Controlled Clinical Trial of the Effect of Cocoa Consumption in Patients With Insulin Resistance

RATIONALE Metabolic syndrome (MS) is a clinical entity associated with obesity, insulin resistance (IR), hypertension, hypertriglyceridemia and low HDL. This syndrome promotes the pathophysiological mechanisms of oxidative stress damage, endothelial inflammation, hypercoagulability, atheromatosis and metabolic dysfunction.

In Colombia, morbidity and mortality from chronic diseases related to MS, such as arterial hypertension and type II diabetes mellitus (DM2) represent high costs to the health system due to the direct attention of these diseases as well as their more frequent complications: acute myocardial infarction, cerebrovascular disease, peripheral neuropathy, retinopathy and renal failure. In addition to social costs due to incapacity for work, loss of years of useful life and reduction in the quality of life of patients and their families.

IR biologically precedes the development of DM2 and some authors propose that it is one of the initial manifestations of MS. It is estimated that 25% of individuals with IR will develop DM2 within 3 to 5 years and 50% will retain their IR status. In the global context, it is estimated that in 2010 approximately 344 million people between the ages of 20 and 79, or 7.9% of the population, are estimated to reach 472 million in 2030, that is, 8.4 million of the adult population with the aggravation that the majority will be located in middle to low income countries.

Despite the relevance of IR in the pathophysiology of DM2, since it is its previous stage, there is no public health policies aimed at conducting an active search for the cases and in the event that the diagnosis is made, there are few alternatives to reverse it or prevent its progression to diabetes. Control of IR demands interventions in people's lifestyles such as increased physical activity, reduced body weight and changes in eating patterns, however, despite the effectiveness of these measures, its real impact is low since it involves drastic modifications in the habits of consumer life that characterize modern Western society.

Grassi et al demonstrated in a short-term (15-day) clinical study that the consumption of black chocolate, as opposed to white chocolate, reduces blood glucose and modulates the mean arterial flow in hypertensive patients who have IR.