Further, cocoa consumption may stimulate changes in redox-sensitive signaling pathways involved in gene expression and the immune response. Antioxidant effects of cocoa may directly influence insulin resistance and, in turn, reduce risk for diabetes. Other cardiovascular effects are mediated through anti-inflammatory effects of cocoa polyphenols, and modulated through the activity of NF-κB. The epicatechin content of cocoa is primarily responsible for its favorable impact on vascular endothelium via its effect on both acute and chronic upregulation of nitric oxide production. The tricyclic structure of the flavonoids determines antioxidant effects that scavenge reactive oxygen species, chelate Fe2+ and Cu+, inhibit enzymes, and upregulate antioxidant defenses. Flavonoids, including catechin, epicatechin, and procyanidins predominate in antioxidant activity. Cocoa contains more phenolic antioxidants than most foods.
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