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Kurlandsky S, Stote K. Cardioprotective effects of chocolate and almond consumption in healthy women. Nutrition Research. 2006; 26(10): 509-516.
Randomized controlled parallel trial.
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Research Design and Implementation Rating:
NEUTRAL: See Research Design and Implementation Criteria Checklist below.
To look at the effects on selected cardiovascular disease (CVD) factors of combining chocolate and almonds as part of the Therapeutic Lifestyle Changes (TLC) diet in healthy individuals.
Description of Study Protocol:
Community and campus-directed e-mail advertisements.
Randomized four-armed, controlled parallel design.
One of the following: 41g dark chocolate with a self-selected diet, 60g almonds with a self-selected diet, both the chocolate and almonds with a self-selected diet or a self-selected diet avoiding nuts and chocolate. The self-selected diet was based on the NCEP ATP III TLC diet.
Univariate statistics were determined for the dependent variables. Repeated measures of analysis of variance were used to compare the characteristics of the four groups at baseline and changes in dietary intakes and biomarkers that occurred between baseline and end of treatment. Tukey post-hoc tests of comparisons were used for further analysis of differences among diet groups. Analysis included stratification of the sample population by baseline LDL cholesterol levels, subject age, and use of hormone replacement therapy (HRT).
Data Collection Summary:
Timing of Measurements
Diet education from an RD based on guidelines and materials provided by NCEP ATP III to include total fat of 25% to 35% of calories from fat, less than 7% SFA, up to 10% PUFA and up to 20% MUFA. Dark chocolate was provided as a candy bar (Dove Silky Dark Chocolate, 1.3oz). All nuts other than almonds, and other chocolate, cocoa, and chocolate-containing foods were to be eliminated. Foods high in flavonoids [red wine, green and black tea, fruit (especially berries)] and selected vegetables were to be limited.
Description of Actual Data Sample:
Summary of Results:
There were no significant differences in baseline diet intakes. There were statistically significant differences among diet groups for energy; percentages of total fat, SFA, PUFA, and MUFA; cholesterol; total fiber; percentages of energy from protein and carbohydrate and vitamin E.
Consumption of study products accounted for most of the observed dietary differences among groups, particularly in the two groups receiving almonds. Total energy and fat intake were higher in all of the treatment groups than in the control group. The percent of energy from total fat increased in the almond and almond and chocolate groups and decreased in the control group. The percentage of calories from SFA decreased across all groups except the chocolate-only group. The percentage of calories from the PUFA and MUFA plus dietary fiber and vitamin E increased in both almond groups. Dietary cholesterol decreased in all groups from baseline to the end of treatment to below the recommended 200mg. Percent energy from SFA remained slightly higher than recommended.
98% of subjects assigned to the treatment groups consumed all assigned study product.
Consumption of chocolate and almonds as part of the TLC diet for six weeks led to favorable dietary changes and showed no harmful effects on subjects' weights, serum lipids and inflammatory markers. A favorable effect of chocolate consumption on circulating ICAM levels and observed improvements in serum triacylglycerols warrant investigation with a larger sample size.
Significance of differences for diet between the groups was difficult to determine from Table 3.
Copyright American Dietetic Association (ADA).