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Journal of Nutrition & Food Sciences

ISSN: 2155-9600

Research Article

Beneficial Effects of the Intake of Chocolate-covered Almonds on Bowel
Movement and Skin Conditions
Yukari Kato1*, Midori Natsume1, Kyoko Ito1, Aiko Nakano1, Kosuke Ozawa1, Masayuki Sato1, Taketo
Yamaji1, Hiroyoshi Inoue2
1
R&D Division, Meiji Co., Ltd., 1-29-1 Nanakuni, Hachioji, Tokyo, Japan; 2Department of Chemistry, Keio University,
Yokohama, Japan
ABSTRACT
Background: It has been reported that chocolates and almonds have a wide variety of health benefits. Chocolatecovered almonds (almond chocolates) are popular chocolate confectioneries in Japan. However, their health benefits
have not yet been explored to date. To clarify their health benefits, we investigated the beneficial effects of the intake
of almond chocolates on bowel movement and skin conditions.
Methods: This single-blinded (investigator-blinded) parallel-group comparison study was conducted on womenwith a tendency toward constipation and subjective symptoms of dry skin. The study included 36 participants
who consumed eight pieces (approximately 30 g) of almond chocolates daily in the treatment (intake) group and
35 participants in the control (no intake) group. Bowel movement and skin conditions of these individuals were
evaluated based on the records in their diaries and the stratum corneum water content measured before intervention(baseline values) and 4 and 8 weeks after intervention, respectively. In addition, questionnaire surveys about
subjective symptoms were administered and an evaluation was conducted based on the obtained responses.
Results: The results showed that the intake of almond chocolates significantly improved the respondents’(participants’) bowel movements (i.e., stool frequency and amount), and the surveys showed improvement in theirgastrointestinal and skin conditions. In addition, stratified analysis of individuals with severely dry skin symptoms
revealed that intake of almond chocolates significantly improved the stratum corneum water content 8 weeks after
the intervention compared with baseline levels (before intervention).
Keywords: Almond; Chocolate; Bowel movement; Skin conditions

INTRODUCTION
It has been reported that chocolates and almonds have awide variety of health benefits [1-5]. Although chocolatecovered almonds (almond chocolates) are popular chocolate
confectioneries in Japan, to date, their health benefits have notbeen explored in detail.
Several studies have reported the beneficial effects of chocolate
ingredients or almonds on intestinal flora; hence, it is expectedthat almond chocolates have beneficial effects on bowel
movement and intestinal flora [6-8]. It is known that constipation
is a contributory factor to the decline in quality of life (QOL),

and improvement of constipation is a worthwhile participantof study in Japan, where many people have subjective symptomsof constipation [9]. In addition, it has been widely known thatexhibiting continuing symptoms of constipation is likely toworsen skin conditions. Against this background, several studies
have reported that improving the intestinal environment may
remedy skin conditions, suggesting that the intake of almondchocolates could exert beneficial effects on skin conditions [1012].
Thus, we conducted a single-blinded, parallel-group comparison
study to verify the beneficial effects of the intake of almondchocolates on bowel movement and skin conditions.

Correspondence to: Yukari Kato, R&D Division, Meiji Co., Ltd., 1-29-1 Nanakuni, Hachioji, Tokyo, Japan, Tel: +81-42-632-5847, Fax: +81-42-6373022; E-mail: yukari.katou@meiji.com
Received: January 28, 2021; Accepted: February 11, 2021; Published: February 18, 2021
Citation: Kato Y, Natsume M, Ito K, Nakano A, Ozawa K, Sato M, et al. (2021) Beneficial Effects of the Intake of Chocolate-covered Almonds on
Bowel Movement and Skin Conditions. J Nutr Food Sci. 11:788.
Copyright: © 2021 Kato Y, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
J Nutr Food Sci, Vol. 11 Iss. 2 No: 788

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MATERIALS AND METHODS
Study design
This randomized, single-blinded, parallel-group comparison
study was conducted according to the principles stipulated in the
Declaration of Helsinki. Written informed consent was obtained
from all participants prior to their participation in the study,
which was conducted from February to April 2017. This study
was approved by the Institutional Review Board of Shinkokai and
the Meiji Institutional Review Board (UMIN000025966).
Participants
Eighty-three healthy Japanese volunteers were screened according
to the inclusion and exclusion criteria described below. The
inclusion criteria were as follows: (1) women who voluntarily
consented to participate in the study; (2) those that were 25-50
years old; (3) those whose stool frequency in 2 weeks immediately
before screening was 2-4 times/week; and (4) those who had
subjective symptoms of dry skin at screening. The exclusion
criteria were as follows(1) those who were undergoing treatment
for any chronic disease; (2) those who had severe symptoms ofpollen allergy; (3) those whose skin conditions at the site to betested were prominently abnormal; (4) those who were allergic
to foods such as cacao, almond, milk, wheat, egg, and soybean;(5) those who commonly consumed a large amount of cacao
products and nuts; (6) those who commonly took medicines
and/or supplements that could affect the results of this study
during the period from 3 months before screening to the end of
the study; (7) those who were receiving specific facial care (such as
facial massager, aesthetic treatment, peeling treatment, and laser
treatment); (8) those who participated in any other study within
1 month before screening; (9) those who were pregnant or hadplans to conceive during the study period; (10) those who werelactating; and (11) those who were considered by an investigatorto be ineligible for the participant of the study.
ProtocolThis single-blinded (investigator-blinded), parallel-groupcomparison study involved an almond chocolate intake group(the intake group) and a non-intake group (the control group).
The participants were randomly allocated to either group so thatthe factors of age, stool frequency, and stratum corneum watercontent at screening might be equivalent.
Participants in the intake group consumed eight pieces of almondchocolates (approximately 30 g) every day for 8 weeks, whereas
those in the control group did not. Table 1 shows the nutritional
composition analytical values of the almond chocolates (Almond
Chocolate Cacao 70%; Meiji Co. Ltd., Tokyo, Japan) used in the
study.

J Nutr Food Sci, Vol. 11 Iss. 2 No: 788

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Table 1: Nutritional composition analytical values of almondchocolates.
-

Per eight almond chocolates/
day

Energy (kcal)

178

Protein (g)5.0

Lipid (g)13.6

Carbohydrate (g)7.1

Dietary fiber (g)3.8

Water soluble (g)0.5Water insoluble (g)3.3

Sodium (mg)

5.8

Vitamin E (a-tocopherol) (mg)2.9

Cacao polyphenols (mg)395

The participants recorded their defecation activities (stool
frequency and amount) in their diaries every day during theperiod from 2 weeks before the intervention to 8 weeks after
intervention. The stool amount was converted to the number of
eggs for recording.
The stratum corneum water content of the skin in the cheeksof the participants was measured before the intervention and 4
and 8 weeks after intervention. To ensure that the measurement
conditions were even, the participants were asked to wash theirfaces in a specific manner and condition their skin in a constanttemperature and humidity room (room temperature, 20 ± 2°C;
humidity, 50 ± 5%) for more than 20 minutes. Then, the stratum
corneum water content was measured using Corneometer®
CM825 (Courage-Khazaka Electronic, Cologne, Germany).
The questionnaire surveys about the gastrointestinal andskin conditions were administered to the participants before
the intervention and 4 and 8 weeks after intervention. Visual
Analog Scale (VAS) was used in the questionnaire survey, and theparticipants were asked to record the feeling levels of symptoms
on the 100-mm line with the leftmost end (0 mm) indicating “verybad” and the rightmost end (100 mm) indicating “very good.”
Outcomes
The outcomes were “stool frequency,” “stool amount,”“stratum corneum water content,” and “gastrointestinal andskin conditions based on the responses to the surveys.” Stool
frequency and amount were evaluated on the basis of the total
value calculated every week during the study period. However,each of the baseline values of stool frequency and amount wascalculated by dividing the total values measured 2 weeks before
intervention by 2. Stratum corneum water content and theoutcomes based on the responses to the questionnaires were2

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OPENevaluated on the basis of values measured on test points (before
intervention and 4 and 8 weeks after intervention).
Statistical analysis
In statistical analysis of baseline characteristics of the participants,a group comparison of stool frequency was performed using
Mann-Whitney’s U-test and a group comparison of age andstratum corneum water content was performed using unpaired
t-test. In statistical analysis of stool frequency and amount,intragroup comparison at the given time points before and after
intervention was made using Wilcoxon signed-rank test andgroup comparison of the amount of change and the change rate
at the given time points before and after intervention was madeusing Mann-Whitney’s U-test. In statistical analysis of age, stratum
corneum water content, and subjective symptoms (VAS) in thequestionnaires, intragroup comparison at the given points before
and after intervention was performed using one-sample t-test andgroup comparison of the change at the given time points before

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and after intervention was made using unpaired t-test. The levelof significance was defined as 5% on both sides. SPSS statistics 24(IBM Corp., Armonk, NY, USA) was used for statistical analyses.

RESULTS
Participants
Out of 142 candidates initially considered for participation in thisstudy, 83 were screened according to the inclusion and exclusion
criteria. The participants were randomly allocated to either theintake group (n=42) or the control group (n=41). Further, except
for dropouts and those who violated the protocol, 71 participants
were analyzed. Figure 1 illustrates the procedural flow of how
participants were enrolled in the study, from the recruitment
stage to analysis, and Table 2 shows the baseline characteristics
of participants. No significant differences in age, stool frequency,
and stratum corneum water content were observed at baseline
between the intake and control groups.

Figure 1: Procedural flow of study participants.
Table 2: Baseline characteristics of participants.
-

Intake group

Control groupp

Number of participants

36

35

-

Age (years)

41.5 ± 6.7

42.8 ± 5.3

0.349

Stool frequency (times/week)

3.8 ± 1.5

4.0 ± 1.4

0.550

Stratum corneum watercontent (AU)46.40 ± 9.37

46.63 ± 9.09

0.918

Note: Values are presented as mean ± standard deviation
Beneficial effects of almond chocolates on stool frequency andamountA change in stool frequency is shown in Table 3, and a transientchange is shown in Figure 2. The stool frequency (times/week)significantly increased throughout the period from 1 to 8
weeks after intervention compared with baseline level (before
J Nutr Food Sci, Vol. 11 Iss. 2 No: 788

intervention) in the intake group, whereas a significant decrease
was observed only at week 1 after intervention in the control
group. The result of the group comparison of the change in stool
frequency demonstrated that a significant difference was observed
throughout the period from weeks 1 to 8 after intervention,suggesting that the intake of almond chocolates improved stool
frequency.
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Table 3: Changes in stool frequency and amount.
Baseline
1 weekIntake group (n=36)
pa
Mean ± SE

Control group (n=35)
pb
pa
Mean ± SE

3.8 ± 0.2

4.0 ± 0.2

4.8 ± 0.3

0.001
0.000
0.003
0.000
0.000
0.000
0.000

3.7 ± 0.2

-

-

0.021

0.000

2 weeks
4.9 ± 0.4
4.1 ± 0.2
0.680
0.005
3 weeks
4.9 ± 0.4
4.1 ± 0.2
0.625
0.045
Stool frequency (times/week)
0.000
4 weeks
5.4 ± 0.4
4.1 ± 0.3
0.662
5 weeks
5.6 ± 0.5
4.1 ± 0.3
0.596
0.001
6 weeks
5.3 ± 0.5
4.1 ± 0.3
0.689
0.005
7 weeks
5.7 ± 0.5
4.0 ± 0.2
0.865
0.001
0.000
8 weeks
5.5 ± 0.5
4.3 ± 0.3
0.747
0.004
Baseline
6.6 ± 0.6
8.6 ± 0.6
1 week
8.5 ± 0.8
0.001
8.5 ± 0.7
0.776
0.001
2 weeks
8.8 ± 0.8
0.001
9.3 ± 0.7
0.205
0.016
3 weeks
8.7 ± 0.8
0.006
9.2 ± 0.6
0.158
0.062
0.000
0.000
4 weeks
10.2 ± 1.0
8.8 ± 0.7
0.798
Stool amount (converted to number of eggs/week)
0.000
5 weeks
9.9 ± 1.0
9.3 ± 0.8
0.185
0.002
0.000
6 weeks
10.5 ± 1.2
9.1 ± 0.8
0.238
0.001
0.000
0.000
7 weeks
10.9 ± 1.2
9.0 ± 0.8
0.447
0.000
8 weeks
10.8 ± 1.2
10.5 ± 1.3
0.052
0.006
Note: a Before-and-after-intervention intracomparison at the given time points. b Group comparison of change before and after
intervention at the given time points.

Figure 2: Change in stool frequency (times/week) from baseline.
Intake of almond chocolates increased the stool frequency.
Values are presented as mean ± standard deviation. Before-andafter-intervention comparison: *p<0.05. Comparison with thecontrol group: #p<0.05.
A change in stool amount converted to the number of eggs isshown in Table 3, and a transition in the change rate of stool
amount, assuming the baseline stool amount as 1 is shown in
Figure 3. The stool amount significantly increased throughout
the period from weeks 1 to 8 after intervention compared withthe baseline level in the intake group, whereas no significant
change was observed in the control group. The result of groupcomparison of the change rate showed that significant differenceswere detected during all weeks since week 1 after intervention
except during week 3, suggesting that the intake of almondchocolates might have increased the stool amount.
J Nutr Food Sci, Vol. 11 Iss. 2 No: 788

Figure 3: Change rate of stool amount/week, assuming thebaseline value as 1. Intake of almond chocolates increased thestool amount. Values are presented as mean ± standard deviation.
Before-and-after-intervention comparison: *p<0.05. Comparison
with the control group: #p<0.05.
Beneficial effects of almond chocolates on stratum corneum
water content
The measured values of stratum corneum water content are
shown in Table 4, and a transition in a change of the stratum
corneum water content is shown in Figure 4. The results ofthe before-and-after comparison and the group comparison
showed no significant differences in stratum corneum watercontent. Accordingly, we performed stratified analysis involving
46 participants with baseline stratum corneum water content
of ≤ 50 AU who were regarded as those with severely dry skin4

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OPENconditions. The facial stratum corneum water content values asmeasured by a corneometer were classified into the following
categories: “super dry skin,” ≤ 50 AU; “dry skin,” between 50 and
60 AU; and “hydrated skin,” ≥ 60 AU [13]. Further, participants
with baseline stratum corneum water content of ≤ 50 AU
demonstrated no significant difference in baseline characteristics
between the intake (n=25) and control (n=21) groups (data notshown). A change in the stratum corneum water content in

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participants with severely dry skin conditions is shown in Figure
5. No significant difference in change amount from the baseline
was observed between the intake and control groups. Although
the result of a before-and-after-intervention comparison revealed
no significant variation in the control group, a significantly highvalue was observed 8 weeks after the intervention compared withbaseline level in the intake group, suggesting that their symptoms
improved.

Table 4: Change in stratum corneum water content.
Intake group (n=36)
pa
Mean ± SE

Control group (n=35)
pa
Mean ± SE

pb

Baseline

46.40 ± 1.56-

46.63 ± 1.54--

4 weeks

46.86 ± 1.36

0.773

46.70 ± 1.66

0.947

0.845

8 weeks

47.83 ± 1.33

0.305

48.27 ± 1.75

0.246

0.913

Stratum
corneum watercontent (AU)Note: a Before-and-after-intervention intracomparison at the given time points. b Group comparison of change before and after
intervention at the given time points.

Figure 5: Change in stratum corneum water content frombaseline among participants with severely dry skin conditions.
Intake of almond chocolates increased the stratum corneum
water content compared with that before intervention. Values
are presented as mean ± standard deviation. Before-and-afterintervention comparison: *p<0.05.

Figure 4: Change in stratum corneum water content frombaseline. A significant change in stratum corneum water content
was not observed in the participants in both the intake and control
groups. Values are presented as mean ± standard deviation.

Table 5: Changes in subjective symptoms (VAS values).
Intake group(n=36)-

Mean ± SEpa

Mean ± SE

Control group(n=35)papb

VAS values ofgastrointestinal
conditions (mm)Baseline

56.9 ± 3.0-

53.5 ± 3.4--

4 weeks
8 weeks

66.1 ± 3.0
68.4 ± 3.1

0.003
0.000

49.5 ± 3.0
50.9 ± 2.8

0.187
0.442

0.002
0.023

VAS values ofskin conditions(mm)

Baseline

50.1 ± 2.5-

50.1 ± 3.3

-

-

0.034
0.271
0.002
46.5 ± 3.2
4 weeks
56.8 ± 2.7
0.006
8 weeks
62.2 ± 2.7
51.4 ± 2.7
0.000
0.620
a
b
Note: Before-and-after-intervention intracomparison at the given time points. Group comparison of change from before
intervention to after intervention at the given time points.

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Beneficial effects of almond chocolates on subjective symptoms
Results of the survey regarding the subjective symptoms ofgastrointestinal and skin conditions using VAS are shownin Table 5. The VAS values of the subjective symptoms of thestomach and intestine increased with time only in the intake
group, and significant differences were observed in the groupcomparison and intragroup comparison conducted 4 and 8
weeks after intervention, suggesting that the subjective symptomsof the stomach and intestine improved. The VAS values of thesubjective symptoms of skin conditions increased with time in
the intake group, and significant differences were observed in
the group comparison and intragroup comparison conducted
4 and 8 weeks after intervention, suggesting that the subjective
symptoms of skin conditions improved.

DISCUSSION
In the present study, an 8-week single-blinded, parallel-groupcomparison study was conducted to verify the beneficial effectsof almond chocolates on constipation and skin conditions, inwhich participants were divided into the intake and control
groups. Analysis of 71 participants revealed that bowel movement(stool frequency and amount) improved in the intake group.
According to the participants’ responses to the questionnaires
about subjective symptoms of the gastrointestinal and skinconditions, these symptoms significantly improved in the intake
group. However, no significant improvement in stratum corneum
water content, an indicator for skin conditions, which was
associated with the intake of almond chocolates, was observed. In
contrast, stratified analysis, which was conducted on participants
with severely dry skin conditions (determined according to thebaseline values of cheek stratum corneum water content), showedthat there was a significant increase in stratum corneum watercontent in the intake group 8 weeks after intervention. Thus, theintake of almond chocolates might improve the bowel movementof individuals with a tendency toward constipation and increase
the stratum corneum water content in people with severely dry
skin, resulting in improved skin conditions.
It is known that intake of food fibers is effective in improving
constipation [14]. In this study, participants (intake group) wereasked to consume eight pieces of almond chocolates per day,which contained 3.8 g of food fiber. The study suggests that the
intake of food fiber contained in almond chocolates improved
constipation. On the other hand, the intestinal flora was notinvestigated in the present study and it is unknown whether
or not there were changes in the flora. However, on the basisof previous reports, it may be considered that the flora mightchange; therefore, change in the intestinal flora is a research issue
to be tackled in the future [6-8].
In contrast, although bowel movement improved, no evident
change was observed in the stratum corneum water content.
To remedy skin conditions via the improvement of bowel
movement, it may take some time before the beneficial effects
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can be observed because such stages as a change in the intestinal
flora and a reduction of waste product in the blood are involved[10-12]. In addition, considering the epidermis requires about 4-6
weeks to reproduce, the time points used in this study might havebeen too short for the stratum corneum water content to change,even at the time point of 8 weeks. However, it should be notedthat stratum corneum water content increased in participants
with severely dry skin conditions; accordingly, a further study
focusing on whether the skin conditions may be improved isrequired in the future.
An improvement was observed in the subjective symptoms ofgastrointestinal and skin conditions, suggesting that participants
might have experienced the above-mentioned beneficial effects.
However, because participants in the control group did notconsume almond chocolates, the improved subjective symptoms
may have been affected by the action of the intake itself.

CONCLUSION
A single-blinded (investigator-blinded), parallel-group comparison
study was conducted on women with a tendency toward
constipation and subjective symptoms of dry skin to verify thebeneficial effects of almond chocolates on the improvement ofintestinal environment and skin conditions. The participants
were randomly allocated either to the intake group or the control
group. During the study period, participants in the intake groupwere asked to consume eight pieces (approximately 30 g) ofalmond chocolates every day.
The results showed that stool frequency and amount significantly
increased in the intake group compared with those in the control
group and subjective symptoms of the stomach and intestine
also significantly improved in the former group. In addition, in
the intake group, the subjective symptoms of skin conditions
significantly improved and stratified analysis of participants
with severely dry skin conditions demonstrated that the stratum
corneum water content significantly increased 8 weeks after
intervention.
Based on these findings, it is suggested that the continuous
intake of almond chocolates improves bowel movement and skinconditions.

ACKNOWLEDGMENTS
We express our deepest appreciation to CEO Masahiro Kuramochi,
Dr. Maiko Tajima, Ms. Ai Marume, all of whom are working at
Beauty and Health Research Inc.; and Dr. Toshitatsu Nogita, whois the director of Shinjuku Minamiguchi Dermatological Clinicof Shinkoukai and professor at the Dermatology Department ofTokyo Medical University, for their contribution to the present
study.

FUNDING
This study was financially supported by Meiji Co., Ltd.

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CONFLICTS OF INTEREST

W, et al. Prebiotic effect of lycopene and dark chocolate on
gut microbiome with systemic changes in liver metabolism,
skeletal muscles and skin in moderately obese persons.
Biomed Res Int. 2019;2019:4625279.

Yukari Kato, Midori Natsume, Kyoko Ito, Aiko Nakano, Kosuke
Ozawa, Masayuki Sato, and Taketo Yamaji are employees of Meiji
Co., Ltd. Hiroyoshi Inoue received a medical advisory fee from
Meiji Co., Ltd.

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