes and hypertension: a comparative review of current guidelines. The Journal of Clinical Hypertension. 2016;18(2):95–100.
Cuenca-García M, Ruiz JR, Ortega FB, et al. Association between chocolate consumption and fatness in European adolescents. Nutrition. 2014;30(2):236–9.
Di Giosia P, Giorgini P, Stamerra CA, et al. Gender differences in epidemiology, pathophysiology, and treatment of hypertension. Current atherosclerosis reports. 2018;20:1–7.
Diaz KM, Shimbo D. Physical activity and the prevention of hypertension. Current hypertension reports. 2013;15:659–68.
Dulloo A, Seydoux J, Girardier L, et al. Green tea and thermogenesis: interactions between catechin-polyphenols, caffeine and sympathetic activity. International journal of obesity. 2000;24(2):252–8.
Edwards RL, Lyon T, Litwin SE, et al. Quercetin reduces blood pressure in hypertensive subjects. The Journal of nutrition. 2007;137(11):2405–11.
Efraim P, Alves AB, Jardim DCP. Polyphenols in cocoa and derivatives: Factors of variation and health effects. Brazilian Journal of Food Technology. 2011;14:181–201.
Firmo JOA, Peixoto SV, Loyola AI de, et al. Health behaviors and hypertension control: the results of ELSI-BRASIL. Cadernos de Saúde Pública. 2019;35.
Fisher ND, Hughes M, Gerhard-Herman M, et al. Flavanol-rich cocoa induces nitric-oxide-dependent vasodilation in healthy humans. Journal of hypertension. 2003;21(12):2281–6.
Galleano M, Pechanova O, G Fraga C. Hypertension, nitric oxide, oxidants, and dietary plant polyphenols. Current pharmaceutical biotechnology. 2010;11(8):837–48.
Garcia-Yu IA, Garcia-Ortiz L, Gomez-Marcos MA, et al. Cocoa-rich chocolate and body composition in postmenopausal women: a randomised clinical trial. British Journal of Nutrition. 2021;125(5):548–56.
Geiss LS, Rolka DB, Engelgau MM. Elevated blood pressure among US adults with diabetes, 1988–1994. American journal of preventive medicine. 2002;22(1):42–8.
Havlik RJ, Hubert HB, Fabsitz RR, et al. Weight and hypertension. Annals of Internal Medicine. 1983;98(5_Part_2):855–9.
Hurtubise J, McLellan K, Durr K, et al. The different facets of dyslipidemia and hypertension in atherosclerosis. Current atherosclerosis reports. 2016;18:1–12.
Kim H, Keeney P. (-)-Epicatechin content in fermented and unfermented cocoa beans. Journal of Food Science. 1984;49(4):1090–2.
Larsson SC, Åkesson A, Gigante B, et al. Chocolate consumption and risk of myocardial infarction: a prospective study and meta-analysis. Heart. 2016.
Leyva-Soto A, Chavez-Santoscoy RA, Lara-Jacobo LR, et al. Daily consumption of chocolate rich in flavonoids decreases cellular genotoxicity and improves biochemical parameters of lipid and glucose metabolism. Molecules. 2018;23(9):2220.
Lôbo, G. B. S., Silva, A. V., Menezes, G. B. L. Polifenóis dietéticos e função endotelial em adultos sem diagnóstico de doenças: Uma revisão sistemática de ensaios randomizados. Brazilian Journal of Development, 2020, 6(11), 85320-85346.
Lohman, Tg. Anthropometric standardization reference manual. Human kinetics books. 1988;55–68.
Lu N, Wang R, Ji M, et al. The value of hip circumference/heightx ratio for identifying childhood hypertension. Scientific reports. 2018;8(1):3236.
Luca VS, Miron A, Aprotosoaie AC. The antigenotoxic potential of dietary flavonoids. Phytochemistry Reviews. 2016;15:591–625.
Martín MÁ, Ramos S, Cordero-Herrero I, et al. Cocoa phenolic extract protects pancreatic beta cells against oxidative stress. Nutrients. 2013;5(8):2955–68.
Murase T, Nagasawa A, Suzuki J, et al. Beneficial effects of tea catechins on diet-induced obesity: stimulation of lipid catabolism in the liver. International journal of obesity. 2002;26(11):1459–64.
Muxfeldt ES, Chedier B, Rodrigues CIS. Hipertensão resistente e refratária: duas faces de uma mesma doença? Brazilian Journal of Nephrology. 2018;41:266–74.
Negishi H, Ikeda K, Kuga S, et al. The relation of oxidative DNA damage to hypertension and other cardiovascular risk factors in Tanzania. Journal of hypertension. 2001;19(3):529–33.
Nickenig G, Jung O, Strehlow K, et al. Hypercholesterolemia is associated with enhanced angiotensin AT1-receptor expression. American Journal of Physiology-Heart and Circulatory Physiology. 1997;272(6):H2701–7. (a)
Nickenig G, Sachinidis A, Michaelsen F, et al. Upregulation of vascular angiotensin II receptor gene expression by low-density lipoprotein in vascular smooth muscle cells. Circulation. 1997;95(2):473–8. (b)
Otsuka T, Takada H, Nishiyama Y, et al. Dyslipidemia and the risk of developing hypertension in a working-age male population. Journal of the American heart association. 2016;5(3):e003053.
Queisser N, Oteiza PI, Stopper H, et al. Aldosterone induces oxidative stress, oxidative DNA damage and NF-κB-activation in kidney tubule cells. Molecular carcinogenesis. 2011;50(2):123–35.
Queisser N, Amann K, Hey V, et al. Blood pressure has only minor influence on aldosterone-induced oxidative stress and DNA damage in vivo. Free Radical Biology and Medicine. 2013;54:17–25.
Roumie CL, Hung AM, Russell GB, et al. Blood pressure control and the association with diabetes mellitus incidence: results from SPRINT randomized trial. Hypertension. 2020;75(2):331–8.
Santos LM. Efeitos dos flavonoides do cacau na glicemia e insulina sérica de indivíduos com diabetes mellitus tipo 2: Uma revisão sistemática. Master's thesis, Niterói, Postgraduate Program in Nutrition, Federal Fluminense University, 2021.
Schmid U, Stopper H, Schweda F, et al. Angiotensin II induces DNA damage in the kidney. Cancer Research. 2008;68(22):9239–46.
Seravalle G, Grassi G. Obesity and hypertension. Pharmacological research. 2017;122:1–7.
Smith L, Grabovac I, Jackson SE, et al. Chocolate consumption and indicators of adiposity in US adults. The American Journal of Medicine. 2020;133(9):1082–7.
Souza, C. A. R.; Souza, G. C.; Miguel, T. S.; Pinho, J. S.; Matos, A. C.; Huguenin, G. V. B. Cocoa effects on blood pressure, endothelial function, and inflammation: a systematic review. Brazilian Journal of Health Review, [S. l.], v. 6, n. 6, p. 27095–27113, 2023.
Spadafranca A, Conesa CM, Sirini S, et al. Effect of dark chocolate on plasma epicatechin levels, DNA resistance to oxidative stress and total antioxidant activity in healthy subjects. British journal of nutrition. 2010;103(7):1008–14.
Strain WD, Paldánius P. Diabetes, cardiovascular disease and the microcirculation. Cardiovascular diabetology. 2018;17:1–10.
Tomaru M, Takano H, Osakabe N, et al. Dietary supplementation with cacao liquor proanthocyanidins prevents elevation of blood glucose levels in diabetic obese mice. Nutrition. 2007;23(4):351–5.
Whelton PK, He J, Appel LJ, et al. Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. Jama. 2002;288(15):1882–8.
Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). European heart journal. 2018;39(33):3021–104.
WHO World Health Organization. Obesity: preventing and managing the global epidemic: report of a WHO consultation. 2000.
WHO World Health Organization, others. Diet, nutrition and the prevention of chronic diseases. 2003.
Yavuzer S, Yavuzer H, Cengiz M, et al. The role of protein oxidation and DNA damage in elderly hypertension. Aging clinical and experimental research. 2016;28:625–32.
Yu Y, Cui Y, Niedernhofer LJ, et al. Occurrence, biological consequences, and human health relevance of oxidative stress-induced DNA damage. Chemical research in toxicology. 2016;29(12):2008–39
