Effects of cocoa-rich chocolate on cognitive performance in postmenopausal women. A randomised clinical trial

ABSTRACT

Objectives

The aim of this research was to evaluate the effects of adding 10 g of cocoa-rich chocolate (99%) to the habitual diet on cognitive performance in postmenopausal women.

Methods

Following a randomised controlled parallel clinical trial, a total of 140 postmenopausal women aged 50–64 were recruited. The intervention group (n = 73) consumed daily 10 g of chocolate (99% cocoa) in addition to their usual food intake for 6 months, whereas the control group (n = 67) did not receive any intervention. Attention and executive functions, verbal memory, working memory, phonological fluency, category fluency and clinical variables were assessed at baseline and 6 months.

Results

Trail Making Test B execution time showed a decreased of −12.08 s (95% CI: −23.99, −0.18; p = 0.047) in the intervention group compared to the control group, after adjusting for age, educational level, time elapsed from the beginning of menopause and daily energy consumption (Cohen’s d = −0.343). Attention, immediate or delayed verbal memory, phonological or category fluency, and working memory remained unchanged.

Conclusions

The consumption of cocoa-rich (99%) chocolate in addition to the habitual diet could be related to a slight improvement in cognitive performance regarding cognitive flexibility and processing speed in postmenopausal women, with no changes in the rest of the cognitive performance variables evaluated.Trial registration: This clinical trial has been registered at clinicaltrials.gov as NCT03492983.

KEYWORDS:

• Chocolate
• polyphenols
• postmenopause
• cognition
• executive function
• attention
• memory

Acknowledgements

The authors are grateful to all the volunteers for their participation, and the professionals involved in the study: José I Recio-Rodríguez, José A Maderuelo-Fernández, Luis García-Ortiz, Manuel A Gómez-Marcos, Irene A García-Yu, Rosario Alonso-Domínguez, Sara Mora-Simón, Natalia Sánchez-Aguadero, Jesús González-Sánchez, Cristina Agudo-Conde, Cristina Lugones-Sánchez, Benigna Sánchez-Salgado, Carmen Castaño-Sánchez, Emiliano Rodríguez-Sánchez, Susana González-Manzano, Olaya Tamayo-Morales, and Susana González-Sánchez.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported in part by grants funded by the Gerencia Regional de Salud de Castilla y León (GRS 1583/B/17).

Notes on contributors

Irene A. Garcia-Yu

Irene A. Garcia-Yu Graduated in Medicine, Master in Public Health and Preventive Medicine and Public Health specialist. Predoctoral student at the University of Salamanca, awarded by a Rio Hortega grant (CM19/00030) ISCIII/FSE. Researcher at the Primary Care Investigation Unit of Salamanca (APISAL) and member of the APSF03 lifestyles and cardiovascular risk group at Biomedical Research Institute of Salamanca (IBSAL).

Luis Garcia-Ortiz

Luis Garcia-Ortiz Family and Community Medicine Specialist, PhD in medicine and graduate in Statistics in health science. Since 1990 family doctor at Primary Care health centre La Alamedilla, being coordinator 7 years. From 1993–96 I was part of the management structure of Primary care in Salamanca. In 2003 for 3 months I was working in the National British health Service. Associate Professor of Health Sciences since 1999 at the Salamanca University and accreditation of full professor (ANECA) in 2014. Training tutor specialized health since 1990. Full member of the Royal Academy of Medicine of Salamanca since 2017. Coordinator of the Primary care Research Unit of Salamanca, integrated into the RETICS program of the Carlos Health Institute III, being the IP of the Castilla y León group and at Biomedical Research Institute of Salamanca (IBSAL), IP of the lifestyle group and head of the APSF area and member of the Research commission. Principal investigator and collaborator in multiple regional and national and international research projects (more than 60). Directed doctoral theses: 10 (5 extraordinary Awards); Publications: 196. H-index: 29. Since 2015, 58% of the publications, and in D1 14%.

Manuel A. Gomez-Marcos

Manuel A. Gomez-Marcos Family and Community Medicine Specialist. Primary care physician in Salamanca. Professor at the University of Salamanca, Medical School. Tutor of specialised health care training since 1989. Coordinator at Garrido Sur Primary Care health centre for 14 years. Coordinator of the undergraduate (practical training of Medicine students) and postgraduate (family medical residents) training at Garrido Sur Primary Care health centre. Member of the Advisory Commission of the Teaching Unit of Family and Community Medicine of Salamanca for 15 years. Coordinator of the Cardiovascular Area of the Primary Care Research Unit of Salamanca, integrated into the RETICS program of the Carlos Health Institute II, being member of the Castilla y León group. Principal investigator of the group APSF09 Cardiovascular Health Promotion of the Biomedical Research Institute of Salamanca (IBSAL). Principal investigator and collaborator in multiple regional, national and international research projects (more than 60). Papers published in JCR: more than 170. Directed doctoral theses: 7 (4 extraordinary awards). Intellectual property registration of 7 products.

Emiliano Rodriguez-Sanchez

Emiliano Rodriguez-Sanchez Doctor in Medicine (1993), Family Medicine specialist (1991). Primary care physician in Salamanca, with a healthcare and teaching position with family medical residents and Medicine students. Associate Professor in Health Sciences (Medicine Department) at the University of Salamanca (USAL). Member of the Advisory Commission of the Teaching Unit of Family and Community Medicine of Salamanca since 2017. Researcher at APISAL (Primary Care Investigation Unit of Salamanca), collaborating in projects on lifestyle and cardiovascular risk (RD06 / 0018/0027), REDIAP and RETICS RD06 / 0018 at Carlos III Institute. Principal Investigator of the aging and dependency prevention group at Salamanca Biosanitary Institute (IBSAL). Member of the Research Group (GIR) Neuropsychology of USAL since 2011. Director of a doctoral thesis, with an extraordinary award. Collaborating member of INTERDEM, a pan-European network of researchers collaborating in the research and dissemination of psychosocial interventions in dementia in Europe. Principal Investigator in multiple regional and national projects (PredictD-CCRT, W-Predictd and Afisdemyf studies) and collaborator in international projects (Meeting Center, INTERDEM). As bibliometric indexes, the H-INDEX = 19 stands out in Research Gate, as well as 107 publications in JCR. Intellectual property registration of 6 products.

Sara Mora-Simon

Sara Mora-Simon Degree in Psychology (2008), MSc in Neuropsychology (2010) and PhD in Official Program of Neuropsychology (2016), University of Salamanca (USAL). Assistant Professor at Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences at University of Salamanca since 2019. Her research is focused on detection of neurodegenerative diseases and its relationship with cardiovascular risk, prevention of dependency and family caregivers of dependent relatives, and Neuropsychology. Since 2009 is a researcher at APISAL, at Aging and Prevention of Dependency Group at IBSAL and GIR of Neuropsychology at USAL. Author of several papers published in high impact factor journals and communications at national and international scientific congresses.

Jose A. Maderuelo-Fernandez

Jose A. Maderuelo-Fernandez Graduated in Medicine, Preventive Medicine and Public Health specialist and PhD. Researcher at the Primary Care Investigation Unit of Salamanca (APISAL) and member of the APSF03 lifestyles and cardiovascular risk group at Biomedical Research Institute of Salamanca (IBSAL). Author of several papers published in high impact factor journals and communications at national and international scientific congresses.

Jose I. Recio-Rodriguez

Jose I. Recio-Rodriguez Graduated in Nursing and Human Nutrition and Dietetics, Master in Research in Primary Care and Doctor in Biosciences with Extraordinary Prize from the University of Salamanca (USAL), University of International Excellence. Professor of the Nursing Department of the University of Salamanca. He has participated in several international, national and regional research projects, author of more than 100 articles related to interventions for the modification of lifestyles, arterial stiffness and effects of nutritional interventions on different aspects of health.