4. Discussion
depression, ’ various mood, fatigue, anxiety
OXIDATIVE STRESS
We conducted a randomized, double-blind, placebo-controlled pilot study to evaluate the effects of flavanol-rich cacao extract on fatigue and mood in healthy middle-aged Japanese women, and the results demonstrated that the intake of cacao flavanols improved the participants’ various mood conditions. In addition, no side effects from the intervention were observed throughout the study, suggesting that cacao flavanols are well tolerated by healthy middle-aged women.The participants’ CFS scores at both 4 and 8 weeks were significantly lower than the baseline scores in both groups (Our present POMS2 results suggest that in middle-aged women, the consumption of flavanol-rich cacao extract reduces negative mood features, such as depression, fatigue, and anxiety, and improves the positive mood features vigor and activity. Gracia-Yu et al. reported that an additional daily consumption of 10 g of cocoa-rich chocolate by postmenopausal women could have a slight impact on their perception of the state of their health, although those authors noted that this was without modifications of the women’s health-related QoL or the dimensions that compose it [An improvement of mood state by flavanol-rich cacao extract may be mediated by antioxidant effects. During reproductive aging, oxidative stress in the form of free radicals and antioxidant deficiencies has been directly linked to the decline of estrogen [The present study’s cacao group showed a decreasing trend in the LF component of autonomic nervous system activity after 8 weeks of cacao flavanol intake compared to the placebo group, although the difference was not significant. This result may indicate that the sympathetic nervous system was relieved by cacao flavanols. Duarte et al. reported that a single dose of dark chocolate increased both parasympathetic modulation and heart rate variability in healthy subjects [The cacao flavanol beverages used in this study contain small amounts of methylxanthines, including caffeine and theobromine. Methylxanthines were reported to have psycho-stimulant effects [Our study has some limitations. Anti-oxidative effects were not evaluated, and the relationship between the improvement of moods and the antioxidant action of cacao flavanols cannot be directly explained. Moreover, we did not conduct a daily dietary survey of the participants. The lack of information on daily energy intake and macronutrient composition limits the evaluation of whether these factors influenced the effects of the cacao flavanols. Analyzing the dietary information of the participants in future studies will give more accurate results. The generalizability of the findings obtained in this study is limited by the fact that it was conducted on Japanese women. Studies with subjects from other regions and ethnicities are desirable. Despite these limitations, the strength of this study is that it was a double-blind, placebo-controlled trial, which is not a conventional approach to examine the efficacy of food ingredients on health.