Cocoa Extract Supplement Found to Have Benefits for Cognition Among Older Adults with Lower Diet Quality

Cocoa extract has shown a potential protective effect on cognition but randomized clinical trials in older adults have had inconsistent results. A new study of cognition in a randomized trial, known as the Cocoa Supplement and Multivitamin Outcomes Study (COSMOS), suggests that taking cocoa extract supplements containing 500 mg per day of cocoa flavanols had cognitive benefits for older adults who had lower habitual diet quality at the time of enrollment in the study. However, cognitive benefits were not found among participants who already had healthy dietary patterns at the start of the study. The study, conducted by researchers at Mass General Brigham, included 573 older adults who underwent detailed, in-person cognitive testing and is published online in The American Journal of Clinical Nutrition.

Results from detailed neuropsychological assessments given over two years showed that daily cocoa extract supplementation, compared to placebo, had no overall benefits for global or domain-specific cognitive function. However, secondary analyses showed that participants with poor diet quality had cognitive benefits from taking the cocoa extract supplement. 

The findings from this study – which was done among COSMOS participants who presented in-person for detailed cognitive testing – are consistent with the results from an earlier study that used a web-based cognitive assessment given over the internet to a separately recruited set of COSMOS participants.

COSMOS is an investigator-initiated large-scale, long-term clinical trial led by Brigham and Women’s Hospital. More than 21,000 older women and men were enrolled across the United States to participate in this randomized, double-blinded, placebo-controlled study to test whether taking daily supplements of a cocoa extract or a common multivitamin reduces the risk for developing heart disease, stroke, cancer, and other important health outcomes. Analyses of the data from COSMOS continue to yield insights about the connections between supplements and human health. 

Funding statement: The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is supported by an investigator-initiated grant from Mars Edge, a segment of Mars dedicated to nutrition research and products, which included infrastructure support and the donation of study pills and packaging. Pfizer Consumer Healthcare (now Haleon) provided support through the partial provision of study pills and packaging. COSMOS is also supported in part by grants AG050657, AG071611, EY025623, and HL157665 from the National Institutes of Health, Bethesda, MD. The Women’s Health Initiative (WHI) program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts 75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, 75N92021D00005. Neither Mars Edge nor Pfizer Consumer Healthcare provided input regarding data analyses, interpretation of results, or manuscript development.