The effects of cocoa products in individuals with metabolic syndrome and related diseases: a systematic review and meta-analysis.

Abstract

Cocoa supplementation has been shown to improve parameters related to metabolic syndrome, although results have been contradictory. We conducted a systematic review and meta-analysis to examine the effect of cocoa products on lipid and glycemic profiles, blood pressure levels, and anthropometric measurements in individuals with metabolic syndrome and related diseases. A search of PubMed, Web of Science, Embase, and Scopus was performed to identify randomized clinical trials (RCTs). To compare the effects of the cocoa product with placebo, mean differences with 95% confidence intervals (CIs) were pooled using a random-effects model. Subgroup analyses and meta-regression were performed to identify the source of heterogeneity, and study quality assessment was conducted using the GRADE approach. A total of 13 RCTs, including 16 arms, that investigated the effects of cocoa on parameters related to metabolic syndrome were included. The meta-analysis showed a significant effect of cocoa supplementation on triacylglycerol levels (-0.21 mmol/L, 95% CI: -0.40, -0.02; p = 0.0333), and subgroup analysis suggested that cholesterol levels were reduced with cocoa supplementation in patients with dyslipidemia and diabetes. Furthermore, the meta-regression analysis suggested a decrease in glycemic and lipid profiles, as well as anthropometric parameters, in studies with longer durations of cocoa supplementation. Our study suggests that cocoa intake has limited evidence of benefit, mainly for triglycerides, furthermore, effects and that the duration, type, and clinical status of patients were important determinants for favorable effects on biomarkers related to metabolic syndrome.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-026-01914-7.