Cocoa extract may have cognitive benefits for older adults with unhealthy diets
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Key takeaways:
- The benefits were only observed in participants with lower diet quality, not those with healthy diets.
- The findings are consistent with a previous analysis involving other participants from the same study.
Cocoa extract supplementation given over 2 years was linked to benefits for cognition among older adults with unhealthy dietary patterns compared with placebo, according to study data published in American Journal of Clinical Nutrition.
Prior research has reported positive associations between cocoa extract and its components like flavanol with multiple health outcomes, including gut wellness, CVD mortality risk and brain function.
“However, randomized clinical trials involving older adults have yielded inconsistent findings,” Chirag M. Vyas, MBBS, MPH, an instructor in clinical investigation at Massachusetts General Hospital, told Healio. “To date, there has not been a randomized clinical trial conducted with in-person, neuropsychological tests covering multiple cognitive domains, such as episodic memory and executive function, to evaluate the long-term effects of cocoa extract on cognitive function.”
For the current study, Vyas and colleagues analyzed data from the Cocoa Supplement and Multivitamin Outcomes Study (COSMOS), in which 21,442 older adults were assigned a daily 500 mg supplementation of cocoa extract or placebo. Their analysis focused on a subset of 573 participants who completed all cognitive tests at baseline. The mean age of participants was 69.6 years and 49.2% were women.
Overall, cocoa extract supplementation — compared with placebo — had no significant effect on 2-year changes in:
- global cognition (mean difference, –0.01; 95% CI, –0.08 to 0.05);
- episodic memory (mean difference, –0.01; 95% CI, –0.13 to 0.1); or
- executive function and attention (mean difference, 0.003; 95% CI, –0.07 to 0.08).
However, the researchers reported that cocoa extract was associated with positive 2-year changes compared with placebo among participants within the lowest tertile of dietary diet quality for:
- global cognition (mean difference, 0.09; 95% CI, –0.04 to 0.23); and
- executive function (mean difference, 0.13; 95% CI, –0.006 to 0.26).
The results did not support Vyas and colleagues’ hypothesis that cocoa extract would result in overall cognitive benefits despite the “strong biological plausibility” from cocoa extract containing functional ingredients like methylxanthines, they wrote.
Still, the findings are consistent with a prior study from earlier this year that involved a web-based cognitive assessment with a separate set of COSMOS participants, according to a press release.
The researchers highlighted several limitations in the study. Because of the 2-year period, it may not have been possible to identify acute or short-term effects of cocoa extract supplementation. Additionally, the study had limited generalizability due to its small number of participants from diverse racial and ethnic populations.
According to Vyas, the key message for primary care physicians “is to advise patients to follow a healthy, balanced diet that includes natural food sources rich in nutrients.”
“Although our research indicates intriguing signals for cognitive benefits with cocoa extract supplementation, especially among individuals with poorer diet quality, it is crucial to emphasize that any health benefits attributed to these supplements need confirmation in a future trial that exclusively focuses on this specific subgroup,” he said.
While the results cannot be used to make recommendations on the use of cocoa extract for the prevention of cognitive decline, Vyas said that “it might be considered as part of a broader strategy for a healthy diet, as identified during the clinical evaluation.”
References:
- Brickman AM, et al. Proc Natl Acad Sci. 2023;doi:10.1073/pnas.2216932120.
- Cocoa extract supplement found to have benefits for cognition among older adults with lower diet quality. https://www.eurekalert.org/news-releases/1010035. Published Dec. 7, 2023. Accessed Dec. 7, 2023.
- Vyas C, et al. Am J Clin Nutr. 2023;doi:10.1016/j.ajcnut.2023.10.031.
Perspective
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This study confirms and builds off previous findings that flavonoids found in cocoa extract have a beneficial effect on cognition. What's most interesting about this study was the subgroup findings, which suggests that cocoa extract has modest impacts on cognitive function for those who have poor diet quality. While no significant changes were found between placebo and those given daily supplementation who otherwise had healthy diets, only 500 mg of cocoa daily was supplemented. It's possible that in order to see significant improvements in other groups, higher doses may be necessary, which warrants further study. A higher dose may also impact other levels of cognition that were studied, like executive function/attention, as the improvements in the subgroup were seen only with global cognition and memory.
These findings are not surprising given the evidence we have that flavonoids can improve cognitive function. For those with otherwise healthy diets, it's possible they are already receiving a therapeutic dose of flavonoids from their diet and, thus, don't need supplementation to receive these benefits. What's also possible is that these individuals with healthy dietary patterns may also be eating enough flavanols found in other foods (anthocyanins, for example) that have also been shown to benefit cognition.
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