Background: The effect of cocoa products on lipid changes is controversial.
Objectives: We aimed to identify and quantify the effect of cocoa on total cholesterol, LDL cholesterol, and HDL cholesterol.
Design: A comprehensive literature search was conducted for relevant trials of cocoa on lipid profile. Weighted mean differences were calculated for net changes in lipid concentrations by using fixed-effects or random-effects models. Previously defined subgroup analyses were performed to identify the source of heterogeneity.
Results: Eight trials (involving 215 participants) were included and evaluated. Because there was only one relatively longer-term study, we focused on the short-term data to evaluate the effects of cocoa on plasma lipid. Cocoa consumption significantly lowered LDL cholesterol by 5.87 mg/dL (95% CI: -11.13, -0.61; P < 0.05) and marginally lowered total cholesterol by 5.82 mg/dL (95% CI: -12.39, 0.76; P = 0.08). However, no significant change was seen in LDL cholesterol in high-quality studies (3 studies included; -4.98 mg/dL; 95% CI: -13.18, 3.21; P = 0.23). Subgroup analyses suggested a cholesterol-lowering effect only in those subjects who consumed a low dose of cocoa and with cardiovascular disease risks. There was no evidence of a dose-effect relation, of any effect in healthy subjects, or of any change in HDL cholesterol.
Conclusions: Short-term cocoa consumption significantly reduced blood cholesterol, but the changes were dependent on the dose of cocoa consumption and the healthy status of participants. There was no dose response and no effect in healthy participants. Future high-quality studies are needed to determine the efficiency of moderate cocoa consumption on lipid profile in long-term intervention and in subjects with other cardiometabolic risk factors.