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The Zutphen Elderly Study

Brian Buijsse, MSc; Edith J. M. Feskens, PhD; Frans J. Kok, PhD; Daan Kromhout, PhD

Arch Intern Med. 2006;166:411-417.

Background:  Small, short-term, intervention studies indicate that cocoa-containing foods improve endothelial function and reduce blood pressure. We studied whether habitual cocoa intake was cross-sectionally related to blood pressure and prospectively related with cardiovascular mortality.

Methods:  Data used were of 470 elderly men participating in the Zutphen Elderly Study and free of chronic diseases at baseline. Blood pressure was measured at baseline and 5 years later, and causes of death were ascertained during 15 years of follow-up. Habitual food consumption was assessed by the cross-check dietary history method in 1985, 1990, and 1995. Cocoa intake was estimated from the consumption of cocoa-containing foods.

Results:  One third of the men did not use cocoa at baseline. The median cocoa intake among users was 2.11 g/d. After adjustment, the mean systolic blood pressure in the highest tertile of cocoa intake was 3.7 mm Hg lower (95% confidence interval [CI], –7.1 to –0.3 mm Hg; P = .03 for trend) and the mean diastolic blood pressure was 2.1 mm Hg lower (95% CI, –4.0 to –0.2 mm Hg; P = .03 for trend) compared with the lowest tertile. During follow-up, 314 men died, 152 of cardiovascular diseases. Compared with the lowest tertile of cocoa intake, the adjusted relative risk for men in the highest tertile was 0.50 (95% CI, 0.32-0.78; P = .004 for trend) for cardiovascular mortality and 0.53 (95% CI, 0.39-0.72; P < .001) for all-cause mortality.

Conclusion:  In a cohort of elderly men, cocoa intake is inversely associated with blood pressure and 15-year cardiovascular and all-cause mortality.

Author Affiliations: Center for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven (Mr Buijsse and Drs Feskens and Kromhout), and Division of Human Nutrition, Wageningen University, Wageningen (Mr Buijsse and Drs Feskens, Kok, and Kromhout), the Netherlands.

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