Tuesday, 4 October 2016

Re: Short-term Chocolate Consumption Has Little Effect on Inflammation or Oxidative Biomarkers in People with HIV

  • Cocoa (Theobroma cacao, Malvaceae)
  • Yerba Maté (Ilex paraguariensis, Aquifoliaceae)
Date: 09-15-2016HC# 081661-552

Petrilli AA, Souza SJ, Teixeira AM, et al. Effect of chocolate and yerba mate phenolic compounds on inflammatory and oxidative biomarkers in HIV/AIDS individuals. Nutrients. May 23, 2016;8(5):132. doi: 10.3390/nu8050132.

In those with human immunodeficiency virus or acquired immune deficiency syndrome (HIV/AIDS), cardiovascular disease (CVD) is more prevalent than in the general population. Mechanisms may include reduced high-density lipoprotein cholesterol (HDL-c) and the generation of excess oxidative stress due to viral proteins that impair antioxidant activity, as well as inflammation from abnormal fat metabolism caused by antiretroviral therapy (ART). Flavonoids are bioactive compounds that have been shown to have antioxidant and anti-inflammatory activity; these compounds are prevalent in commonly consumed foods including cocoa (Theobroma cacao, Malvaceae) and yerba maté (Ilex paraguariensis, Aquifoliaceae). This randomized, double-blind, placebo-controlled crossover trial investigated the potential beneficial effects of cocoa and yerba maté on markers of oxidative stress and inflammation in patients who were HIV-positive.
The study took place from 2011 to 2015, apparently at the University of São Paulo in São Paulo, Brazil. Included patients were HIV-positive, 19-59 years old, and had been on ART for 6 months or more and had an undetectable viral load (<500 viral copies/ml). Exclusion criteria included a history of CVD, kidney, liver, or thyroid diseases or severe intestinal illness, Chagas disease, hepatitis B or C or "opportunistic" infections, diabetes, hypertension, pregnancy, use of recreational drugs or anti-inflammatory drugs, participation in another nutritional study, "supplement intolerance," and vegetarianism. Clinical and demographic parameters, as well as ART history, were assessed at baseline, 15, 45, 75, and 105 days.
The chocolate treatment consisted of 65 g per day for 15 days of a chocolate bar standardized to contain 36 g of cocoa containing about 2864 mg of total polyphenols and 550 mg of flavonoids. The chocolate bar was developed by the Institute of Food Technology in Campinas, Brazil, and produced by JAF INOX® Integrated Systems Cocoa to Chocolate in São Roque, Brazil; the cocoa liquor and cocoa butter were acquired from Barry Callebaut Brazil Industry and Trade in Food Products (Zürich, Switzerland). Other ingredients were not described. Placebo for chocolate was white chocolate, said to be nutritionally comparable except lacking phenolic compounds. Yerba maté tea treatment consisted of 3 g daily of water-soluble granulated yerba maté (Leão Alimentos e Bebidas®; São Paulo, Brazil) for 15 days, standardized to 107 mg/g total phenolic compounds, together with maltodextrin, peach (Prunus persica, Rosaceae) artificial flavoring, and potassium sorbate. Placebo for yerba maté consisted of maltodextrin, caramel food coloring, peach artificial flavoring, and potassium sorbate.  
Patients received all 4 treatments in random order. After each 15-day treatment period, there was a 15-day washout period. Randomization to 1 of 4 possible sequences was done at baseline. Physical parameters measured at the end of each treatment period included weight, height, body mass index, waist circumference, and fat mass percentage. Blood also was collected for high-sensitivity C-reactive protein (hs-CRP), fibrinogen, thiobarbituric acid reactive substances (TBARS, a lipid peroxidation marker), lipid profile, white blood cell count, and markers of immune response.
From a total of 1104 patients screened, 201 were randomly assigned, with 109 patients excluded due to baseline viral load >500 copies/ml, loss to follow up, or changes in ART or other medication; thus, 92 finished the study and were included in the final analysis. Of these patients, 63% were men, and the average age was 45 years. The only significant differences between those that finished the study and 62 who began the study but did not finish was age (P<0.05), with the mean age of those who did not finish being 41; the authors conclude that since inflammation markers were not different, age did not significantly confound results. There were no significant alterations in physical parameters throughout the study. The hs-CRP concentrations of 66.3% of patients were considered higher than normal at baseline [the normal range of hs-CRP concentration was not provided]. Fibrinogen was considered normal in 71.7% of patients, and HDL-c "adequate" in about 62%. Abdominal obesity was noted in 24.1% of men and 61.8% of women. Other parameters were considered to be normal in the large majority of patients.
HDL-c was significantly higher after chocolate treatment than after treatments with yerba maté (P=0.04) or placebo for yerba maté (P=0.01) and as compared with baseline (P=0.008). The difference between chocolate treatment and chocolate placebo was not significant (P=0.09). Mean values of HDL-c were 49.8 mg/dl at baseline vs. 52.1 mg/dl after chocolate consumption and 50.6 mg/dl after consumption of placebo chocolate. HDL-c may modulate inflammatory processes, as reported in other studies. However, no differences were observed in any of the other parameters. It is suggested that the lack of effects on most of the parameters measured may be due to dosage, short duration of treatment, or altered metabolism of phenolic compounds from viral infection or ART. Further studies with longer duration and various dosages may help discern any potential for CVD risk reduction by chocolate or yerba maté consumption in this population.
Amy C. Keller, PhD