Department of Nutrition and Food Sciences, Human Nutrition, University of Bonn, Meckenheimer Allee 166a, 53115 Bonn, Germany.
Nutrients. 2022 Oct 26;14(21):4500. doi: 10.3390/nu14214500.
Growing evidence exists that consumption of cocoa-rich food improves the parameters of cardiometabolic health. These effects are ascribed to cocoa flavanols, particularly to (-)-epicatechin (EC), a natural ingredient of cocoa. Hence, to evaluate if EC may explain the effects of cocoa, this systematic review aimed to provide an overview on randomized controlled trials (RCTs) investigating the impact of an EC intake on cardiometabolic biomarkers. For this, the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement was considered and the risk of bias (RoB) was assessed by using the Cochrane RoB 2 tool. In total, 11 studies were included examining parameters on vascular function, glucose/lipid metabolism, oxidative stress, inflammation, appetite sensations, and body weight before and after EC treatment. Except for a dose-dependent acute increase in flow-mediated dilatation (FMD) and in the peripheral arterial tonometry (PAT) index in healthy young adults, effects by EC treatment were not observed. For most trials, some concerns exist for overall RoB. Thus, EC intake may improve endothelial function in healthy young adults. For further parameters (mostly secondary outcomes), it remains unclear if EC has no effect or if this was not detectable. Unbiased RCTs on the impact of an EC intake are needed, which should also investigate the additive or synergistic effects of EC with other cocoa ingredients.
越来越多的证据表明，食用富含可可的食物可以改善心血管代谢健康的参数。这些效果归因于可可黄烷醇，特别是（-）-表儿茶素（EC），可可的一种天然成分。因此，为了评估 EC 是否可以解释可可的作用，本系统评价旨在提供关于研究 EC 摄入对心血管代谢生物标志物影响的随机对照试验（RCT）的概述。为此，考虑了系统评价和荟萃分析的首选报告项目（PRISMA）2020 声明，并使用 Cochrane RoB 2 工具评估了偏倚风险（RoB）。总共纳入了 11 项研究，这些研究检查了血管功能、葡萄糖/脂质代谢、氧化应激、炎症、食欲感觉和体重等参数，在 EC 治疗前后进行了研究。除了在健康年轻成年人中观察到 EC 治疗剂量依赖性的急性血流介导的扩张（FMD）和外周动脉张力计（PAT）指数增加外，没有观察到 EC 治疗的效果。对于大多数试验，总体 RoB 存在一些问题。因此，EC 摄入可能改善健康年轻成年人的内皮功能。对于进一步的参数（主要是次要结局），尚不清楚 EC 是否没有效果，或者是否无法检测到。需要进行关于 EC 摄入影响的无偏 RCT，还应研究 EC 与其他可可成分的协同或协同作用。
