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Li J, Sesso HD, Kim E, Manson JE, Friedenberg G, Clar A, Copeland T, Shadyab AH, Wactawski-Wende J, Tinker L, Liu S. Cocoa Extract Supplementation and Risk of Type 2 Diabetes: The Cocoa Supplement and Multivitamin Outcomes Study (COSMOS) Randomized Clinical Trial. Diabetes Care 2023; 46:2278-2284. [PMID: 37816167 DOI: 10.2337/dc23-1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/22/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVE Observational studies have indicated that cocoa flavanol supplementation may be a promising strategy for type 2 diabetes (T2D) prevention. We aimed to directly evaluate its clinical efficacy in a large randomized clinical trial (RCT). RESEARCH DESIGN AND METHOD The Cocoa Supplement and Multivitamin Outcomes Study (COMSOS) was a 2 × 2 factorial RCT performed from June 2015 to December 2020 that tested cocoa extract and a multivitamin for the prevention of cardiovascular disease (CVD) and cancer. A total of 21,442 U.S. adults free of CVD and recent cancer, including 12,666 women aged ≥65 years and 8,776 men aged ≥60 years, were randomly assigned to receive cocoa extract [500 mg/day cocoa flavanols, including 80 mg (-)-epicatechin] or placebo. In this study, we included 18,381 participants without diabetes at enrollment and examined the effect of cocoa extract supplementation on incident self-reported T2D in intention-to-treat analyses. RESULTS During a median follow-up of 3.5 years, 801 incident T2D cases were reported. Compared with placebo, taking a cocoa extract supplement did not reduce T2D (adjusted hazard ratio 1.04, 95% CI 0.91-1.20, P = 0.58). Stratification analyses showed that the effect of cocoa extract supplementation was not significantly modified by sex, race, BMI, smoking, physical activity, dietary quality, flavanol status at baseline, or randomized multivitamin assignment. CONCLUSIONS Middle-aged and older adults taking a cocoa extract supplement for a median of 3.5 years did not reduce their risk of incident T2D. Further studies of cocoa extract supplementation beginning earlier in adulthood and in populations with different background diets are warranted.
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Affiliation(s)
- Jie Li
- Department of Epidemiology and Center for Global Cardiometabolic Health, School of Public Health, Brown University, Providence, RI
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Howard D Sesso
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Eunjung Kim
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Georgina Friedenberg
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Allison Clar
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Trisha Copeland
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | - Jean Wactawski-Wende
- School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - Lesley Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Simin Liu
- Department of Epidemiology and Center for Global Cardiometabolic Health, School of Public Health, Brown University, Providence, RI
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Medicine, The Warrant Alpert School of Medicine, Brown University, Providence, RI
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Li Y, Liu Y, Tan R, Liu Y. Effect of flavonoids on skeletal muscle mass, strength and physical performance in middle-aged and older adults with or without Sarcopenia: A meta-analysis of randomized controlled trials. Front Nutr 2022; 9:1013449. [PMID: 36299989 PMCID: PMC9589257 DOI: 10.3389/fnut.2022.1013449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022] Open
Abstract
The role of flavonoids in regulating the synthesis and function of skeletal muscles is increasingly recognized. However, randomized controlled trials have yielded inconsistent results on the influence of flavonoids on human muscular parameters. Therefore, we performed a meta-analysis to evaluate the possible effects of flavonoids on sarcopenia-related parameters in middle-aged and elderly people. Eligible literature and randomized controlled trials reports have been extensively searched from PubMed, Cochrane Library, Web of Science, and EMBASE databases until April 2022. A total of 20 articles involving 796 participants were available for the meta-analysis. There were significant benefits for participants in appendicular muscle mass gain (SMD = 0.29; 95% CI: 0.07, 0.52; P = 0.01) and 6-min walk distance (SMD = 0.37; 95% CI: 0.01, 0.73; P = 0.05). A subgroup analysis indicated that flavonoid significantly improves appendicular muscle mass (SMD = 0.50; 95% CI: 0.21, 0.80; P < 0.01) and Timed-Up and Go test (SMD = −0.47; 95% CI: −0.85, −0.09; P = 0.02) in Sarcopenia population. Our results provide insight into the effects of flavonoids on skeletal muscle mass and gait speed for those without exercise. However, there was no significant improvement in the subjects' muscle strength.
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Affiliation(s)
- Yuzhuo Li
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China,Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Yun Liu
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China,Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Rongshao Tan
- Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Yan Liu
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China,Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China,*Correspondence: Yan Liu
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Deane CS, Din USU, Sian TS, Smith K, Gates A, Lund JN, Williams JP, Rueda R, Pereira SL, Atherton PJ, Phillips BE. Curcumin Enhances Fed-State Muscle Microvascular Perfusion but Not Leg Glucose Uptake in Older Adults. Nutrients 2022; 14:nu14061313. [PMID: 35334969 PMCID: PMC8953570 DOI: 10.3390/nu14061313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 02/05/2023] Open
Abstract
Therapeutic interventions aimed at enhancing blood flow may combat the postprandial vascular and metabolic dysfunction that manifests with chronological ageing. We compared the effects of acute curcumin (1000 mg) coupled with an oral nutritional supplement (ONS, 7.5 g protein, 24 g carbohydrate and 6 g fat) versus a placebo and ONS (control) on cerebral and leg macrovascular blood flow, leg muscle microvascular blood flow, brachial artery endothelial function, and leg insulin and glucose responses in healthy older adults (n = 12, 50% male, 73 ± 1 year). Curcumin enhanced m. tibialis anterior microvascular blood volume (MBV) at 180 and 240 min following the ONS (baseline: 1.0 vs. 180 min: 1.08 ± 0.02, p = 0.01 vs. 240 min: 1.08 ± 0.03, p = 0.01), and MBV was significantly higher compared with the control at both time points (p < 0.05). MBV increased from baseline in the m. vastus lateralis at 240 min after the ONS in both groups (p < 0.05), and there were no significant differences between groups. Following the ONS, leg blood flow and leg vascular conductance increased, and leg vascular resistance decreased similarly in both conditions (p < 0.05). Brachial artery flow-mediated dilation and middle cerebral artery blood flow were unchanged in both conditions (p > 0.05). Similarly, the curcumin and control groups demonstrated comparable increases in glucose uptake and insulin in response to the ONS. Thus, acute curcumin supplementation enhanced ONS-induced increases in m. tibialis anterior MBV without potentiating m. vastus lateralis MBV, muscle glucose uptake, or systemic endothelial or macrovascular function in healthy older adults.
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Affiliation(s)
- Colleen S. Deane
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter EX1 2LU, UK;
- Living Systems Institute, University of Exeter, Stocker Road, Exeter EX4 4QD, UK
| | - Ushnah S. U. Din
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
| | - Tanvir S. Sian
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby DE22 3NE, UK
| | - Ken Smith
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
| | - Amanda Gates
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
| | - Jonathan N. Lund
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby DE22 3NE, UK
| | - John P. Williams
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby DE22 3NE, UK
| | - Ricardo Rueda
- Research and Development, Abbott Nutrition, 18004 Granada, Spain;
| | | | - Philip J. Atherton
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Correspondence: (P.J.A.); (B.E.P.)
| | - Bethan E. Phillips
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Correspondence: (P.J.A.); (B.E.P.)
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Din USU, Sian TS, Deane CS, Smith K, Gates A, Lund JN, Williams JP, Rueda R, Pereira SL, Atherton PJ, Phillips BE. Green Tea Extract Concurrent with an Oral Nutritional Supplement Acutely Enhances Muscle Microvascular Blood Flow without Altering Leg Glucose Uptake in Healthy Older Adults. Nutrients 2021; 13:nu13113895. [PMID: 34836149 PMCID: PMC8619110 DOI: 10.3390/nu13113895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 01/10/2023] Open
Abstract
Postprandial macro- and microvascular blood flow and metabolic dysfunction manifest with advancing age, so vascular transmuting interventions are desirable. In this randomised, single-blind, placebo-controlled, crossover trial, we investigated the impact of the acute administration of green tea extract (GTE; containing ~500 mg epigallocatechin-3-gallate) versus placebo (CON), alongside an oral nutritional supplement (ONS), on muscle macro- and microvascular, cerebral macrovascular (via ultrasound) and leg glucose/insulin metabolic responses (via arterialised/venous blood samples) in twelve healthy older adults (42% male, 74 ± 1 y). GTE increased m. vastus lateralis microvascular blood volume (MBV) at 180 and 240 min after ONS (baseline: 1.0 vs. 180 min: 1.11 ± 0.02 vs. 240 min: 1.08 ± 0.04, both p < 0.005), with MBV significantly higher than CON at 180 min (p < 0.05). Neither the ONS nor the GTE impacted m. tibialis anterior perfusion (p > 0.05). Leg blood flow and vascular conductance increased, and vascular resistance decreased similarly in both conditions (p < 0.05). Small non-significant increases in brachial artery flow-mediated dilation were observed in the GTE only and middle cerebral artery blood flow did not change in response to GTE or CON (p > 0.05). Glucose uptake increased with the GTE only (0 min: 0.03 ± 0.01 vs. 35 min: 0.11 ± 0.02 mmol/min/leg, p = 0.007); however, glucose area under the curve and insulin kinetics were similar between conditions (p > 0.05). Acute GTE supplementation enhances MBV beyond the effects of an oral mixed meal, but this improved perfusion does not translate to increased leg muscle glucose uptake in healthy older adults.
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Affiliation(s)
- Ushnah S. U. Din
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
| | - Tanvir S. Sian
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby DE22 3NE, UK
| | - Colleen S. Deane
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter EX1 2LU, UK;
- Living Systems Institute, University of Exeter, Stocker Road, Exeter EX4 4QD, UK
| | - Ken Smith
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
| | - Amanda Gates
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
| | - Jonathan N. Lund
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby DE22 3NE, UK
| | - John P. Williams
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby DE22 3NE, UK
| | - Ricardo Rueda
- Research and Development, Abbott Nutrition, 18004 Granada, Spain;
| | | | - Philip J. Atherton
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Correspondence: (P.J.A.); (B.E.P.)
| | - Bethan E. Phillips
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Correspondence: (P.J.A.); (B.E.P.)
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