Cardiovascular Risk Factor Clinical Trial
Official title:
Bioavailability and Beneficial Properties of Espresso Coffee and Confectionery Derived Coffee Bioactive Compounds
The aim of this study will be to define the bioavailability and the beneficial properties of
coffee bioactive compounds. Moreover, the contribution of cocoa-based products containing
coffee to the pool of circulating metabolites will be investigated with the aim of evaluating
the effect of the combination of bioactives from different sources.
To study the bioavailability of coffee/cocoa bioactive compounds and their effects in
cardiometabolic health, the objectives will be:
i) Assessing the bioavailability of the four main groups of phytochemicals in roasted coffee
(methylxanthines, phenolic compounds, trigonelline, and diterpenes), its modulation by the
level of consumption, and establishing the daily average concentration of coffee-derived
plasma circulating metabolites; ii) Investigating the effect of different levels of coffee
consumption on cardiometabolic risk factors; iii) Evaluating circulating metabolites and
their putative bioactivity when substituting coffee consumption with the intake of
cocoa-based products containing coffee.
A 3-arm, crossover, randomized trial will be conducted. Twenty-one volunteers will be
randomly assigned to consume three treatments in a random order for 1 month: 1 cup of
espresso coffee/day, 3 cups of espresso coffee/day, 1 cup of espresso coffee at breakfast and
2 cocoa-based products containing coffee two times per day. The last day of the treatment
subjects will refer to the ambulatory where blood and urine samples will be collected at
specific time points up to 24 hours following the consumption of the testing coffee or of the
cocoa-based products containing coffee. In addition to the bioavailability of the bioactive
compounds, the effect of the coffee consumption on several cardiometabolic risk factors
(blood pressure, anthropometric measures, inflammatory markers, nitric oxide, blood lipids,
fasting indices of glucose/insulin metabolism, DNA damage, eicosanoids, nutri-metabolomics)
will be investigated. At the end of the treatment, the same protocol will be repeated,
switching the allocation group.
A human bioavailability study will be carried out to achieve the above-described goals. The
human intervention study will consist of a short-term randomized cross-over trial, addressed
at measuring the daily mean concentrations of each coffee/cocoa-derived circulating
metabolite (CCDCM) for the four main groups of coffee/cocoa phytochemicals (methylxanthines,
trigonelline, phenolics, diterpenes). On the basis of different patterns of consumption, this
free-living study (although some minimal dietary restrictions will be provided two days
before sampling times) will also take into consideration the effects of repeated doses on the
bioavailability of coffee/cocoa bioactives.
The study will follow a repeat-dose, 3-arm, cross-over design. This design has been chosen
according to ILSI's guidelines for intervention trials with dietary products.
Subjects were assigned to consume the following treatments in a random order for 1 month:
1. 1 cup of espresso coffee/day ("low consumers") at 9.00 A.M.
2. 3 cups of espresso coffee/day ("high consumers") at 9.00 A.M., 12.00 P.M.noon and 3.00
P.M.
3. 1 cup of espresso coffee at breakfast 9.00 A.M. and 2 cocoa-based products containing
coffee two times per day (at 12.00 P.M.noon and 3.00 P.M.). The group will be named
"medium consumers", considering the caffeine content of the cocoa-based products
containing coffee.
Minimal recommendations to avoid other sources of coffee/cocoa phytochemicals besides what
introduced through the assigned treatment, and to standardise the time of coffee consumption,
will be provided for the two days prior to each sampling day and on the sampling day. Dinner
timing and composition will also be standardised the day before the sampling day. Only water
could be drunk during the night. At the sampling day (i.e. the last day of each intervention
period), the subjects will refer in the morning at the ambulatory where fasting baseline
blood and urine samples will be collected. Then, low and high consumers will drink one or
three cups of espresso coffee, respectively (without sugar, sweeteners, and milk for the
first coffee; with 5 g of sugar for the last two coffees), while medium consumers will drink
a cup of espresso coffee and 2 cocoa-based products containing coffee twice during the day,
following the above-described timing. After ingestion of the first coffee together with a
phytochemical-free breakfast (a pastry), blood and urine samples will be collected at
selected time points along the following 24-h. Five hours after the consumption of the first
coffee, participants will receive a standardised mixed meal (sandwich with ham and cheese)
free of coffee/cocoa phytochemical-related compounds. Water will be available ad libitum.
Twenty-four hours after receiving the treatment, blood and urine samples will also be taken
in order to assess return to baseline. In addition, anthropometric characteristics and blood
pressure (BP) will be measured.
Socio-demographic variables will be assessed through a generic questionnaire filled at
recruitment. The questionnaire will also contain questions useful to identify possible
exclusion criteria (e.g. diagnosis for diseases, regular consumption of medication, food
allergy). Dietary habits of volunteers will also be evaluated during the enrollment, through
a semi-quantitative food frequency questionnaire (FFQ) for the assessment of dietary total
antioxidant capacity. In addition, participants' food intakes and compliance with the study
requirements will be assessed by means of 3-day dietary records, administered throughout each
intervention period at two time points: i) in the middle of each intervention period during
two weekdays and a weekend day, and ii) at the end of each intervention period, 2 days prior
to the sampling day and the sampling day. The habitual physical activity level of each
participant will be measured through a validated International Physical Activity
Questionnaires.
Blood sample collection will be carried out in the ambulatory unit of the Department of
Medicine and Surgery. Blood collection will be carried out by a physician. A venous catheter
will be inserted into the antecubital vein and blood samples from each subject will be
collected in specific tubes over 24 hours. Blood sampling at time-point 24h after first
coffee consumption will be done by venipuncture. Urine samples will be collected during
different periods of time using urine collectors.
Blood samples will be centrifuged and plasma, serum and peripheral blood mononuclear cells
(PBMCs) will be collected, aliquoted, and stored at -80 °C for further processing. Urine
samples will be aliquoted and stored at -80°C for further processing.
The primary selected endpoint of the study is the quantification of the daily mean
concentration of coffee-derived plasma circulating phenolic metabolites, whereas the study of
the bioavailability of other coffee-derived circulating bioactives, the bioavailability of
cocoa-derived circulating phytochemicals, and the assessment of cardiometabolic markers will
be considered secondary endpoints.
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