Eur J Nutr. 2026 Feb 3;65(2):38. doi: 10.1007/s00394-026-03893-0.
ABSTRACT
PURPOSE: Cocoa is a significant source of theobromine, a bioactive compound proposed to provide cardiovascular protection. However, relatively few studies have provided conclusive evidence of the potential beneficial health effects. The aim of this study was to determine the relationship between the consumption of cocoa products containing theobromine and cardiovascular risk factors in the U.S. population sample using 2015-2020 National Health and Nutrition Examination Survey (NHANES) data.
METHOD: This cross-sectional study included 8531 individuals aged 20-70 years and 3808 people in a fasting sub-sample. Theobromine and cocoa product intake levels were obtained from 24-h dietary recalls and linked to the Food and Nutrient Database for Dietary Studies database. Primary outcomes included systolic and diastolic blood pressure, hypertension, serum total, HDL and LDL cholesterol, triglyceride, glycohemoglobin, insulin, plasma glucose, and high-sensitivity C-reactive protein (hs-CRP). Linear regression models were applied to analyze the associations between theobromine or cocoa product consumption and cardiovascular risk factors.
RESULTS: The consumption of cocoa was not associated with cardiovascular disease risk factors compared to non-consumption. The amounts of cocoa consumed were inversely associated with glycohemoglobin levels (mean ± SE, - 0.04 ± 0.02% per 100 g, P = 0.04). Theobromine intake (vs. no intake) was positively associated with serum insulin (1.85 ± 0.85 μU/mL; P = 0.03). Theobromine levels consumed were inversely associated with glycohemoglobin (- 0.05 ± 0.03% per 100 mg, P = 0.04), serum triglycerides (- 5.4 ± 2.73 mg/dL, P = 0.05), and hs-CRP levels (- 0.26 ± 0.12 mg/L, P = 0.04). These associations were also mostly observed in people with healthier profiles.
CONCLUSION: Increased cocoa consumption is associated with reduced glycohemoglobin levels, while higher theobromine intake is associated with reduced triglyceride, glycohemoglobin, and hs-CRP levels compared to a lower intake. The positive link between theobromine intake, as opposed to no intake, and serum insulin required further investigation. Overall findings support the inclusion of cocoa-derived compounds in healthy diets.
PMID:41632311 | DOI:10.1007/s00394-026-03893-0