Anderson, GarnetNeuhouser, MarianBeery, Daniel Manalang2023-09-272023-09-272023-09-272023Beery_washington_0250O_26183.pdfhttp://hdl.handle.net/1773/50883Thesis (Master's)--University of Washington, 2023Question Can cocoa extract supplementation improve subjective mental health and prevent the onset of incident late-life depression in older adults?Findings In this secondary analysis of 21,442 adults aged 60 or older, cocoa extract supplementation did not result in a statistically significant change in subjective mental health scores compared to placebo. In 16,059 participants without a previous lifetime diagnosis of depression or receiving depression treatment (anti-depressant use or counseling within the past 2 years or regular selective serotonin reuptake inhibitor [SSRI] use), cocoa extract supplementation did not result in a reduction in incident late-life depression compared to placebo. Meaning These findings do not support the use of cocoa extract supplementation in improving subjective mental health in older adults or as a prophylactic treatment for late-life depression. Importance Late-life depression (LLD) has a lower remission rate, a higher recurrence rate, and is less responsive to pharmacological treatment than early-onset depression, warranting novel prophylactic and therapeutic treatments. Objective To test the effects of cocoa extract supplementation on subjective mental health outcomes and the incidence of late-life depression in older adults. Design, Setting, and Participants There were 21,442 men and women aged 60 years or older in the COcoa Supplement and Multivitamin Outcomes Study (COSMOS) trial, a randomized clinical trial investigating the effects of cocoa extract supplementation and a multivitamin on the primary prevention of cardiovascular disease and cancer. The intervention phase was from June 2015 to December 2020, and participants were followed for a median duration of 3.6 years. 10,723 participants were randomized to placebo and 10719 participants were randomized to cocoa extract supplementation. There were 16,059 participants at risk for incident depression. Intervention Randomized assignment in a 2 x 2 factorial design to cocoa extract supplementation [2 capsules/d containing 500 mg cocoa flavanols] and multivitamin or placebo. Main Outcomes and Measures The primary outcomes were mean Mental Health Inventory 5 (MHI-5) scores after 1 year and risk of incident late-life depression. Results Cocoa extract supplementation did not result in a significant difference in MHI-5 scores at 1 year in older adults (β = -0.21, 95% CI: -0.50, 0.09). No interactions between cocoa extract and sex, baseline MHI5, or depression treatment were observed. Cocoa extract supplementation did not result in a significant difference in incident depression in older adults (HR = 0.92, 95% CI: 78, 1.09) (Table 3). No interactions between cocoa extract and sex, baseline MHI-5, or time since randomization were observed. Conclusions and Relevance Among adults >60 years who were free of MI, stroke, and recently diagnosed cancer, cocoa extract was not effective in improving MHI-5 scores and reducing the risk of incident depression. The findings do not support the use of cocoa extract in improving subjective mental health outcomes or as prophylactic treatment for late-life depression.application/pdfen-USnoneCocoaDepressionFlavanolsMental HealthMHI-5NutritionNutritionPublic healthNutritional sciencesThesis