Internal and Emergency Medicine

, Volume 13, Issue 8, pp 1211–1217 | Cite as

Hazelnut and cocoa spread improves flow-mediated dilatation in smokers

  • Lorenzo Loffredo
  • Ludovica Perri
  • Simona Battaglia
  • Cristina Nocella
  • Danilo Menichelli
  • Vittoria Cammisotto
  • Marta Novo
  • Roberto Carnevale
  • Francesco VioliEmail author


Hazelnut and cocoa spread is an Italian product containing cocoa and hazelnut. Several epidemiological studies suggest that cocoa and hazelnuts cocoa exert beneficial cardiovascular effects. To investigate whether in smokers, hazelnut and cocoa spread elicits artery dilatation via down-regulation of oxidative stress. Flow-mediated dilatation (FMD), oxidative stress (as assessed by serum isoprostanes excretion, Nox2 activation and NO bioavailability) and antioxidant status [as assessed by vitamin E levels, plasma total polyphenols and H2O2 breaking down activity (HBA)] were studied in 20 smokers in a crossover, single-blind study. Patients were randomly allocated to 60 g of Hazelnut and cocoa spread or 60 g of milk chocolate (≤ 35% cocoa). FMD, serum isoprostanes, Nox2 activation, NOx, vitamin E, HBA and total polyphenols were assessed at baseline and 2 h after chocolate ingestion. After Hazelnut and cocoa spread intake, FMD and NOx significantly increased (from 4.3 ± 2.8 to 8.0 ± 3.2%, p < 0.001 and from 23.1 ± 5.5 to 32.0 ± 12.6 µM, p = 0.016, respectively); conversely, serum isoprostanes and Nox2 activation significantly decreased (from 302.8 ± 59.8 to 240.7 ± 90.8 pmol/l, p = 0.03 and from 25 ± 4.4 to 22.6 ± 3.2, p = 0.03, respectively). After Hazelnut and cocoa spread intake, serum total polyphenols, vitamin E and HBA significantly increased (from 133.8 ± 49.7 to 202.5 ± 69.5 mg/l GAE, p = 0.001; from 3.56 ± 1.4 to 4.5 ± 1.0 μmol/mmol cholesterol, p = 0.002 and from 63.3 ± 13.2 to 74.2 ± 12.4%, p = 0.003, respectively). No changes in the above variables were observed after milk chocolate intake. A linear correlation analysis shows that Δ (expressed by difference of values between before and after chocolate intake) of FMD correlates with Δ of total polyphenols and Δ of vitamin E. This study shows that Hazelnut and cocoa spread improves FMD with a mechanism potentially involving downregulation of oxidative stress and eventually increased NO generation in smokers.


Cocoa Hazelnut Flow-mediated dilation Oxidative stress 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed written consent was obtained from all subjects; the study conformed to the ethical guidelines of the 1975 Declaration of Helsinki, and was approved by the Sapienza University of Rome Ethics Committee.


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Copyright information

© Società Italiana di Medicina Interna 2018

Authors and Affiliations

  • Lorenzo Loffredo
    • 1
  • Ludovica Perri
    • 1
  • Simona Battaglia
    • 1
  • Cristina Nocella
    • 2
  • Danilo Menichelli
    • 1
  • Vittoria Cammisotto
    • 1
  • Marta Novo
    • 1
  • Roberto Carnevale
    • 1
    • 3
  • Francesco Violi
    • 1
    Email author
  1. 1.Department of Internal Medicine and Medical Specialties, I Clinica MedicaSapienza University of RomeRomeItaly
  2. 2.Department of AngioCardioNeurologyIRCCS NeuroMedPozzilliItaly
  3. 3.Department of Medical-Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly

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