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Effects of Fermented Food Consumption on Non-Communicable Diseases. Foods 2023; 12:foods12040687. [PMID: 36832762 PMCID: PMC9956079 DOI: 10.3390/foods12040687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
The gastrointestinal flora consists of several microbial strains in variable combinations in both healthy and sick humans. To prevent the risk of the onset of disease and perform normal metabolic and physiological functions with improved immunity, a balance between the host and gastrointestinal flora must be maintained. Disruption of the gut microbiota triggered by various factors causes several health problems, which promote the progression of diseases. Probiotics and fermented foods act as carriers of live environmental microbes and play a vital role in maintaining good health. These foods have a positive effect on the consumer by promoting gastrointestinal flora. Recent research suggests that the intestinal microbiome is important in reducing the risk of the onset of various chronic diseases, including cardiac disease, obesity, inflammatory bowel disease, several cancers, and type 2 diabetes. The review provides an updated knowledge base about the scientific literature addressing how fermented foods influence the consumer microbiome and promote good health with prevention of non-communicable diseases. In addition, the review proves that the consumption of fermented foods affects gastrointestinal flora in the short and long term and can be considered an important part of the diet.
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Sekikawa A, Wharton W, Butts B, Veliky CV, Garfein J, Li J, Goon S, Fort A, Li M, Hughes TM. Potential Protective Mechanisms of S-equol, a Metabolite of Soy Isoflavone by the Gut Microbiome, on Cognitive Decline and Dementia. Int J Mol Sci 2022; 23:11921. [PMID: 36233223 PMCID: PMC9570153 DOI: 10.3390/ijms231911921] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/27/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022] Open
Abstract
S-equol, a metabolite of soy isoflavone daidzein transformed by the gut microbiome, is the most biologically potent among all soy isoflavones and their metabolites. Soy isoflavones are phytoestrogens and exert their actions through estrogen receptor-β. Epidemiological studies in East Asia, where soy isoflavones are regularly consumed, show that dietary isoflavone intake is inversely associated with cognitive decline and dementia; however, randomized controlled trials of soy isoflavones in Western countries did not generally show their cognitive benefit. The discrepant results may be attributed to S-equol production capability; after consuming soy isoflavones, 40-70% of East Asians produce S-equol, whereas 20-30% of Westerners do. Recent observational and clinical studies in Japan show that S-equol but not soy isoflavones is inversely associated with multiple vascular pathologies, contributing to cognitive impairment and dementia, including arterial stiffness and white matter lesion volume. S-equol has better permeability to the blood-brain barrier than soy isoflavones, although their affinity to estrogen receptor-β is similar. S-equol is also the most potent antioxidant among all known soy isoflavones. Although S-equol is available as a dietary supplement, no long-term trials in humans have examined the effect of S-equol supplementation on arterial stiffness, cerebrovascular disease, cognitive decline, or dementia.
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Affiliation(s)
- Akira Sekikawa
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Whitney Wharton
- School of Nursing and Medicine, Emory University, Atlanta, GA 30322, USA
| | - Brittany Butts
- School of Nursing and Medicine, Emory University, Atlanta, GA 30322, USA
| | - Cole V. Veliky
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Joshua Garfein
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Jiatong Li
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Shatabdi Goon
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Annamaria Fort
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Mengyi Li
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Timothy M. Hughes
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
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Hariri M, Baradaran HR, Gholami A. The effect of soy protein containing soy isoflavones on serum concentration of cell adhesion molecules: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med 2021; 61:102764. [PMID: 34333131 DOI: 10.1016/j.ctim.2021.102764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Soy protein in combination with soy isoflavones might reduce the serum concentration of inflammatory mediators. In this study, we attempted to summarize the effect of soy protein combined with soy isoflavones on circulating E-selectin, intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) in adults. METHODS Clinicaltrials.gov, Web of Science, Cochrane Library, PubMed, and Scopus were searched for English articles with no time limit regarding publication up to December 2020. Thereafter, the mean changes from baseline and their standard deviations (SDs) for both intervention and comparison groups were used to calculate the effect size. We used DerSimonian and Laird random-effects model if the heterogeneity test was statistically significant. Cochran's Q test and I-squared statistic were also used to calculate the statistical heterogeneity of the intervention effects. RESULTS Eight articles were found as eligible for this study. The treatment duration was between 6 and 24 weeks. Soy isoflavones dose was in a range of 30-112 mg/day and soy protein dose was in a range of 11.25-52 g/day. Overall, taking soy protein supplements containing soy isoflavones was not associated with changes in cell adhesion molecules, E-selectin, ICAM-1, or VCAM-1 (WMD = 0.65, 95 % CI: -2.58, 3.89; p = 0.692; WMD = 2.68, 95 % CI: -0.98, 6.34; p = 0.151; WMD = 2.66, 95 % CI: -6.28, 11.61; p = 0.559, respectively). CONCLUSION The combination of soy protein and soy isoflavones was not significantly associated with changes in levels of E-selectin, ICAM-1, and VCAM-1. However, we need more studies with a large sample size and more participants with different age categories in this regard.
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Affiliation(s)
- Mitra Hariri
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran; Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Hamid Reza Baradaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran; Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition University of Aberdeen, Aberdeen, UK
| | - Ali Gholami
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran.
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Bosland MC, Enk E, Schmoll J, Schlicht MJ, Randolph C, Deaton RJ, Xie H, Zeleniuch-Jacquotte A, Kato I. Soy protein supplementation in men following radical prostatectomy: a 2-year randomized, placebo-controlled clinical trial. Am J Clin Nutr 2021; 113:821-831. [PMID: 33564828 PMCID: PMC8024002 DOI: 10.1093/ajcn/nqaa390] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/23/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Many studies have addressed effects of dietary supplementation with soy protein, but most have been inconsistent and few have been long-term studies in men. OBJECTIVES This study was a secondary analysis of body weight, blood pressure, thyroid hormones, iron status, and clinical chemistry in a 2-y trial of soy protein supplementation in middle-aged to older men. METHODS Data were analyzed as secondary outcomes of a randomized controlled trial of dietary supplementation with 20 g/d soy protein isolate, providing 41 mg/d total isoflavones and 23 mg/d genistein, in 44- to 75-y-old men who were at risk of cancer recurrence following prostatectomy randomized to soy (n = 50) or a casein-based placebo (n = 43). Weight, blood pressure, and blood samples were collected at baseline, every 2 mo in year 1, and every 3 mo in year 2. RESULTS Compared with casein, soy supplementation did not affect body weight, blood pressure, serum total cholesterol, calcium, phosphorus, and thyroid hormones. Serum ferritin concentrations doubled over 2 y in both groups (117-129%), whereas hemoglobin and hematocrit increased slightly. In an exploratory subgroup analysis of soy group data, weight increased in subjects producing equol but not in nonproducers. Blood pressure was reduced in nonequol producers but not in producers. Other endpoints were not affected by equol production status. CONCLUSIONS Soy protein supplementation for 2 y compared with a casein-based placebo did not affect body weight, blood pressure, serum total cholesterol, iron status parameters, calcium, phosphorus, and thyroid hormones. Exploratory analysis suggests that equol production status of subjects on soy may modify effects of soy on body weight and possibly blood pressure. This trial was registered at clinicaltrials.gov as NCT00765479.
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Affiliation(s)
| | - Erika Enk
- Department of Pathology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Joanne Schmoll
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Michael J Schlicht
- Department of Pathology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Carla Randolph
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Ryan J Deaton
- Department of Pathology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Hui Xie
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Ikuko Kato
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA,Departments of Oncology and Pathology, Wayne State University, Detroit, MI, USA
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Zhao H, Song A, Zheng C, Wang M, Song G. Effects of plant protein and animal protein on lipid profile, body weight and body mass index on patients with hypercholesterolemia: a systematic review and meta-analysis. Acta Diabetol 2020; 57:1169-1180. [PMID: 32314018 DOI: 10.1007/s00592-020-01534-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/04/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We conducted a meta-analysis on the effect of plant protein or animal protein on body weight (BW), body mass index (BMI) and blood lipid profiles in patients with hypercholesterolemia. MATERIALS AND METHODS We used subject and free words to search PubMed, Embase and Cochrane Library databases. The risk-of-bias evaluation tool was used to assess literature quality. Data merging and statistical analyses were carried out using Review Manager 5.3 and Stata 13.0. All indicators were expressed as the mean difference (MD) and 95% confidence interval (95% CI). The heterogeneity test was conducted according to I2 and Q tests. We used Egger's test to evaluate publication bias quantitatively. RESULTS This was a meta-analysis of intervention trials. Thirty-two studies (1562 patients) were included. The quality of the included studies was acceptable. Compared with consumption of animal protein, plant protein reduced total cholesterol (TC) (MD = - 0.19 mmol/L, 95% CI - 0.26, - 0.12), triglyceride (MD = - 0.07 mmol/L, 95% CI - 0.13, - 0.02), low-density lipoprotein cholesterol (LDL-C) (MD = - 0.19 mmol/L, 95% CI - 0.26, - 0.13), very low-density lipoprotein cholesterol (MD = - 0.05 mmol/L, 95% CI - 0.09, - 0.01), TC/LDL-C ratio (MD = - 0.17, 95% CI - 0.32, - 0.02) and LDL-C/HDL-C ratio (MD = - 0.20, 95% CI - 0.33, - 0.06) significantly and increased high-density lipoprotein cholesterol (HDL-C) (MD = 0.03 mmol/L, 95% CI 0.01, 0.06) levels, but had no effect on BW (MD = - 0.41 kg, 95% CI - 2.14, 1.33) or BMI (MD = 0.11 kg/m2, 95% CI - 0.51, 0.73). CONCLUSION Compared with animal protein, consumption of plant protein could improve lipid profile in patients with hypercholesterolemia.
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Affiliation(s)
- Hang Zhao
- Endocrinology Department, Hebei General Hospital, 348, Heping West Road, Shijiazhuang, 050051, Hebei, China
| | - An Song
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Chong Zheng
- Pediatric Orthopaedics, Shijiazhuang the Third Hospital, 15, Sports South Street, Shijiazhuang, 050011, Hebei, China
| | - Mengdi Wang
- Graduate School of North, China University of Science and Technology, 21, Bohai Avenue, Caofeidian New Town, Tangshan, 063210, Hebei, China
| | - Guangyao Song
- Endocrinology Department, Hebei General Hospital, 348, Heping West Road, Shijiazhuang, 050051, Hebei, China.
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Afifah DN, Nabilah N, Supraba GT, Pratiwi SN, Nuryanto, Sulchan M. The Effects of Tempeh Gembus, an Indonesian Fermented Food, on Lipid Profiles in Women with Hyperlipidemia. CURRENT NUTRITION & FOOD SCIENCE 2020. [DOI: 10.2174/1573401314666180807112549] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background:
Hyperlipidemia is the major precursor of lipid-related diseases. Consumption
of high fiber foods may decrease lipid profiles. The fiber content in tempeh gembus is three times
higher than regular tempeh.
Objective:
This study was conducted to investigate the effect of tempeh gembus on lipid profiles in
women with hyperlipidemia.
Methods:
This research used the quasi-experimental design with nonequivalent control group design.
Subjects were 41 women with hyperlipidemia, classified into 3 groups: control group, treatment group
1 given 103 g/day tempeh gembus, and treatment group 2 given 206 g/day tempeh gembus for 14 days.
All of the groups received nutrition education. Total cholesterol and HDL-C were determined by
CHOD-PAP method, triglyceride determined by enzymatic GPO-PAP method after subjects had been
fasting for approximately 10 hours. LDL-C was calculated by Friedewald equation.
Results:
These results showed that consumption of tempeh gembus 103 g/day and 206 g/day decreased
LDL-C 27.9% and 30.9% as well as decreased total cholesterol 17.7% and 19.8% respectively. However,
HDL-C increased 3.91% and 8.79% and triglyceride increased 2.3% and 3.1%. Tempeh gembus
given 206 g/day was more effective to decrease total cholesterol and LDL-C than 103 g/day.
Conclusion:
Increasing tempeh gembus consumption in women with hyperlipidemia should be addressed
to decrease LDL-C and total cholesterol.
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Affiliation(s)
- Diana Nur Afifah
- Department of Nutrition Science, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Nida Nabilah
- Department of Nutrition Science, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Galuh Tamarasani Supraba
- Department of Nutrition Science, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Syafira Noor Pratiwi
- Department of Nutrition Science, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Nuryanto
- Department of Nutrition Science, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Mohammad Sulchan
- Department of Nutrition Science, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
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Moradi M, Daneshzad E, Azadbakht L. The effects of isolated soy protein, isolated soy isoflavones and soy protein containing isoflavones on serum lipids in postmenopausal women: A systematic review and meta-analysis. Crit Rev Food Sci Nutr 2019; 60:3414-3428. [PMID: 31858808 DOI: 10.1080/10408398.2019.1689097] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Many randomized controlled trials (RCTs) have assessed the effects of soy products on serum lipids. However, the responsible soy components and the magnitude of effects in healthy or hypercholesterolemic postmenopausal women are unclear. This review assessed the quality of these RCTs and estimated the effects of isolated soy protein, isolated soy isoflavones and soy protein containing isoflavones on total cholesterol (TC), LDL-C, HDL-C, triglycerides (TG), Apolipoprotein (Apo) A-1 and Apo B among postmenopausal women.Design: Forty-six eligible randomized controlled trials published up to 20 May 2019 were identified from the PubMed, Web of Science and Scopus databases. Weighted mean effect sizes were calculated for net changes in serum lipid concentrations by using random-effect models. Specific subgroup analyses were performed to identify the effect of covariates on serum lipid changes.Results: Soy consumption was associated with significant decrease in TG (mean differences (MD): -5.04 mg/dl; 95% CI: -9.95, -0.13; P = 0.044), TC (MD: -3.02 mg/dl; 95% CI: -5.56, -0.47; P = 0.02), LDL-C (MD: -3.27 mg/dl; 95% CI: -6.01, -0.53; P = 0.019) and HDL-C (MD: -2.28 mg/dl; 95% CI: -4.27, -0.29; P = 0.025). The reduction in LDL-C, TG and HDL were larger in subjects consuming isolated soy protein than isolated soy isoflavones. There was a significant decrease in serum TG and HDL levels with dosages of >25 grams per day soy protein rather than lower dosages of soy protein. The reductions in Apo A-1 were significantly larger in hypercholesterolemic subjects than in healthy subjects.Conclusions: Isolated soy protein significantly reduced serum TG, TC, LDL-C, HDL-C and Apo-B levels in postmenopausal women. Isolated soy isoflavones had a significant lowering effect on serum TC and Apo B levels. Soy protein containing isoflavones significantly reduced TG, TC, LDL-C and Apo B levels. Therefore, hyperlipidemia risk reduction with soy products is not uniform and strongly depends on the protein and isoflavone content of soy products, duration and dosage of consumption.
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Affiliation(s)
- Maedeh Moradi
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elnaz Daneshzad
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran, Iran
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Jenkins DJA, Blanco Mejia S, Chiavaroli L, Viguiliouk E, Li SS, Kendall CWC, Vuksan V, Sievenpiper JL. Cumulative Meta-Analysis of the Soy Effect Over Time. J Am Heart Assoc 2019; 8:e012458. [PMID: 31242779 PMCID: PMC6662359 DOI: 10.1161/jaha.119.012458] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Soy protein foods have attracted attention as useful plant protein foods with mild cholesterol‐lowering effects that are suitable for inclusion in therapeutic diets. But on the basis of the lack of consistency in significant cholesterol reduction by soy in 46 randomized controlled trials, the US Food and Drug Administration (FDA) is reassessing whether the 1999 heart health claim for soy protein should be revoked. Methods and Results We have, therefore, performed a cumulative meta‐analysis on the 46 soy trials identified by the FDA to determine if at any time, since the 1999 FDA final rule that established the soy heart health claim, the soy effect on serum cholesterol lost significance. The cumulative meta‐analysis for both total cholesterol and low‐density lipoprotein cholesterol demonstrated preservation of the small, but significant, reductions seen both before and during the subsequent 14 years since the health claim was originally approved. For low‐density lipoprotein cholesterol, the mean reduction in 1999 was −6.3 mg/dL (95% CI, −8.7 to −3.9 mg/dL; P=0.00001) and remained in the range of −4.2 to −6.7 mg/dL (P=0.0006 to P=0.0002, respectively) in the years after 1999. At no time point did the total cholesterol or low‐density lipoprotein cholesterol reductions lose significance or were the differences at individual time points in the cumulative meta‐analysis significantly different from those seen in 1999 when the health claim was approved. Conclusions A cumulative meta‐analysis of the data selected by the FDA indicates continued significance of total cholesterol and low‐density lipoprotein cholesterol reduction after soy consumption and supports the rationale behind the original soy FDA heart health claim. See Editorial Petersen and Kris‐Etherton
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Affiliation(s)
- David J A Jenkins
- 1 Department of Nutritional Sciences Faculty of Medicine University of Toronto Ontario Canada.,2 Department of Medicine Faculty of Medicine University of Toronto Ontario Canada.,3 Clinical Nutrition and Risk Factor Modification Centre St. Michael's Hospital, Toronto Ontario Canada.,4 Division of Endocrinology and Metabolism St. Michael's Hospital, Toronto Ontario Canada.,5 Li Ka Shing Knowledge Institute St. Michael's Hospital, Toronto Ontario Canada.,8 Toronto 3D Knowledge Synthesis and Clinical Trials Unit St. Michael's Hospital Toronto Ontario Canada
| | - Sonia Blanco Mejia
- 1 Department of Nutritional Sciences Faculty of Medicine University of Toronto Ontario Canada.,3 Clinical Nutrition and Risk Factor Modification Centre St. Michael's Hospital, Toronto Ontario Canada.,8 Toronto 3D Knowledge Synthesis and Clinical Trials Unit St. Michael's Hospital Toronto Ontario Canada
| | - Laura Chiavaroli
- 1 Department of Nutritional Sciences Faculty of Medicine University of Toronto Ontario Canada.,3 Clinical Nutrition and Risk Factor Modification Centre St. Michael's Hospital, Toronto Ontario Canada.,8 Toronto 3D Knowledge Synthesis and Clinical Trials Unit St. Michael's Hospital Toronto Ontario Canada
| | - Effie Viguiliouk
- 1 Department of Nutritional Sciences Faculty of Medicine University of Toronto Ontario Canada.,8 Toronto 3D Knowledge Synthesis and Clinical Trials Unit St. Michael's Hospital Toronto Ontario Canada
| | - Siying S Li
- 1 Department of Nutritional Sciences Faculty of Medicine University of Toronto Ontario Canada.,7 School of Medicine Faculty of Health Sciences Queen's University Kingston Ontario Canada
| | - Cyril W C Kendall
- 1 Department of Nutritional Sciences Faculty of Medicine University of Toronto Ontario Canada.,3 Clinical Nutrition and Risk Factor Modification Centre St. Michael's Hospital, Toronto Ontario Canada.,6 College of Pharmacy and Nutrition University of Saskatchewan Saskatoon Saskatchewan, Canada.,8 Toronto 3D Knowledge Synthesis and Clinical Trials Unit St. Michael's Hospital Toronto Ontario Canada
| | - Vladmir Vuksan
- 1 Department of Nutritional Sciences Faculty of Medicine University of Toronto Ontario Canada.,2 Department of Medicine Faculty of Medicine University of Toronto Ontario Canada.,3 Clinical Nutrition and Risk Factor Modification Centre St. Michael's Hospital, Toronto Ontario Canada.,4 Division of Endocrinology and Metabolism St. Michael's Hospital, Toronto Ontario Canada.,5 Li Ka Shing Knowledge Institute St. Michael's Hospital, Toronto Ontario Canada
| | - John L Sievenpiper
- 1 Department of Nutritional Sciences Faculty of Medicine University of Toronto Ontario Canada.,3 Clinical Nutrition and Risk Factor Modification Centre St. Michael's Hospital, Toronto Ontario Canada.,4 Division of Endocrinology and Metabolism St. Michael's Hospital, Toronto Ontario Canada.,5 Li Ka Shing Knowledge Institute St. Michael's Hospital, Toronto Ontario Canada.,8 Toronto 3D Knowledge Synthesis and Clinical Trials Unit St. Michael's Hospital Toronto Ontario Canada
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Blanco Mejia S, Messina M, Li SS, Viguiliouk E, Chiavaroli L, Khan TA, Srichaikul K, Mirrahimi A, Sievenpiper JL, Kris-Etherton P, Jenkins DJA. A Meta-Analysis of 46 Studies Identified by the FDA Demonstrates that Soy Protein Decreases Circulating LDL and Total Cholesterol Concentrations in Adults. J Nutr 2019; 149:968-981. [PMID: 31006811 PMCID: PMC6543199 DOI: 10.1093/jn/nxz020] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/05/2018] [Accepted: 01/25/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Certain plant foods (nuts and soy protein) and food components (viscous fibers and plant sterols) have been permitted by the FDA to carry a heart health claim based on their cholesterol-lowering ability. The FDA is currently considering revoking the heart health claim for soy protein due to a perceived lack of consistent LDL cholesterol reduction in randomized controlled trials. OBJECTIVE We performed a meta-analysis of the 46 controlled trials on which the FDA will base its decision to revoke the heart health claim for soy protein. METHODS We included the 46 trials on adult men and women, with baseline circulating LDL cholesterol concentrations ranging from 110 to 201 mg/dL, as identified by the FDA, that studied the effects of soy protein on LDL cholesterol and total cholesterol (TC) compared with non-soy protein. Two independent reviewers extracted relevant data. Data were pooled by the generic inverse variance method with a random effects model and expressed as mean differences with 95% CI. Heterogeneity was assessed and quantified. RESULTS Of the 46 trials identified by the FDA, 43 provided data for meta-analyses. Of these, 41 provided data for LDL cholesterol, and all 43 provided data for TC. Soy protein at a median dose of 25 g/d during a median follow-up of 6 wk decreased LDL cholesterol by 4.76 mg/dL (95% CI: -6.71, -2.80 mg/dL, P < 0.0001; I2 = 55%, P < 0.0001) and decreased TC by 6.41 mg/dL (95% CI: -9.30, -3.52 mg/dL, P < 0.0001; I2 = 74%, P < 0.0001) compared with non-soy protein controls. There was no dose-response effect or evidence of publication bias for either outcome. Inspection of the individual trial estimates indicated most trials (∼75%) showed a reduction in LDL cholesterol (range: -0.77 to -58.60 mg/dL), although only a minority of these were individually statistically significant. CONCLUSIONS Soy protein significantly reduced LDL cholesterol by approximately 3-4% in adults. Our data support the advice given to the general public internationally to increase plant protein intake. This trial was registered at clinicaltrials.gov as NCT03468127.
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Affiliation(s)
- Sonia Blanco Mejia
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital,Toronto, ON, Canada
| | | | - Siying S Li
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Effie Viguiliouk
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital,Toronto, ON, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital,Toronto, ON, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital,Toronto, ON, Canada
| | - Korbua Srichaikul
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Arash Mirrahimi
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital,Toronto, ON, Canada,Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Penny Kris-Etherton
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA
| | - David J A Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital,Toronto, ON, Canada,Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Address correspondence to DJAJ (e-mail: )
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Khodarahmi M, Jafarabadi MA, Moludi J, Abbasalizad Farhangi M. A systematic review and meta-analysis of the effects of soy on serum hs-CRP. Clin Nutr 2019; 38:996-1011. [PMID: 30314925 DOI: 10.1016/j.clnu.2018.09.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/13/2018] [Accepted: 09/06/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIM The results of studies about the effect of soy products on serum highly sensitive C-reactive protein (hs-CRP) are inconsistent. The aim of this systematic review and meta-analysis of randomized clinical trials (RCTs) was to investigate the effect of soy products intake on serum hs-CRP concentration. METHODS We searched PubMed, EMBASE, Science Direct, ISI Web of Science, Google Scholar and Cochrane Central Register of Controlled Trials up to December 2016 without language restrictions. Random-effect model was used for quantitative data synthesis. RESULTS Thirty-six studies were included in our analyses. A meta-analysis revealed a non-significant reduction in serum hs-CRP concentrations following soy products consumption, -0.19 (mg/L) (95% CI: -0.49 to 0.09; I2 = 95.6%). Subgroup analyses suggested that natural soya products may reduce plasma levels of CRP by -0.18 mg/L (95% CI: -0.28 to -0.08; I2: 11.6) in comparison to other source of isoflavones (soya extracts, supplements). Moreover, the effect was stronger among subjects with baseline hs-CRP concentrations of less than 2.52 mg/L, -0.15 (95% CI: -0.27 to -0.02; I2: 34.6). A meta-regression analysis revealed that dosage of isoflavones seems to be a strong predictor of the effect of soya on serum hs-CRP levels. CONCLUSION Present review of RCTs published up to December 2016 did not provide strong evidence regarding the beneficial effect of soya products consumption on blood hs-CRP concentrations. However, it appears that natural soya products may reduce plasma levels of hs-CRP in comparison to other source of isoflavones. Large and well-designed studies are recommended to confirm this conclusion. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018069371.
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Affiliation(s)
- Mahdieh Khodarahmi
- Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran; Student Research Committee, Department of Nutrition, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jalal Moludi
- Nutritional Sciences Department, Faculty of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahdieh Abbasalizad Farhangi
- Research Center for Evidence-Based Medicine (RCEBM), Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran; Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Sekikawa A, Ihara M, Lopez O, Kakuta C, Lopresti B, Higashiyama A, Aizenstein H, Chang YF, Mathis C, Miyamoto Y, Kuller L, Cui C. Effect of S-equol and Soy Isoflavones on Heart and Brain. Curr Cardiol Rev 2019; 15:114-135. [PMID: 30516108 PMCID: PMC6520578 DOI: 10.2174/1573403x15666181205104717] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Observational studies in Asia show that dietary intake of soy isoflavones had a significant inverse association with coronary heart disease (CHD). A recent randomized controlled trial (RCT) of soy isoflavones on atherosclerosis in the US, however, failed to show their benefit. The discrepancy may be due to the much lower prevalence of S-equol producers in Westerners: Only 20-30% of Westerners produce S-equol in contrast to 50-70% in Asians. S-equol is a metabolite of dietary soy isoflavone daidzein by gut microbiome and possesses the most antiatherogenic properties among all isoflavones. Several short-duration RCTs documented that soy isoflavones improves arterial stiffness. Accumulating evidence shows that both atherosclerosis and arterial stiffness are positively associated with cognitive decline/dementia. Therefore, potentially, soy isoflavones, especially S-equol, are protective against cognitive decline/dementia. METHODS/RESULTS This narrative review of clinical and epidemiological studies provides an overview of the health benefits of soy isoflavones and introduces S-equol. Second, we review recent evidence on the association of soy isoflavones and S-equol with CHD, atherosclerosis, and arterial stiffness as well as the association of atherosclerosis and arterial stiffness with cognitive decline/ dementia. Third, we highlight recent studies that report the association of soy isoflavones and S-equol with cognitive decline/dementia. Lastly, we discuss the future directions of clinical and epidemiological research on the relationship of S-equol and CHD and dementia. CONCLUSIONS Evidence from observational studies and short-term RCTs suggests that S-equol is anti-atherogenic and improves arterial stiffness and may prevent CHD and cognitive impairment/ dementia. Well-designed long-term (≥ 2years) RCTs should be pursued.
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Affiliation(s)
- Akira Sekikawa
- Address correspondence to this author at the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 North Bellefield Avenue, Suite 336, Pittsburgh, PA 15213, USA; Tel: 412-383-1063; Fax: 412-648-4401;
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12
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Li SS, Blanco Mejia S, Lytvyn L, Stewart SE, Viguiliouk E, Ha V, de Souza RJ, Leiter LA, Kendall CWC, Jenkins DJA, Sievenpiper JL. Effect of Plant Protein on Blood Lipids: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc 2017; 6:e006659. [PMID: 29263032 PMCID: PMC5779002 DOI: 10.1161/jaha.117.006659] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 11/06/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is a heightened interest in plant-based diets for cardiovascular disease prevention. Although plant protein is thought to mediate such prevention through modifying blood lipids, the effect of plant protein in specific substitution for animal protein on blood lipids remains unclear. To assess the effect of this substitution on established lipid targets for cardiovascular risk reduction, we conducted a systematic review and meta-analysis of randomized controlled trials using the Grading of Recommendations Assessment, Development, and Evaluation system. METHODS AND RESULTS MEDLINE, EMBASE, and the Cochrane Registry were searched through September 9, 2017. We included randomized controlled trials of ≥3 weeks comparing the effect of plant protein in substitution for animal protein on low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B. Two independent reviewers extracted relevant data and assessed risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences with 95% confidence intervals. Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). The overall quality (certainty) of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system. One-hundred twelve randomized controlled trials met the eligibility criteria. Plant protein in substitution for animal protein decreased low-density lipoprotein cholesterol by 0.16 mmol/L (95% confidence interval, -0.20 to -0.12 mmol/L; P<0.00001; I2=55%; moderate-quality evidence), non-high-density lipoprotein cholesterol by 0.18 mmol/L (95% confidence interval, -0.22 to -0.14 mmol/L; P<0.00001; I2=52%; moderate-quality evidence), and apolipoprotein B by 0.05 g/L (95% confidence interval, -0.06 to -0.03 g/L; P<0.00001; I2=30%; moderate-quality evidence). CONCLUSIONS Substitution of plant protein for animal protein decreases the established lipid targets low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B. More high-quality randomized trials are needed to improve our estimates. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02037321.
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Affiliation(s)
- Siying S Li
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Sonia Blanco Mejia
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Lyubov Lytvyn
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Departments of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sarah E Stewart
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Effie Viguiliouk
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Vanessa Ha
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Departments of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Departments of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence A Leiter
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Cyril W C Kendall
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David J A Jenkins
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - John L Sievenpiper
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada
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Birru RL, Ahuja V, Vishnu A, Evans RW, Miyamoto Y, Miura K, Usui T, Sekikawa A. The impact of equol-producing status in modifying the effect of soya isoflavones on risk factors for CHD: a systematic review of randomised controlled trials. J Nutr Sci 2016; 5:e30. [PMID: 27547393 PMCID: PMC4976117 DOI: 10.1017/jns.2016.18] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/19/2016] [Accepted: 04/25/2016] [Indexed: 11/30/2022] Open
Abstract
Recent studies suggest that the ability to produce equol, a metabolite of the soya isoflavone daidzein, is beneficial to coronary health. Equol, generated by bacterial action on isoflavones in the human gut, is biologically more potent than dietary sources of isoflavones. Not all humans are equol producers. We investigated whether equol-producing status is favourably associated with risk factors for CHD following an intervention by dietary soya isoflavones. We systematically reviewed randomised controlled trials (RCT) that evaluated the effect of soya isoflavones on risk factors for CHD and that reported equol-producing status. We searched PubMed, EMBASE, Ovid Medline and the Cochrane Central Register for Controlled Trials published up to April 2015 and hand-searched bibliographies to identify the RCT. Characteristics of participants and outcomes measurements were extracted and qualitatively analysed. From a total of 1671 studies, we identified forty-two articles that satisfied our search criteria. The effects of equol on risk factors for CHD were mainly based on secondary analyses in these studies, thus with inadequate statistical power. Although fourteen out of the forty-two studies found that equol production after a soya isoflavone intervention significantly improved a range of risk factors including cholesterol and other lipids, inflammation and blood pressure variables, these results need further verification by sufficiently powered studies. The other twenty-eight studies primarily reported null results. RCT of equol, which has recently become available as a dietary supplement, on CHD and its risk factors are awaited.
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Affiliation(s)
- Rahel L. Birru
- Department of Environmental and Occupational Health and Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vasudha Ahuja
- Department of Environmental and Occupational Health and Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Abhishek Vishnu
- Health Sciences Center, West Virginia University, Morgantown, WV, USA
| | - Rhobert W. Evans
- Department of Environmental and Occupational Health and Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yoshihiro Miyamoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Katsuyuki Miura
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Takeshi Usui
- Clinical Research Institute, National Hospital Organization, Kyoto Medical Center, Kyoto, Kyoto 612-8555, Japan
| | - Akira Sekikawa
- Department of Environmental and Occupational Health and Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
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Probiotic Soy Product Supplemented with Isoflavones Improves the Lipid Profile of Moderately Hypercholesterolemic Men: A Randomized Controlled Trial. Nutrients 2016; 8:nu8010052. [PMID: 26797632 PMCID: PMC4728664 DOI: 10.3390/nu8010052] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/03/2015] [Accepted: 12/16/2015] [Indexed: 02/07/2023] Open
Abstract
Background: Cardiovascular disease is the leading cause of worldwide morbidity and mortality. Several studies have demonstrated that specific probiotics affect the host’s metabolism and may influence the cardiovascular disease risk. Objectives: The aim of this study was to investigate the influence of an isoflavone-supplemented soy product fermented with Enterococcus faecium CRL 183 and Lactobacillus helveticus 416 on cardiovascular risk markers in moderately hypercholesterolemic subjects. Design: Randomized placebo-controlled double-blind trial Setting: São Paulo State University in Araraquara, SP, Brazil. Participants: 49 male healthy men with total cholesterol (TC) >5.17 mmol/L and <6.21 mmol/L Intervention: The volunteers have consumed 200 mL of the probiotic soy product (group SP-1010 CFU/day), isoflavone-supplemented probiotic soy product (group ISP–probiotic plus 50 mg of total isoflavones/100 g) or unfermented soy product (group USP-placebo) for 42 days in a randomized, double-blind study. Main outcome measures: Lipid profile and additional cardiovascular biomarkers were analyzed on days 0, 30 and 42. Urine samples (24 h) were collected at baseline and at the end of the experiment so as to determine the isoflavones profile. Results: After 42 days, the ISP consumption led to improved total cholesterol, non-HDL-C (LDL + IDL + VLDL cholesterol fractions) and electronegative LDL concentrations (reduction of 13.8%, 14.7% and 24.2%, respectively, p < 0.05). The ISP and SP have prevented the reduction of HDL-C level after 42 days. The C-reactive protein and fibrinogen levels were not improved. The equol production by the ISP group subjects was inversely correlated with electronegative LDL concentration. Conclusions: The results suggest that a regular consumption of this probiotic soy product, supplemented with isoflavones, could contribute to reducing the risk of cardiovascular diseases in moderately hypercholesterolemic men, through the an improvement in lipid profile and antioxidant properties.
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15
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Padhi EM, Blewett HJ, Duncan AM, Guzman RP, Hawke A, Seetharaman K, Tsao R, Wolever TM, Ramdath DD. Whole Soy Flour Incorporated into a Muffin and Consumed at 2 Doses of Soy Protein Does Not Lower LDL Cholesterol in a Randomized, Double-Blind Controlled Trial of Hypercholesterolemic Adults. J Nutr 2015; 145:2665-74. [PMID: 26446482 PMCID: PMC4656908 DOI: 10.3945/jn.115.219873] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/02/2015] [Accepted: 09/09/2015] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Soy protein may reduce coronary heart disease (CHD) risk by lowering LDL cholesterol, but few studies have assessed whether whole soy flour displays a similar effect. OBJECTIVE The aim of this study was to assess the dose effect of whole soy flour incorporated into muffins on plasma LDL cholesterol in hypercholesterolemic adults. METHODS Adults aged 30-70 y (n = 243) with elevated LDL cholesterol (≥3.0 and ≤5.0 mmol/L) were stratified by LDL cholesterol and randomly assigned to consume 2 soy muffins containing 25 g soy protein [high-dose soy (HDS)], 1 soy and 1 wheat muffin containing 12.5 g soy protein and 12.5 g whey protein [low-dose soy (LDS)], or 2 wheat muffins containing 25 g whey protein (control) daily for 6 wk while consuming a self-selected diet. Fasting blood samples were collected at weeks 0, 3, and 6 for analysis of plasma lipids [total, LDL, and HDL cholesterol and triglycerides (TGs)], glucose, insulin, C-reactive protein (CRP), and isoflavones. Blood pressures also were measured. Dietary intake was assessed at weeks 0 and 4 with the use of 3 d food records. Treatment effects were assessed with the use of intention-to-treat analysis with multiple imputation and LDL cholesterol as the primary outcome. RESULTS In total, 213 (87.6%) participants completed the trial. Participants were primarily Caucasian (83%) and mostly female (63%), with a mean ± SD body mass index (in kg/m2) of 28.0 ± 4.6 and systolic and diastolic blood pressures of 122 ± 16 and 77 ± 11 mm Hg, respectively. Despite a dose-dependent increase in plasma isoflavones (P < 0.001), neither HDS nor LDS had a significant effect on LDL cholesterol compared with control (mean ± SEM changes: control, -0.04 ± 0.05 mmol/L; HDS, 0.01 ± 0.05 mmol/L; and LDS, -0.04 ± 0.06 mmol/L). There were no significant treatment effects on total or HDL cholesterol, TGs, CRP, homeostatic model assessment of insulin resistance, blood pressure, or the Framingham 10-y CHD risk score. CONCLUSION Consuming 12.5 or 25 g protein from defatted soy flour incorporated into muffins does not reduce LDL cholesterol or other CHD risk factors in hypercholesterolemic adults. This trial was registered at clinicaltrials.gov as NCT01547585.
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Affiliation(s)
- Emily Mt Padhi
- Guelph Food Research Centre, Agriculture and Agri-Food Canada, Guelph, Canada; Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Canada
| | - Heather J Blewett
- Canadian Centre for Agri-Food Research in Health and Medicine, Agriculture and Agri-Food Canada, Winnipeg, Canada; and
| | - Alison M Duncan
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Canada
| | - Randolph P Guzman
- Canadian Centre for Agri-Food Research in Health and Medicine, Agriculture and Agri-Food Canada, Winnipeg, Canada; and
| | - Aileen Hawke
- Guelph Food Research Centre, Agriculture and Agri-Food Canada, Guelph, Canada
| | | | - Rong Tsao
- Guelph Food Research Centre, Agriculture and Agri-Food Canada, Guelph, Canada
| | | | - D Dan Ramdath
- Guelph Food Research Centre, Agriculture and Agri-Food Canada, Guelph, Canada;
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Krul ES, Mauro L, Mukherjea R. Justification for soy protein to still have a category ‘A’ coronary heart disease risk reduction health claim. Trends Food Sci Technol 2014. [DOI: 10.1016/j.tifs.2013.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Ma L, Grann K, Li M, Jiang Z. A pilot study to evaluate the effect of soy isolate protein on the serum lipid profile and other potential cardiovascular risk markers in moderately hypercholesterolemic Chinese adults. Ecol Food Nutr 2012; 50:473-85. [PMID: 22077928 DOI: 10.1080/03670244.2011.620875] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This article examines the effect of soy isolate protein on the serum lipids and other potential cardiovascular risk markers in 90 moderately hypercholesterolemic Chinese adults (64 women and 26 men, aged 25 to 70 years). Fasting blood samples were taken before and after consuming 24 g of protein supplied by soy isolate protein supplement (including 18 g soy protein and 6 g milk protein) or milk protein supplement daily for 8 weeks. Dietary intake was assessed by a 3-day record collected at baseline, week 4, and week 8 of the study. The results indicate that the two kinds of protein can modestly improve serum lipids and markers associated with obesity and inflammation.
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Affiliation(s)
- Lili Ma
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
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18
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Scientific Opinion on the substantiation of a health claim related to isolated soy protein and reduction of blood LDL-cholesterol concentrations pursuant to Article 14 of Regulation (EC) No 1924/2006. EFSA J 2012. [DOI: 10.2903/j.efsa.2012.2555] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Esteves EA, Bressan J, Costa NMB, Martino HSD, Donkin SS, Story JA. Modified soybean affects cholesterol metabolism in rats similarly to a commercial cultivar. J Med Food 2011; 14:1363-9. [PMID: 21501092 DOI: 10.1089/jmf.2010.0160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The consumption of soy protein lowers blood cholesterol in humans and animals. Breeding may alter the physiological effects of soybeans, such as its cholesterol-lowering property. Our hypothesis is that breeding affects the hypocholesterolemic effect of soy by modulating the expression of key hepatic enzymes related to cholesterol and bile acid biosynthesis, as well as altering fecal neutral and acidic steroid excretion. Therefore the aim of this study was to evaluate the effect of a new Brazilian soybean cultivar (UFV-116), lacking lipoxygenases 2 and 3, compared with a commercial cultivar (OCEPAR-19), on 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGR) and cholesterol 7α-hydroxylase (CYP7A) mRNA expression and fecal steroid output in rats. Thirty-six male rats were fed UFV-116, OCEPAR-19, or casein as the protein source, with or without addition of dietary cholesterol (0.25%). Blood and liver cholesterol, HMGR and CYP7A mRNA abundance, and fecal excretion of steroids were measured. Blood and liver cholesterol levels were lowered by both soybean cultivars, with and without cholesterol, but UFV-116 was more effective when included in the cholesterol-free diet. Both soy diets promoted lower levels of HMGR mRNA, higher levels of CYP7A mRNA, and higher excretion of fecal secondary bile acids. There was higher fecal neutral steroid output when cholesterol was added to all diets. These data show that both soybean cultivars acted similarly in lowering serum and hepatic cholesterol; therefore, breeding did not affect the hypocholesterolemic effect of the new cultivar.
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Affiliation(s)
- Elizabethe A Esteves
- Department of Nutrition, Federal University of Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.
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Anderson JW, Bush HM. Soy protein effects on serum lipoproteins: a quality assessment and meta-analysis of randomized, controlled studies. J Am Coll Nutr 2011; 30:79-91. [PMID: 21730216 DOI: 10.1080/07315724.2011.10719947] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Many randomized controlled trials (RCTs) have assessed the effects of soy protein on serum lipoprotein risk factors for coronary heart disease (CHD). This review and meta-analysis assessed the quality of these RCTs and estimated the effects of soy protein consumption on serum lipoproteins. DATA SOURCES A comprehensive search using multiple databases was conducted for the years 1996 through 2008 to identify clinical trials related to soy protein intake and serum lipoprotein changes. STUDY ELIGIBILITY RCTs were assessed that met these requirements: soy protein intake compared with nonsoy protein, provided information on serum low-density lipoprotein (LDL)-cholesterol values, provided no more than 65 g of soy protein daily, and obtained LDL-cholesterol measurements between 4 and 18 weeks of treatment. Randomized parallel and crossover studies were evaluated. METHODS Studies were graded for quality using 12 criteria with a possible maximum grade of 24. Net changes in lipoproteins with soy protein consumption compared with nonsoy control diets were analyzed by meta-analyses and funnel plots. Confidence intervals were constructed using inverse weighting. Analyses compared parallel to crossover studies and studies with lower and higher grades. RESULTS Analyses included 20 parallel-design studies and 23 crossover studies. Parallel studies scored significantly higher (p < 0.001) in study quality, with a mean grade of 15.8 (95% confidence interval [CI], 14.3 to 17.3) compared with 10.1 (95% CI, 8.2 to 11.9) for crossover trials. Soy protein intake was associated with net changes in serum LDL-cholesterol values of -0.23 mmol/l (95% CI, -0.28 to -0.18 mmol/l) or a 5.5% reduction in parallel studies and -0.16 mmol/l (95% CI, -0.22 to -0.11 mmol/l) or a reduction of 4.2% with crossover studies (p < 0.001 for parallel vs crossover). In parallel studies, net serum HDL-cholesterol values were 3.2% higher (p < 0.007) with soy vs control, and fasting serum triacylglycerol values were 10.7% lower (p < 0.008) for soy vs control. CONCLUSIONS AND IMPLICATIONS Soy protein consumption with a median of 30 g/d was associated with a significant improvement in lipoprotein risk factors for CHD. Compared with crossover RCTs, parallel RCTs had significantly higher quality grades and were associated with significantly greater improvements in serum LDL-cholesterol values. Regular consumption of 1 to 2 servings of soy protein daily (15 to 30 g) has a significant favorable impact on serum lipoprotein risk factors for CHD.
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Affiliation(s)
- James W Anderson
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA.
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Scientific Opinion on the substantiation of health claims related to soy isoflavones and protection of DNA, proteins and lipids from oxidative damage (ID 1286, 4245), maintenance of normal blood LDL cholesterol concentrations (ID 1135, 1704a, 3093a), reduction of vasomotor symptoms associated with menopause (ID 1654, 1704b, 2140, 3093b, 3154, 3590), maintenance of normal skin tonicity (ID 1704a), contribution to normal hair growth (ID 1704a, 4254), “cardiovascular health” (ID 3587), treatment of prostate cancer (ID 3588) and “upper respiratory tract” (ID 3589) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA J 2011. [DOI: 10.2903/j.efsa.2011.2264] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Jenkins DJA, Mirrahimi A, Srichaikul K, Berryman CE, Wang L, Carleton A, Abdulnour S, Sievenpiper JL, Kendall CWC, Kris-Etherton PM. Soy protein reduces serum cholesterol by both intrinsic and food displacement mechanisms. J Nutr 2010; 140:2302S-2311S. [PMID: 20943954 DOI: 10.3945/jn.110.124958] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The apparently smaller LDL cholesterol (LDL-C)-lowering effect of soy in recent studies has prompted the U.S. FDA to reexamine the heart health claim previously allowed for soy products. We therefore attempted to estimate the intrinsic and extrinsic (displacement) potential of soy in reducing LDL-C to determine whether the heart health claim for soy continues to be justified. The intrinsic effect of soy was derived from a meta-analysis using soy studies (20-133 g/d soy protein) included in the recent AHA Soy Advisory. The extrinsic effect of soy in displacing foods higher in saturated fat and cholesterol was estimated using predictive equations for LDL-C and NHANES III population survey data with the substitution of 13-58 g/d soy protein for animal protein foods. The meta-analysis of the AHA Soy Advisory data gave a mean LDL-C reduction of 0.17 mmol/L (n = 22; P < 0.0001) or 4.3% for soy, which was confirmed in 11 studies reporting balanced macronutrient profiles. The estimated displacement value of soy (13-58 g/d) using NHANES III population survey data was a 3.6-6.0% reduction in LDL-C due to displacement of saturated fats and cholesterol from animal foods. The LDL-C reduction attributable to the combined intrinsic and extrinsic effects of soy protein foods ranged from 7.9 to 10.3%. Thus, soy remains one of a few food components that reduces serum cholesterol (>4%) when added to the diet.
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Affiliation(s)
- David J A Jenkins
- Clinical Nutrition and Risk Factor Modification Center, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
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Cano A, García-Pérez MÁ, Tarín JJ. Isoflavones and cardiovascular disease. Maturitas 2010; 67:219-26. [DOI: 10.1016/j.maturitas.2010.07.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 07/26/2010] [Accepted: 07/27/2010] [Indexed: 01/15/2023]
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Scientific Opinion on the substantiation of a health claim related to soy protein and reduction of blood cholesterol concentrations pursuant to Article 14 of the Regulation (EC) No 1924/2006. EFSA J 2010. [DOI: 10.2903/j.efsa.2010.1688] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Vega-López S, Matthan NR, Ausman LM, Harding SV, Rideout TC, Ai M, Otokozawa S, Freed A, Kuvin JT, Jones PJ, Schaefer EJ, Lichtenstein AH. Altering dietary lysine:arginine ratio has little effect on cardiovascular risk factors and vascular reactivity in moderately hypercholesterolemic adults. Atherosclerosis 2009; 210:555-62. [PMID: 20042191 DOI: 10.1016/j.atherosclerosis.2009.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 11/23/2009] [Accepted: 12/02/2009] [Indexed: 01/28/2023]
Abstract
BACKGROUND Information is scarce regarding the effect of dietary protein type, with specific focus on the lysine-to-arginine (Lys:Arg) ratio, on cardiovascular risk factors and vascular reactivity in humans. OBJECTIVE Determine the effect of dietary Lys:Arg ratio on cardiovascular risk factors and vascular reactivity in moderately hypercholesterolemic adults. DESIGN Randomized cross-over design of two 35-day diet phases; thirty adults (21 females and 9 males, >or=50 years, LDL cholesterol>or=120 mg/dL). Diets had 20% energy (E) protein, 30%E fat, 50%E carbohydrate and were designed to have low (0.7) or high (1.4) Lys:Arg ratio. Measures included fasting and postprandial lipid, lipoprotein, apolipoprotein concentrations; fasting high sensitivity C-reactive protein (hsCRP), small dense LDL (sdLDL) cholesterol, remnant lipoprotein cholesterol (RemLC), glycated albumin, adiponectin and immunoreactive insulin concentrations, endogenous cholesteryl ester transfer protein (CETP) and lecithin:cholesterol acyl transferase (LCAT) activities; cholesterol fractional synthesis rate (FSR); and flow mediated dilation (FMD) and peripheral artery tonometry (PAT). RESULTS No differences were observed in fasting and/or postprandial total, LDL, HDL and sdLDL cholesterol, RemLC, Lp(a) or apo B concentrations, LCAT and CETP activities, FSR, glycated albumin, immunoreactive insulin, FMD or PAT. The low, relative to the high, Lys:Arg ratio diet resulted in lower postprandial VLDL cholesterol (-24%, P=0.001) and triglycerides (-23%, P=0.001), and small but significant differences in fasting (-3%, P=0.003) and postprandial (-3%, P=0.018) apo AI, and fasting adiponectin concentrations (+7%, P=0.035). Fasting and postprandial hsCRP concentrations were 23% lower after the low Lys:Arg ratio diet (P=0.020 for both). CONCLUSIONS Diets differing in Lys:Arg ratios had no or small effects on cardiovascular risk factors and vascular reactivity.
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Affiliation(s)
- Sonia Vega-López
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111, USA
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Beavers KM, Jonnalagadda SS, Messina MJ. Soy consumption, adhesion molecules, and pro-inflammatory cytokines: a brief review of the literature. Nutr Rev 2009; 67:213-21. [PMID: 19335715 DOI: 10.1111/j.1753-4887.2009.00191.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Given the interest in the vascular effects of both soyfoods and soy isoflavones, the purpose of this short review is to evaluate clinical trials that have examined the effects of isoflavone-rich soy products on the novel cardiovascular risk factors, cellular adhesion molecules, and pro-inflammatory cytokines. A total of 14 randomized clinical studies were assessed. From the data evaluated, evidence suggests that neither soyfoods nor soy isoflavones affect IL-6 or TNF-alpha expression. In contrast, the effects of soy on cellular adhesion molecules are mixed. Study design characteristics possibly contributing to the inconsistent data are discussed and recommendations for future research in this area are presented.
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Affiliation(s)
- Kristen M Beavers
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, Texas 76798-7313, USA.
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Shidfar F, Ehramphosh E, Heydari I, Haghighi L, Hosseini S, Shidfar S. Effects of soy bean on serum paraoxonase 1 activity and lipoproteins in hyperlipidemic postmenopausal women. Int J Food Sci Nutr 2009; 60:195-205. [DOI: 10.1080/09637480701669463] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Farzad Shidfar
- School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Ehramphosh
- School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Iraj Heydari
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ladan Haghighi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Alimentary proteins, amino acids and cholesterolemia. Amino Acids 2009; 38:15-22. [DOI: 10.1007/s00726-009-0239-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 01/12/2009] [Indexed: 11/26/2022]
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BORODIN EA, MENSHIKOVA IG, DOROVSKIKH VA, FEOKTISTOVA NA, SHTARBERG MA, YAMAMOTO T, TAKAMATSU K, MORI H, YAMAMOTO S. Effects of Two-Month Consumption of 30 g a Day of Soy Protein Isolate or Skimmed Curd Protein on Blood Lipid Concentration in Russian Adults with Hyperlipidemia. J Nutr Sci Vitaminol (Tokyo) 2009; 55:492-7. [DOI: 10.3177/jnsv.55.492] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Harland JI, Haffner TA. Systematic review, meta-analysis and regression of randomised controlled trials reporting an association between an intake of circa 25 g soya protein per day and blood cholesterol. Atherosclerosis 2008; 200:13-27. [PMID: 18534601 DOI: 10.1016/j.atherosclerosis.2008.04.006] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Revised: 03/27/2008] [Accepted: 04/04/2008] [Indexed: 12/14/2022]
Abstract
AIMS To determine the effect of a daily intake of circa 25 g soya protein on blood lipids in adults with normal or mildly elevated cholesterolaemia. METHODS Medline and other scientific databases were searched to identify randomised controlled trials (RCTs); these were systematically reviewed against pre-determined criteria. Eligible RCTs evaluated the effect of 25 g (range 15-40 g) soya protein on measures of blood lipids. Results from RCTs were pooled using standard meta-analysis methods. RESULTS Thirty studies containing 42 treatment arms (n=2913), with an average soya protein intake of 26.9 g met the inclusion criteria. Soya protein inclusion led to reductions in standard difference in mean low density lipoprotein (LDL), total cholesterol and blood triglycerides of 0.23 mmol/L (95% confidence interval (CI) -0.160 to -0.306, p<0.0001), 0.22 mmol/L (95% CI -0.142 to -0.291, p<0.0001) and 0.08 mmol/L (95% CI -0.004 to -0.158, p=0.04), respectively. There was no effect on mean difference in apolipoprotein A (ApoA), but ApoB was reduced by 0.021 g/L (p=0.01) in the soya group. Meta-regression analysis indicated no dose response relationship between soya protein intake in the range of 15-40 g and standard difference in LDL or HDL. All data were tested for heterogeneity and none identified. CONCLUSIONS The inclusion of modest amounts soya protein (ca. 25 g) into the diet of adults with normal or mild hypercholesterolaemia resulted in small, highly significant reductions in total and LDL cholesterol, equivalent to ca. 6% LDL reduction. This practically achievable intake, particularly when combined with other dietary measures, can make a useful contribution to blood cholesterol management.
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Affiliation(s)
- Janice I Harland
- HarlandHall Associates, The Stables, Ranbury Ring, London Road, Poulton, Cirencester, Glos GL7 5HN, UK.
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31
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Greany KA, Nettleton JA, Wangen KE, Thomas W, Kurzer MS. Consumption of isoflavone-rich soy protein does not alter homocysteine or markers of inflammation in postmenopausal women. Eur J Clin Nutr 2007; 62:1419-25. [PMID: 17805230 DOI: 10.1038/sj.ejcn.1602885] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVE To investigate the effect of soy protein containing isoflavones on homocysteine (Hcy), C-reactive protein (CRP), soluble E-selectin (sE-selectin), soluble vascular adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecule-1 (sICAM-1). SUBJECT/METHODS In a randomized crossover design, 34 postmenopausal women consumed soy protein isolate (26+/-5 g protein containing 44+/-8 mg isoflavones per day) or milk protein isolate (26+/-5 g protein per day) for 6 weeks each. Fasting blood samples were collected at the end of each diet period and end points analyzed by enzyme-linked immunosorbent assay. RESULTS Concentrations of Hcy, CRP, sE-selectin, sVCAM-1 and sICAM-1 were not different between soy and milk diet treatments. Results did not differ by equol production status or by baseline lipid concentration. Adjustment for intake of folate and methionine did not alter the Hcy results. CONCLUSIONS These data suggest that decreasing vascular inflammation and Hcy concentration are not likely mechanisms by which soy consumption reduces coronary heart disease risk.
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Affiliation(s)
- K A Greany
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, MN 55108, USA
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Sirtori CR, Eberini I, Arnoldi A. Hypocholesterolaemic effects of soya proteins: results of recent studies are predictable from the Anderson meta-analysis data. Br J Nutr 2007; 97:816-22. [PMID: 17408521 DOI: 10.1017/s0007114507670810] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In 1995, Andersonet al.published a meta-analysis, derived from most of the clinical studies on soya proteins given to individuals with varying levels of cholesterolaemia that had been reported up to that time. The meta-analysis clearly indicated that cholesterolaemias were generally reduced by diets with soya given as a partial or total substitution of animal proteins, with final mean total and LDL-cholesterol reductions of 23·2 mg/dl and 21·7 mg/dl, respectively. These findings were recently strongly criticised, based on the evaluation of later studies, frequently involving individuals with normal or moderately elevated cholesterolaemias. In the present paper, these more recent studies were re-evaluated using a ‘nomogram’ prepared on the basis of the quartiles of initial cholesterol concentrations in the Anderson meta-analysis and their corresponding CI for net cholesterol change. The five studies belonging to the first quartile and thirteen out of the fourteen belonging to the second quartile gave results perfectly in line with the nomogram. Out of the fourteen studies belonging to the third quartile, ten agreed with the nomogram and two gave lower cholesterol reductions, whereas two gave higher reductions. Unfortunately, none of the recent studies belonged to the fourth quartile as treatment with statins or other lipid-lowering drugs is now mandatory in the presence of very high cholesterol levels. The re-evaluation thus shows that the thirty-three studies published in the past 10 years are in agreement with the Anderson meta-analysis and confirm its validity.
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Affiliation(s)
- Cesare R Sirtori
- Department of Pharmacological Sciences, University of Milano, Italy.
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Adams MR, Anthony MS, Chen H, Clarkson TB. Replacement of dietary soy protein isolate with concentrates of soy 7S or 11S globulin has minimal or no effects on plasma lipoprotein profiles and biomarkers of coronary risk in monkeys. Atherosclerosis 2007; 196:76-80. [PMID: 17350024 PMCID: PMC2239216 DOI: 10.1016/j.atherosclerosis.2007.01.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Revised: 01/09/2007] [Accepted: 01/29/2007] [Indexed: 11/18/2022]
Abstract
Effects of soy peptide fractions on risk factors for coronary heart disease are unknown. We compared the effects of a soy protein isolate, a soy 7S fraction concentrate and a soy 11S fraction concentrate on total plasma cholesterol, HDL cholesterol, LDL+VLDL cholesterol and triacylglycerol in adult male cynomolgus monkeys. Effects on biomarkers of coronary risk [soluble E-selectin, vascular cell-adhesion molecule-1 (VCAM-1), monocyte chemoattractant protein-1 (MCP-1), transforming growth factor beta-1 (TGF-beta-1) and plasminogen activator inhibitor-1 (PAI-1)] were also determined. Relative to a soy- and isoflavone-free diet (casein and lactalbumin as the source of protein), soy protein isolate had the predicted favorable effects on plasma lipoproteins, i.e., reductions in total and VLDL+LDL cholesterol (8 and 14%, respectively) (P's<0.05) and a 41% increase in HDL (P<0.05). Effects of 7S and 11S on these variables were less favorable. In fact, there was a 7% increase in total plasma cholesterol concentration (P<0.05) in monkeys fed 7S that was accounted for primarily by an increase in VLDL+LDL cholesterol. There was no effect of any protein source on cardiovascular biomarkers. Replacement of dietary soy protein isolate with concentrated 7S or 11S does not result in improvement of plasma lipoprotein profiles or cardiovascular biomarkers in monkeys.
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Affiliation(s)
- Michael R Adams
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
| | - Mary S Anthony
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Haiying Chen
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Thomas B Clarkson
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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Abstract
INTRODUCTION Menopause is associated with mid-life, a time when many women begin to experience the signs and symptoms of aging, such as increases in blood pressure, changes in lipid profiles, loss of bone mass density, and diminished memory and cognition. Given the result of the Women's Health Initiative, many women no longer consider hormone therapy the first option for promoting healthy aging. Instead, they are turning to botanical and dietary supplement (BDS) products in place of hormone therapy. This paper reviews the evidence available for use of isoflavones from soy and red clover for the treatment or prevention of these health issues. METHODS The MEDLINE and EMBASE databases were searched for articles relating to soy or red clover supplement use for prevention and/or treatment of heart disease, hyperlipidemia, osteoporosis, mood disorders and cognitive abilities. Studies were included if they were randomized, controlled trials and included peri- or postmenopausal women. RESULTS Isoflavone products appear to be the most useful for improving lipid profiles; however, the evidence suggests that isoflavone extracts from soy are less effective than products containing soy protein or red clover isoflavones. Soy protein appears to reduce levels of total cholesterol and low density lipoprotein cholesterol, while red clover reduces levels of triglycerides and increases high density lipoprotein cholesterol. The data were somewhat less convincing, although promising, for increasing bone mass density and improving cognitive abilities. CONCLUSIONS Research suggests that isoflavones found in soy foods and red clover appear to have a small but positive health effect on plasma lipid concentrations, bone mass density, and cognitive abilities. Given the lack of serious safety concerns in the short term, it would appear that including soy and red clover in the diet of postmenopausal women, not withstanding a soy allergy, might be beneficial.
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Affiliation(s)
- Stacie E. Geller
- Address Correspondence to: Stacie E. Geller, Ph.D., College of Medicine, 820 S. Wood Street (MC 808), University of Illinois, Chicago, Chicago, Illinois 60612, (312) 355-0467, (312) 996-4238 (fax),
| | - Laura Studee
- Department of Obstetrics and Gynecology, College of Medicine
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Schubert CM, Rogers NL, Remsberg KE, Sun SS, Chumlea WC, Demerath EW, Czerwinski SA, Towne B, Siervogel RM. Lipids, lipoproteins, lifestyle, adiposity and fat-free mass during middle age: the Fels Longitudinal Study. Int J Obes (Lond) 2006; 30:251-60. [PMID: 16247511 DOI: 10.1038/sj.ijo.0803129] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Although lipid profiles tend to worsen with age, it is not fully known if such age-related changes are influenced primarily by body composition and lifestyle or by other aspects of aging. OBJECTIVE We investigated the extent to which the fat and fat-free components of body mass index (BMI) and lifestyle factors influence patterns of change in lipids independent of age. DESIGN Serial data were analyzed using sex-specific longitudinal models. These models use serial data from individuals to assume a general pattern of change over time, while allowing baseline age and the rate of change to vary among individuals. SUBJECTS Serial data were obtained from 940 examinations of 269 healthy white participants (126 men, 143 women), aged 40-60 years, in the Fels Longitudinal Study. MEASUREMENTS Measurements included age, the fat (FMI) and fat-free mass (FFMI) components of BMI, high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), triglycerides (TG), total cholesterol (TC), fasting glucose and insulin, physical activity, alcohol use and smoking, and women's menopausal status and estrogen use. RESULTS In both sexes, increased FMI was significantly associated with increased LDL-C, TG and TC, and decreased HDL-C. Increased FFMI was significantly related to decreased HDL-C and increased TG. Independent age effects remained significant only for LDL-C and TC in men and TC in women. Increased insulin was significantly related to increased TG in women. Moderate alcohol consumption was associated with higher HDL-C in men. Physical activity lowered male LDL-C and TC levels, and increased female HDL-C levels. Menopause was associated with increases in LDL-C. Premenopausal women not using estrogen had significantly lower HDL-C, TG, and TC than postmenopausal women taking estrogen. CONCLUSIONS (1) Age is an important independent predictor for LDL-C and TC in men, and TC in women, but it is not as influential as body composition and lifestyle on HDL-C and TG in men and women, and LDL-C in women. (2) Increasing FMI is the major contributor to elevated TC, LDL-C and TG levels, and decreased HDL-C levels in men and women. (3) FFMI significantly influences HDL and TG levels in both sexes. (4) Maintaining a lower BMI via a reduced fat component may be more beneficial in lowering CVD risks than other factors.
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Affiliation(s)
- C M Schubert
- Lifespan Health Research Center, Department of Community Health, Wright State University School of Medicine, Dayton, OH 45420, USA.
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Nies LK, Cymbala AA, Kasten SL, Lamprecht DG, Olson KL. Complementary and alternative therapies for the management of dyslipidemia. Ann Pharmacother 2006; 40:1984-92. [PMID: 17047144 DOI: 10.1345/aph.1h040] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review the literature on select alternative therapies for the management of dyslipidemia. DATA SOURCES Searches of MEDLINE and PubMed (1965-March 2006) were conducted using the key terms omega-3-fatty acids, policosanol, plant stanols and sterols, flaxseed, red yeast rice, guggulipid, garlic, fiber, almonds, and cholesterol and/or lipids. STUDY SELECTION AND DATA EXTRACTION Meta-analyses, published in English and involving adults, that incorporated randomized, controlled trials on alternative therapies for dyslipidemia were reviewed. Additionally, trials published subsequent to the meta-analyses were reviewed. Articles deemed relevant were included in this review. DATA SYNTHESIS Of the aforementioned alternative therapies, randomized controlled trials were found for omega-3-fatty acids, policosanol, plant stanols and sterols, flaxseed, red yeast rice, guggulipid, garlic, fiber, almonds, and soy. Studies for each of these agents report varying degrees of lipid reduction. Based on published data, effective therapeutic options for lipid-lowering include intake of fiber, intake of plant stanols/sterols, replacement of animal protein with soy protein, and substitution of foods high in saturated fat with those with monounsaturated fatty acids (eg, dry roasted almonds). Adding omega-3-fatty acids is effective for reducing triglycerides in patients with hypertriglyceridemia. Well-designed studies with long-term outcome data are necessary to further define the role for guggul, red yeast rice, policosanol, garlic, and flaxseed in the management of dyslipidemia. CONCLUSIONS Alternative therapeutic approaches with complementary therapies are becoming increasingly popular among patients. It is important for healthcare providers to be familiar with the safety and efficacy of these agents to facilitate optimal outcomes for patients with dyslipidemia.
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Affiliation(s)
- Leslie K Nies
- Department of Pharmacy, Kaiser Permanente of Colorado, Aurora, CO 80011-9045, USA
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Sacks FM, Lichtenstein A, Van Horn L, Harris W, Kris-Etherton P, Winston M. Soy protein, isoflavones, and cardiovascular health: a summary of a statement for professionals from the american heart association nutrition committee. Arterioscler Thromb Vasc Biol 2006; 26:1689-92. [PMID: 16857959 DOI: 10.1161/01.atv.0000227471.00284.ef] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sacks FM, Lichtenstein A, Van Horn L, Harris W, Kris-Etherton P, Winston M. Soy protein, isoflavones, and cardiovascular health: an American Heart Association Science Advisory for professionals from the Nutrition Committee. Circulation 2006; 113:1034-44. [PMID: 16418439 DOI: 10.1161/circulationaha.106.171052] [Citation(s) in RCA: 370] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Soy protein and isoflavones (phytoestrogens) have gained considerable attention for their potential role in improving risk factors for cardiovascular disease. This scientific advisory assesses the more recent work published on soy protein and its component isoflavones. In the majority of 22 randomized trials, isolated soy protein with isoflavones, as compared with milk or other proteins, decreased LDL cholesterol concentrations; the average effect was approximately 3%. This reduction is very small relative to the large amount of soy protein tested in these studies, averaging 50 g, about half the usual total daily protein intake. No significant effects on HDL cholesterol, triglycerides, lipoprotein(a), or blood pressure were evident. Among 19 studies of soy isoflavones, the average effect on LDL cholesterol and other lipid risk factors was nil. Soy protein and isoflavones have not been shown to lessen vasomotor symptoms of menopause, and results are mixed with regard to soy's ability to slow postmenopausal bone loss. The efficacy and safety of soy isoflavones for preventing or treating cancer of the breast, endometrium, and prostate are not established; evidence from clinical trials is meager and cautionary with regard to a possible adverse effect. For this reason, use of isoflavone supplements in food or pills is not recommended. Thus, earlier research indicating that soy protein has clinically important favorable effects as compared with other proteins has not been confirmed. In contrast, many soy products should be beneficial to cardiovascular and overall health because of their high content of polyunsaturated fats, fiber, vitamins, and minerals and low content of saturated fat.
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Hilpert KF, Kris-Etherton PM, West SG. Lipid response to a low-fat diet with or without soy is modified by C-reactive protein status in moderately hypercholesterolemic adults. J Nutr 2005; 135:1075-9. [PMID: 15867284 DOI: 10.1093/jn/135.5.1075] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recent evidence suggests that individuals with high concentrations of C-reactive protein (CRP), a marker of inflammation, are less responsive to cholesterol-lowering diets. CRP concentrations are increased by oral estrogen; however, the effect of soy phytoestrogens on inflammation has not been studied comprehensively, especially in women receiving hormone replacement therapy (HRT). This study was conducted to determine whether adding soy to a low-fat, high-fiber diet affects CRP and interleukin (IL)-6, and to examine the association between CRP levels and lipid response in moderately hypercholesterolemic adults (men = 18, postmenopausal women = 14; 6 receiving HRT). After a 3-wk run-in period with consumption of a Step I diet (27% total fat, 7% saturated fat, 275 mg cholesterol), participants were randomly assigned to diets containing 25 g/d soy protein (+ 90 mg/d isoflavones) or 25 g/d milk protein for 6 wk in a crossover design. Lipids and lipoproteins, CRP, and IL-6 were measured at the end of each diet and participants were categorized into high (>3.5 mg/L) or low CRP groups based on a median split. The addition of soy or milk protein to the Step I diet did not affect lipids or inflammatory markers. Regardless of protein source, those with low CRP exhibited significant decreases in LDL cholesterol (-3.5%) and the LDL:HDL cholesterol ratio (-4.8%), whereas those with high CRP had significant increases in LDL cholesterol (+4.8%), the LDL:HDL cholesterol ratio (+5.2%), apolipoprotein B (+3.8%), and lipoprotein(a) (+13.5%) compared with the run-in diet. These results suggest that inflammation may not only attenuate lipid responses, but also aggravate dyslipidemia in hypercholesterolemic subjects consuming a cholesterol-lowering diet.
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Affiliation(s)
- Kirsten F Hilpert
- Department of Nutritional Sciences, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, USA.
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