Nutrition Research and Practice

The Korean Nutrition Society (한국영양학회)
권호 표지
DOI QR코드

DOI QR Code

Changes in body weight, blood pressure and selected metabolic biomarkers with an energy-restricted diet including twice daily sweet snacks and once daily sugar-free beverage

  • Nickols-Richardson, Sharon M. (Department of Food Science and Human Nutrition, The University of Illinois) ;
  • Piehowski, Kathryn E. (Dietitian) ;
  • Metzgar, Catherine J. (Department of Food Science and Human Nutrition, The University of Illinois) ;
  • Miller, Debra L. (The Hershey Company) ;
  • Preston, Amy G. (The Hershey Company)
  • Received : 2014.01.10
  • Accepted : 2014.06.26
  • Published : 2014.12.01
Download PDF
⟨ Previous Next ⟩

Abstract

BACKGROUND/OBJECTIVES: The type of sweet snack incorporated into an energy-restricted diet (ERD) may produce differential effects on metabolic improvements associated with body weight (BW) loss. This study compared effects of incorporating either twice daily energy-controlled dark chocolate snacks plus once daily sugar-free cocoa beverage (DC) to non-chocolate snacks plus sugar-free non-cocoa beverage (NC) into an ERD on BW loss and metabolic outcomes. MATERIALS/METHODS: In an 18-week randomized comparative trial, 60 overweight/obese premenopausal women were assigned to DC (n = 30) or NC group (n = 30). Dietary intake was measured at baseline and week 18, and BW, anthropometrics, blood pressure (BP) and serum glucose, insulin and lipid concentrations were measured at baseline, and weeks 6, 12 and 18. Data were analyzed using repeated measures ANOVA. RESULTS: Using intention-to-treat analysis, women in DC and NC groups reduced energy intake (both P < 0.001) and lost $4.4{\pm}0.6kg$ and $5.0{\pm}0.9kg$ (both P < 0.001), respectively. Both groups lowered systolic and diastolic BP [DC = 2.7 (P < 0.05), 2.7 (P < 0.01); NC = 3.4 (P < 0.01), 4.2 (P < 0.01) mmHg, respectively]. Glucose and insulin concentrations decreased by 0.72 mmol/L (P < 0.001) and 13.20 pmol/L (P < 0.01) in DC group and by 0.83 mmol/L (P < 0.001) and 13.20 pmol/L (P < 0.01), respectively, in NC group. Total cholesterol increased in NC group (P < 0.05), with no significant lipid changes in DC group. There were no significant differences in biomarker outcomes between groups. CONCLUSIONS: Overweight/obese premenopausal women following an 18-week ERD that included either DC or NC sweet snack and sugar-free beverage lost equivalent amounts of BW and improved BP measurements and glucose and insulin concentrations.

Keywords

References

  1. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 2012;307:491-7. https://doi.org/10.1001/jama.2012.39
  2. Withrow D, Alter DA. The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obes Rev 2011;12:131-41. https://doi.org/10.1111/j.1467-789X.2009.00712.x
  3. Hankey CR. Session 3 (joint with the British Dietetic Association): management of obesity: weight-loss interventions in the treatment of obesity. Proc Nutr Soc 2010;69:34-8. https://doi.org/10.1017/S0029665109991844
  4. Wu T, Gao X, Chen M, van Dam RM. Long-term effectiveness of diet-plus-exercise interventions vs. diet-only interventions for weight loss: a meta-analysis. Obes Rev 2009;10:313-23. https://doi.org/10.1111/j.1467-789X.2008.00547.x
  5. Sears B, Lawren B. Enter the Zone: A Dietary Road Map. New York (NY): Harper Collins; 1995.
  6. Ornish D. Eat More, Weigh Less: Dr. Dean Ornish's Program for Losing Weight Safely While Eating Abundantly. New York (NY): Harper Collins; 2001.
  7. Atkins RC. Dr. Atkins' New Diet Revolution. New York (NY): Harper Collins; 2002.
  8. Agatston A. The South Beach Diet : The Delicious, Doctor-Designed, Foolproof Plan for Fast and Healthy Weight Loss. Emmaus (PA): Rodale; 2003.
  9. Piehowski KE, Preston AG, Miller DL, Nickols-Richardson SM. A reduced-calorie dietary pattern including a daily sweet snack promotes body weight reduction and body composition improvements in premenopausal women who are overweight and obese: a pilot study. J Am Diet Assoc 2011;111:1198-203. https://doi.org/10.1016/j.jada.2011.05.013
  10. Rozin P, Levine E, Stoess C. Chocolate craving and liking. Appetite 1991;17:199-212. https://doi.org/10.1016/0195-6663(91)90022-K
  11. Zellner DA, Garriga-Trillo A, Rohm E, Centeno S, Parker S. Food liking and craving: a cross-cultural approach. Appetite 1999;33:61-70. https://doi.org/10.1006/appe.1999.0234
  12. Lewis JR, Prince RL, Zhu K, Devine A, Thompson PL, Hodgson JM. Habitual chocolate intake and vascular disease: a prospective study of clinical outcomes in older women. Arch Intern Med 2010;170:1857-8.
  13. O'Neil CE, Fulgoni VL 3rd, Nicklas TA. Candy consumption was not associated with body weight measures, risk factors for cardiovascular disease, or metabolic syndrome in US adults: NHANES 1999-2004. Nutr Res 2011;31:122-30. https://doi.org/10.1016/j.nutres.2011.01.007
  14. Golomb BA, Koperski S, White HL. Association between more frequent chocolate consumption and lower body mass index. Arch Intern Med 2012;172:519-21. https://doi.org/10.1001/archinternmed.2011.2100
  15. Khawaja O, Gaziano JM, Djousse L. Chocolate and coronary heart disease: a systematic review. Curr Atheroscler Rep 2011;13:447-52. https://doi.org/10.1007/s11883-011-0203-2
  16. Grassi D, Lippi C, Necozione S, Desideri G, Ferri C. Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons. Am J Clin Nutr 2005;81:611-4.
  17. Grassi D, Desideri G, Necozione S, Lippi C, Casale R, Properzi G, Blumberg JB, Ferri C. Blood pressure is reduced and insulin sensitivity increased in glucose-intolerant, hypertensive subjects after 15 days of consuming high-polyphenol dark chocolate. J Nutr 2008;138:1671-6.
  18. Taubert D, Roesen R, Lehmann C, Jung N, Schomig E. Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: a randomized controlled trial. JAMA 2007;298:49-60. https://doi.org/10.1001/jama.298.1.49
  19. Allen RR, Carson L, Kwik-Uribe C, Evans EM, Erdman JW Jr. Daily consumption of a dark chocolate containing flavanols and added sterol esters affects cardiovascular risk factors in a normotensive population with elevated cholesterol. J Nutr 2008;138:725-31.
  20. Almoosawi S, Fyfe L, Ho C, Al-Dujaili E. 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. Br J Nutr 2010;103:842-50. https://doi.org/10.1017/S0007114509992431
  21. Ried K, Sullivan TR, Fakler P, Frank OR, Stocks NP. Effect of cocoa on blood pressure. Cochrane Database Syst Rev 2012;8:CD008893.
  22. Shrime MG, Bauer SR, McDonald AC, Chowdhury NH, Coltart CE, Ding EL. Flavonoid-rich cocoa consumption affects multiple cardiovascular risk factors in a meta-analysis of short-term studies. J Nutr 2011;141:1982-8. https://doi.org/10.3945/jn.111.145482
  23. Davison K, Coates AM, Buckley JD, Howe PR. Effect of cocoa flavanols and exercise on cardiometabolic risk factors in overweight and obese subjects. Int J Obes (Lond) 2008;32:1289-96. https://doi.org/10.1038/ijo.2008.66
  24. Hooper L, Kay C, Abdelhamid A, Kroon PA, Cohn JS, Rimm EB, Cassidy A. Effects of chocolate, cocoa, and flavan-3-ols on cardiovascular health: a systematic review and meta-analysis of randomized trials. Am J Clin Nutr 2012;95:740-51. https://doi.org/10.3945/ajcn.111.023457
  25. Mursu J, Voutilainen S, Nurmi T, Rissanen TH, Virtanen JK, Kaikkonen J, Nyyssonen K, Salonen JT. Dark chocolate consumption increases HDL cholesterol concentration and chocolate fatty acids may inhibit lipid peroxidation in healthy humans. Free Radic Biol Med 2004;37:1351-9. https://doi.org/10.1016/j.freeradbiomed.2004.06.002
  26. Jia L, Liu X, Bai YY, Li SH, Sun K, He C, Hui R. Short-term effect of cocoa product consumption on lipid profile: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2010;92:218-25. https://doi.org/10.3945/ajcn.2009.28202
  27. Corti R, Flammer AJ, Hollenberg NK, Luscher TF. Cocoa and cardiovascular health. Circulation 2009;119:1433-41. https://doi.org/10.1161/CIRCULATIONAHA.108.827022
  28. Fernandez-Murga L, Tarin JJ, Garcia-Perez MA, Cano A. The impact of chocolate on cardiovascular health. Maturitas 2011;69:312-21. https://doi.org/10.1016/j.maturitas.2011.05.011
  29. Tey SL, Brown RC, Gray AR, Chisholm AW, Delahunty CM. Long-term consumption of high energy-dense snack foods on sensory-specific satiety and intake. Am J Clin Nutr 2012;95:1038-47. https://doi.org/10.3945/ajcn.111.030882
  30. Farhat G, Drummond S, Fyfe L, Al-Dujaili EA. Dark chocolate: an obesity paradox or a culprit for weight gain? Phytother Res 2014;28:791-7. https://doi.org/10.1002/ptr.5062
  31. Panel on Macronutrients; Panel on the Definition of Dietary Fiber; Subcommittee on Upper Reference Levels of Nutrients; Subcommittee on Interpretation and Uses of Dietary Reference Intakes; Standing Committee on the Scientific Evaluation of Dietary Reference Intakes; Food and Nutrition Board; Institute of Medicine (US). Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids. Washington, D.C.: National Academies Press; 2005.
  32. Harris JA, Benedict FG. A Biometric Study of Basal Metabolism in Man. Washington, D.C.: Carnegie Institute of Washington; 1919.
  33. Hill JO, Peters JC. Environmental contributions to the obesity epidemic. Science 1998;280:1371-4. https://doi.org/10.1126/science.280.5368.1371
  34. Stroebele N, Ogden LG, Hill JO. Do calorie-controlled portion sizes of snacks reduce energy intake? Appetite 2009;52:793-6. https://doi.org/10.1016/j.appet.2009.02.015
  35. Sciamanna CN, Kiernan M, Rolls BJ, Boan J, Stuckey H, Kephart D, Miller CK, Jensen G, Hartmann TJ, Loken E, Hwang KO, Williams RJ, Clark MA, Schubart JR, Nezu AM, Lehman E, Dellasega C. Practices associated with weight loss versus weight-loss maintenance results of a national survey. Am J Prev Med 2011;41:159-66. https://doi.org/10.1016/j.amepre.2011.04.009
  36. Rolls BJ. Plenary lecture 1: dietary strategies for the prevention and treatment of obesity. Proc Nutr Soc 2010;69:70-9. https://doi.org/10.1017/S0029665109991674
  37. Sallis JF, Haskell WL, Wood PD, Fortmann SP, Rogers T, Blair SN, Paffenbarger RS Jr. Physical activity assessment methodology in the Five-City Project. Am J Epidemiol 1985;121:91-106.
  38. Tsai MC, Chang CM, Huang TL. Changes in high-density lipoprotein and homeostasis model assessment of insulin resistance in medicated schizophrenic patients and healthy controls. Chang Gung Med J 2010;33:613-8.
  39. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499-502.
  40. Greenberg JA, Buijsse B. Habitual chocolate consumption may increase body weight in a dose-response manner. PLoS One 2013;8:e70271. https://doi.org/10.1371/journal.pone.0070271
  41. Desch S, Kobler D, Schmidt J, Sonnabend M, Adams V, Sareban M, Eitel I, Bluher M, Schuler G, Thiele H. Low vs. higher-dose dark chocolate and blood pressure in cardiovascular high-risk patients. Am J Hypertens 2010;23:694-700. https://doi.org/10.1038/ajh.2010.29
  42. Matsui N, Ito R, Nishimura E, Yoshikawa M, Kato M, Kamei M, Shibata H, Matsumoto I, Abe K, Hashizume S. Ingested cocoa can prevent high-fat diet-induced obesity by regulating the expression of genes for fatty acid metabolism. Nutrition 2005;21:594-601. https://doi.org/10.1016/j.nut.2004.10.008
  43. Min SY, Yang H, Seo SG, Shin SH, Chung MY, Kim J, Lee SJ, Lee HJ, Lee KW. Cocoa polyphenols suppress adipogenesis in vitro and obesity in vivo by targeting insulin receptor. Int J Obes (Lond) 2013;37:584-92. https://doi.org/10.1038/ijo.2012.85
  44. Tokede OA, Gaziano JM, Djousse L. Effects of cocoa products/dark chocolate on serum lipids: a meta-analysis. Eur J Clin Nutr 2011;65:879-86. https://doi.org/10.1038/ejcn.2011.64
  45. Engler MB, Engler MM, Chen CY, Malloy MJ, Browne A, Chiu EY, Kwak HK, Milbury P, Paul SM, Blumberg J, Mietus-Snyder ML. Flavonoid-rich dark chocolate improves endothelial function and increases plasma epicatechin concentrations in healthy adults. J Am Coll Nutr 2004;23:197-204. https://doi.org/10.1080/07315724.2004.10719361
  46. Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy WS Jr, Brehm BJ, Bucher HC. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med 2006;166:285-93. https://doi.org/10.1001/archinte.166.3.285
  47. Makris A, Foster GD. Dietary approaches to the treatment of obesity. Psychiatr Clin North Am 2011;34:813-27. https://doi.org/10.1016/j.psc.2011.08.004
  48. Schoeller DA. How accurate is self-reported dietary energy intake? Nutr Rev 1990;48:373-9.

Cited by

  1. Facilitators and barriers to weight loss and weight loss maintenance: a qualitative exploration vol.28, pp.6, 2014, https://doi.org/10.1111/jhn.12273
  2. Effects of nutrition education on weight gain prevention: a randomized controlled trial vol.15, pp.1, 2015, https://doi.org/10.1186/s12937-016-0150-4
  3. Determinants of Weight Gain Prevention in Young Adult and Midlife Women: Study Design and Protocol of a Randomized Controlled Trial vol.4, pp.1, 2015, https://doi.org/10.2196/resprot.4008
  4. A Systematic Review and Meta-Analysis of the Effects of Flavanol-Containing Tea, Cocoa and Apple Products on Body Composition and Blood Lipids: Exploring the Factors Responsible for Variability in Their Efficacy vol.9, pp.7, 2017, https://doi.org/10.3390/nu9070746
  5. Epicatechin, procyanidins, cocoa, and appetite: a randomized controlled trial vol.104, pp.3, 2016, https://doi.org/10.3945/ajcn.115.129783
  6. Does cocoa/dark chocolate supplementation have favorable effect on body weight, body mass index and waist circumference? A systematic review, meta-analysis and dose-response of randomized clinical trials pp.1549-7852, 2018, https://doi.org/10.1080/10408398.2018.1451820
  7. Snacking Behaviour and Its Determinants among College-Going Students in Coastal South India vol.2018, pp.2090-0732, 2018, https://doi.org/10.1155/2018/6785741
  8. Relationship between Cocoa Intake and Healthy Status: A Pilot Study in University Students vol.24, pp.4, 2019, https://doi.org/10.3390/molecules24040812
  9. Dark chocolate and reduced snack consumption in mildly hypertensive adults: an intervention study vol.14, pp.1, 2014, https://doi.org/10.1186/s12937-015-0075-3
  10. Health beneficial effects of cocoa phenolic compounds: a mini-review vol.14, pp.None, 2014, https://doi.org/10.1016/j.cofs.2016.12.002
  11. Role of Theobromine in Cocoa’s Metabolic Properties in Healthy Rats vol.67, pp.13, 2014, https://doi.org/10.1021/acs.jafc.8b07248
  12. Effects of Cocoa Polyphenols and Dark Chocolate on Obese Adults: A Scoping Review vol.12, pp.12, 2014, https://doi.org/10.3390/nu12123695
  13. Impact of cocoa flavanols on human health vol.151, pp.None, 2014, https://doi.org/10.1016/j.fct.2021.112121
  14. Timing of chocolate intake affects hunger, substrate oxidation, and microbiota: A randomized controlled trial vol.35, pp.7, 2014, https://doi.org/10.1096/fj.202002770rr
  15. The Health Effects of Chocolate and Cocoa: A Systematic Review vol.13, pp.9, 2014, https://doi.org/10.3390/nu13092909