HDHL- Combining vitamin E-functionalized chocolate with physical exercise to reduce the risk of protein-energy malnutrition in aged people (CHOKO-AGE)

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This project will examine whether combining the antioxidant and cytoprotective functions of vitamin E with the cortisol lowering effect of chocolate polyphenols and physical activity will help prevent the age-dependent declines in key cellular functions that underpin the onset of muscle wasting in the elderly. In order to do this, the consortia will initially work with the Nestle company to develop a dark chocolate with high vitamin E content that is also rich in polyphenols. This will be investigated combined with physical activity in a 6-month trial examining a well-defined population of elderly subjects at risk of undernutrition and frailty. The test subjects will initially be stabilized on a protein rich diet (0.9-1.0 g protein/Kg ideal body weight/day) and a physical exercise program (High Intensity Interval Training specifically developed for these subjects). They will then be randomly allocated to 3 groups each containing 25 subjects. The groups will either continue on the baseline diet and exercise programme alone (Group A), or will additionally receive 30 g/day of dark chocolate (containing more than 500 mg total polyphenols and 100 mg vitamin E) (Group B), or will additionally receive the high polyphenol chocolate without the additional vitamin E (Group C). The duration of the intervention will be 6 months.The main outcome that will be assessed will be the muscle mass of the subjects and we will also study their neurocognitive status and biomolecular indices of frailty. Muscle biopsies will be taken from the subjects at the beginning and end of the studies and examined to determine the strength of their contraction force and the activity of key energy-producing organelles, called mitochondria. Laboratory tests will assess how well the subjects have complied with the study and also examine markers of how effective the intervention has been in modifying key markers of frailty. These parameters will be investigated in muscle and blood cells by state-of-the-art "omics" techniques. The effects of the components of the modified chocolate will also be examined in tests of cell cultures including muscle cells, blood leukocytes and nerve cells. Finally, all of these data will be integrated in a new bioinformatics programme that will be developed with a company called Molecular Horizon Srl. This will allow us to interpret the responses to the nutritional intervention and to personalize the subsequent application of the results.