Effect of cocoa flavanols and exercise on cardiometabolic risk factors in overweight and obese subjects

Objective: Impaired endothelial function in obesity may reduce blood flow to sites of metabolism, contributing to impaired fat oxidation and insulin resistance. This study investigated the effects of cocoa flavanols and regular exercise, interventions known to improve endothelial function, on cardiometabolic function and body composition in obese individuals. Design: Overweight and obese adults were randomly assigned to high-flavanol cocoa (HF, 902mg flavanols), HF and exercise, low-flavanol cocoa (LF, 36 mg flavanols), or LF and exercise for 12 weeks (exercise duration was 3 x 45 min per week at 75% of age-predicted maximum heart rate). Body composition was assessed by dual-energy X-ray absorptiometry at 0 and 12 weeks. Brachial artery flow-mediated dilatation (FMD), supine blood pressure (BP) and fasting plasma insulin, and glucose levels were assessed at 0, 6 and 12 weeks, respectively. Insulin sensitivity/resistance was determined using the modified homeostasis model assessment of insulin resistance (HOMA2). Results: A total of 49 subjects (M = 18; F = 31) completed the intervention. Baseline averages were as follows: body mass index = 33.5 kg/m(2); BP = 123/76 mm Hg; HOMA2 = 2.4; FMD = 4.3%; rate of fat oxidation during exercise = 0.34 g min(-1); abdominal fat = 45.7% of total abdominal mass. Compared to LF, HF increased FMD acutely (2 h post-dose) by 2.4% (P < 0.01) and chronically (over 12 weeks; P < 0.01) by 1.6% and reduced insulin resistance by 0.31% (P < 0.05), diastolic BP by 1.6 mm Hg and mean arterial BP by 1.2 mm Hg (P < 0.05), independent of exercise. Regular exercise increased fat oxidation during exercise by 0.10 g min(-1) (P < 0.01) and reduced abdominal fat by 0.92% (P < 0.05). Conclusion: Although HF consumption was shown to improve endothelial function, it did not enhance the effects of exercise on body fat and fat metabolism in obese subjects. However, it may be useful for reducing cardiometabolic risk factors in this population.