• Can cocoa modulate blood lipids in type 2 diabetes?
  • Razieh Anari,1,*
    1. Ahvaz Jundishapur University of Medical Sciences


  • Introduction: The risk of cardiovascular morbidity and mortality is higher in patients with diabetes. A potential risk factor, hyperlipidemia, is frequently observed in type 2 diabetes (T2D). Cocoa, a natural source of flavanols, may exert beneficial impacts on lipid metabolism.
  • Methods: A systematic review studied clinical trials assessing blood lipid changes following cocoa product consumption in T2D published until January 2024 in PubMed, Scopus, and Embase. Risk of bias was assessed using the Cochrane tool, and publication bias was assessed using funnel plot and Egger’s test. Grading of recommendations, assessment, development, and evaluation (GRADE) was used to evaluate the certainty of evidence. Data was analyzed using Stata software 14 and the random effect model was applied.
  • Results: Eleven trials met the inclusion criteria (506 subjects, mean age: 61.6 years). Chocolate (k = 4) and cocoa (k = 7) were used. Studies lasted for a few hours to a year. Cocoa decreased serum triglyceride (−0.20 mmol/L [−0.27, −0.13]), cholesterol (−0.18 mmol/L [−0.39, 0.03]), HDL-C (0.03 mmol/L [−0.02, 0.08]), and LDL-C (−0.19 mmol/L [−0.39, 0.01]). The GRADE evaluation showed “very low” certainty of evidence for lipid changes following cocoa intake. We found no evidence of a dose-response relationship between serum lipids and cocoa antioxidants epicatechins, Proanthocyanidins, Catechins, and Theobromine. A severe heterogeneity was observed among the studies, possibly due to differences in age, baseline lipid levels, types and durations of interventions, and diabetes history.
  • Conclusion: This study confirmed that cocoa modifies serum lipids, especially serum TG, in T2D patients, but the changes were of low clinical importance. The inconsistency in the results warrants further examination in this regard.
  • Keywords: cocoa, chocolate, diabetes, hyperlipidemia, serum lipids