The ChoKo-Age project starts from the assumption that nutritional factors can support physical exercise to target underlying mechanisms of protein-energy malnutrition (PEM) and muscle wasting in the elderly at risk of frailty and disability. These mechanisms of age-dependent PEM include specific alterations of endocrine factors, such as cortisol and insulin, and a reduced competence of tissues, including the muscle and immune cells, to prevent the degenerative effects of molecular oxygen and its reactive metabolites, and to repair lesions. The experimental hypothesis behind this project is that physical activity and chocolate polyphenols can combine their cortisol lowering effects with the antioxidant and cytoprotection function of vitamin E to prevent the age-dependent decline of mitochondrial function and nutrient metabolism in skeletal muscle, which are key underlying events in PEM. Positive effects are also expected on immune cells and in the homeostatic control of inflammatory pathways.
To test this hypothesis, a vitamin E-functionalized dark chocolate rich in polyphenols will be developed in collaboration with Perugina, Nestlè company, and its effects will be investigated combined with a high-intensity interval physical training in a 6-month randomized case-control trial in dementia elderly patients. This is a well-defined population of subjects at risk of PEM and frailty. Muscle mass will be the primary endpoint in this intervention study, whereas metabolomics and proteomics data on muscle metabolism, together with cortisol levels and clinical and laboratory indices of neurological and immuno-inflammatory functions, will represent secondary end-points important to interpret molecular and mechanistic aspects standing behind the response to nutritional and physical activity treatments.
The fundamental aim of this project is to develop novel nutritionally-enhanced and palatable food to support physical activity in preventing malnutrition in the elderly, i.e. PEM.
The CHOKO-AGE project involves a consortium of 5 university partners located in Italy, Norway, United Kingdom, and Spain, and of two external collaborators: “Perugina, Nestlè Italiana, Spa” and “Molecular Horizon Srl”.

● the CHOKO-AGE project will develop a new vitamin E-functionalized dark chocolate food product
● content and biological activity of the functional agents present in the innovative food product (type, content and activity) will be preliminarily verified in cell models,
● a high-intensity interval physical training program tailored to treat elderly subjects at risk of malnutrition and frailty will be designed,
● the effects of the innovative food product and physical activity on indices of protein-caloric malnutrition will be verified in a randomized clinical trial,
● molecular and functional data of muscle tissue metabolism and immuno-inflammatory function will be generated,
● study outcomes will be utilized to develop models of personalized nutrition and physical activity in the aged at risk of malnutrition and frailty,
● results will be available for the scientific community, national and local health systems, and the general public.