Essential fatty acids and USDA's Food Guide Pyramid

The Effect of Soy Isoflavones on Steroid Metabolism

Objective: This study is a post-hoc analysis of steroid hormones before and after administration of pharmacological doses of soy isoflavones in a large cohort of men and women from two independent studies. Isoflavones are reported to inhibit mineralo- and glucocorticoid hormone production as well as reproductive steroids in vivo and in vitro. We focused on cytochrome P450 17α-hydroxylase (CYP17A1) which catalyses the production of dehydroepiandrosterone (DHEA), in the androgen biosynthesis pathway to elucidate effects on sex steroids in vitro. Design and Setting: Effects of soy isoflavones on steroid levels in two studies comprising 400 patients were examined: 200 men (study 1; 3 months duration) and 200 postmenopausal women (study 2; 6 months duration), randomized to consume 15 g soy protein with 66 mg isoflavones (SPI) or 15 g soy protein alone without isoflavones (SP) daily. Effects of genistein and daidzein on steroid metabolism were determined in vitro, in HEK293 cells expressing CYP17A1 and in the human adrenocortical carcinoma H295R cell model. Results: SPI decreased serum dehydroepiandrosterone sulfate (DHEAS) levels in both men and women (P < 0.01), with decreased androstenedione (A4) (P < 0.01) in women not observed in men (P < 0.86). Cortisol, cortisone, 11-deoxycortisol, aldosterone, testosterone (T), or estradiol (E2) levels were unchanged. The dual hydroxylase and lyase activity of CYP17A1, which catalyses the biosynthesis of androgen precursors, and 3β-hydroxysteroid dehydrogenase (3βHSD2) were investigated in vitro. In transiently transfected HEK293 cells, only the lyase activity was inhibited by both genistein, 20% (P < 0.001) and daidzein, 58% (P < 0.0001). In forskolin-stimulated H295R cells DHEA production was decreased by daidzein (P < 0.05) and genistein, confirming inhibition of the lyase activity by the isoflavones. Conclusion: In Vivo clinical data suggested inhibition of CYP17A1 17,20 lyase within the adrenal in men and within the ovary and adrenal in females. This was confirmed in vitro with inhibition of the lyase activity by both genistein and daidzein. In addition, 3βHSD2 was inhibited perhaps accounting for decreased A4 levels observed in females. The decreased DHEAS and A4 levels together with the inhibition of the 17,20 lyase activity of CYP17A1, may impact production of androgens in clinical conditions associated with androgen excess. ISRCTN number: ISRCTN55827330 ISRCTN number: ISRCTN 90604927.

Soy isoflavones improve cardiovascular disease risk markers in women during the early menopause

BACKGROUND

Hormone replacement therapy may be beneficial for cardiovascular disease risk (CVR) in post-menopausal women. Soy isoflavones may act as selective estrogen receptor modulators. The aim of this study was to evaluate whether soy isoflavones had an effect on CVR markers.

METHODS

The expected 10-year risk of cardiovascular disease and mortality were calculated as a secondary endpoint from a double blind randomised parallel study involving 200 women (mean age 55 years, Caucasian, Hull, UK, 2012) in the early menopause who were randomised to 15 g soy protein with 66 mg isoflavone (SPI) or 15 g soy protein alone (depleted of all isoflavones; SP) given as a snack bar between meals daily for 6 months. Age, diabetes, smoking, blood pressure and lipid profiles were used to calculate CVR using the Framingham CVR engine.

RESULTS

SPI treatment resulted in a significant reduction in the metabolic parameters and systolic blood pressure compared to SP (p < 0.01). There were no changes in fasting lipid profile and diastolic blood pressure with either treatment. At 6 months, changes in these parameters with SPI treatment were reflected in a calculated 27% (p < 0.01) reduction in 10 year coronary heart disease risk, a 37% (p < 0.01) reduction in myocardial infarction risk, a 24% (p < 0.04) reduction in cardiovascular disease and 42% (p < 0.02) reduction in cardiovascular disease death risk.

CONCLUSIONS

Supplementation with soy protein with isoflavones for 6 months significantly improved CVR markers and calculated CVR at 6 months during early menopause compared to soy protein without isoflavones.

ISRCTN REGISTRY

ISRCTN34051237.

The Effect of Phytoestrogen on Thyroid in Subclinical Hypothyroidism: Randomized, Double Blind, Crossover Study

Objective: Soy phytoestrogens are suggested to impair thyroid function but the effects of pharmacological doses of soy phytoestrogens are unknown; therefore, this study was performed to determine the effect of high dose soy phytoestrogens (66 mg) on thyroid function in subclinical hypothyroidism. Design and setting: Randomized, double-blind, crossover study. Participants: Forty four patients with subclinical hypothyroidism. Intervention: Participants were randomly allocated to either 66 mg phytoestrogen with 30 g soy protein (active) or 0 mg phytoestrogen with 30 g soy protein (placebo) supplementation for 8 weeks, washed out for 8 weeks and then crossed over for another 8 week period. Main outcome measures: The primary outcome was progression to overt hypothyroidism with the secondary outcome measures were changes in thyroid function tests. Results: Two patients in this trial progressed into overt hypothyroidism after high dose phytoestrogen supplementation. TSH, free thyroxine and triiodothyronine did not differ between groups. Conclusion: A pharmacological dose of 66 mg of soy phytoestrogens did not increase the overt thyroid failure rate or alter thyroid function tests in patients with subclinical hypothyroidism.

The Effect of High Dose Isoflavone Supplementation on Serum Reverse T3 in Euthyroid Men With Type 2 Diabetes and Post-menopausal Women

Background: The health benefits of soy are widely reported but there are queries on the effect of soy isoflavones on thyroid function and the underlying mechanism of action. Materials and Methods: We examined the effect of soy isoflavones on reverse tri-iodothyronine (or 3,3',5'-tri-iodothyronine; rT₃) in two studies comprising 400 patients: 200 men (study 1; 3 months) and 200 post-menopausal women (study 2; 6 months) who were randomized to consume 15 g soy protein with 66 mg of isoflavones (SPI) daily, or 15 g soy protein alone without isoflavones (SP) daily. Results: SPI supplementation increased rT₃ serum concentration in both men 0.41 (0.12) vs. 0.45 (0.14) nmol/L and women 0.33 (0.12) vs. 0.37 (0.09) nmol/L at 3 months compared to SP that was not seen at 6 months. Thyroid stimulating hormone (TSH) serum concentrations increased while free thyroxine (fT₄) concentrations decreased with 3 months of SPI compared to SP supplementation for both men and women. rT₃ correlated with TSH in both studies (p = 0.03) but not with either fT₃ or fT₄. fT₃ levels did not differ between the SPI and SP preparations. Conclusion: Soy isoflavones transiently increased rT3 levels within 3 months though reverted to baseline at 6 months. The mechanism for this would be either rT3 degrading deiodinase 1 and/or deiodinase 2 activities are transiently inhibited at 3 months, or inhibition of deiodinase 3, which generates rT3 from T4 is induced at 6 months. These changes were mirrored in the TSH concentrations, suggesting that short-term high dose isoflavone transiently impairs thyroid function in the first 3 months and may impact on general health during this period. ISRCTN Registry: ISRCTN 90604927; ISRCTN34051237.

Comparison of phytoestrogens dietary intake from vegetables and fruit in selected population in Slovakia

Phytoestrogens are compounds that are naturally present in almost all plant foods to a varying degree. They include several different classes of chemical compounds known as isoflavones, coumestans and lignans. In our work we analyzed intake of phytoestrogens is based upon our answer questionaries' in different ages. Evaluating health effects of phytoestrogens is difficult and depends on numerous factors, including the kind and dose (amount) of phytoestrogens eaten and the age, gender, and health of the person. We are exposed daily to highly variable amounts of phytoestrogens. While adults are eating a vegetarian diet or those taking dietary supplements containing phytoestrogens have high levels of exposure, infants drinking soy-based formula have the highest exposure levels by far. Accurate information about dietary phytoestrogens is therefore important but there is very limited data concerning food contents. In this study, we analyzed the phytoestrogen content in fresh and processed fruits and vegetables. The comprehensive database of phytoestrogen content determined simultaneously in vegetables and fruits foods has been developed. The important source of phytoestrogens in Slovak men and women is garlic. Phytoestrogen intake of fruits in men as an in woman is very low. Slovak populations consume a lot of fruits but the total intake is low due to the lower content of phytoestrogens.

Isoflavones, their Glycosides and Glycoconjugates. Synthesis and Biological Activity

Glycosylation of small biologically active molecules, either of natural or synthetic origin, has a profound impact on their solubility, stability, and bioactivity, making glycoconjugates attractive compounds as therapeutic agents or nutraceuticals. A large proportion of secondary metabolites, including flavonoids, occur in plants as glycosides, which adds to the molecular diversity that is much valued in medicinal chemistry studies. The subsequent growing market demand for glycosidic natural products has fueled the development of various chemical and biotechnological methods of glycosides preparation. The review gives an extensive overview of the processes of the synthesis of isoflavones and discusses recently developed major routes towards isoflavone-sugar formation processes. Special attention is given to the derivatives of genistein, the main isoflavone recognized as a useful lead in several therapeutic categories, with particular focus on anticancer drug design. The utility of chemical glycosylations as well as glycoconjugates preparation is discussed in some theoretical as well as practical aspects. Since novel approaches to chemical glycosylations and glycoconjugations are abundant and many of them proved suitable for derivatization of polyphenols a new body of evidence has emerged, indicating that sugar moiety can play a much more significant role, when attached to a pharmacophore, then being a mere “solubilizer”. In many cases, it has been demonstrated that semisynthetic glycoconjugates are much more potent cytostatic and cytotoxic agents than reference isoflavones. Moreover, the newly designed glycosides or glycoside mimics can act through different mechanisms than the parent active molecule.

Phytoestrogens dietary intake and health status of retiree from middle-north Slovakia region

Phytoestrogens found in foods of plant origin presents chemical substances that possess a wide range of biochemical benefits. It has been found that they contribute in different health related problems. A wide range of commonly consumed foods contain appreciable amounts of phytoestrogens. Consumption of diet rich to phytoestrogen acts as a protective factor against many diseases such as cardiovascular diseases, post-menopausal symptoms in the context of osteoporosis, cancerous illnesses of colon, prostate and breast. Three main classes of phytoestrogens covers: isoflavones, lignans and coumestans. Selected nine major phytoestrogens had been analyzed simultaneously in the same foods. Questionnaire designed to determine intake frequency as well as amount of selected foods and the most common diseases presented in the population has been used to find relationships between dietary habits and health status. Evaluation of selected goals in the present study has been realized in cooperation with 140 respondents in retired age (divided into Males - covered by 34 individuals and Females - 106 individuals), comming from middle-north Slovakia region. On the base of collected data it can be concluded, that evaluated population is presented by high values of lignans intake and particularly secoisolariciresinol, mainly caused by relative high proportion of cereals and linseed in the diet. Furthermore, the relationship between phytoestrogens intake and eating habits as well as its contribution in protection against selected diseases was demonstrated.

Hormonal and nonhormonal treatment of vasomotor symptoms

This article focuses on the cause, pathophysiology, differential diagnosis of, and treatment options for vasomotor symptoms. In addition, it summarizes important points for health care providers caring for perimenopausal and postmenopausal women with regard to health maintenance, osteoporosis, cardiovascular disease, and vaginal atrophy. Treatment options for hot flashes with variable effectiveness include systemic hormone therapy (estrogen/progestogen), nonhormonal pharmacologic therapies (selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitors, clonidine, gabapentin), and nonpharmacologic therapy options (behavioral changes, acupuncture). Risks and benefits as well as contraindications for hormone therapy are further discussed.

The higher plasma malondialdehyde concentrations are determined by metabolic syndrome-related glucolipotoxicity

This study aimed to elucidate the determinants of higher plasma malondialdehyde (MDA) in free-living adults. In a cross-sectional study we evaluated 148 free-living subjects (54 ± 11 years, 78% women) at high risk for or with metabolic syndrome (MetS). They were assessed by anthropometry and body composition, dietary intake, and clinical and laboratorial analysis. The analysis of plasma MDA was performed by HPLC, and concentration values were used to provide four groups according to percentile distribution. Subjects with higher plasma MDA showed higher prevalence of MetS and higher values of waist circumference (WC), glucose, triglycerides (TG), γ-glutamyltransferase (γ-GT), and higher energy intake. Multiadjusted logistic regression analysis identified as determinants of higher plasma MDA the altered values of WC and γ-GT followed by hypertriglyceridemia, hyperglycemia, insulin resistance, higher dietary sugar-intake, and presence of MetS. In conclusion, the glucolipotoxic state predisposed by the presence of MetS seems to be the major determinant of higher plasma MDA concentrations.

Phytoestrogens impact on menopausal symptomatology

CONFLICT OF INTEREST

none declared.

INTRODUCTION

The balance of endocrine and autocrine activity usually starts to fade after age of 45 years in women. This is particularly true for the imbalance of estrogen and progesterone. This imbalance creates a number of clinical syndromes and disorders.

GOAL

The goal of the study is to determine the effects of phytoestrogens on the psychological, somatic-vegetative and urogenital symptoms of menopause.

MATERIAL AND METHODS

The study included 275 respondents who are more than three in menopause. Respondents were taking commercially available phytoestrogens, in duration of 12 months.

RESULTS AND DISCUSSION

Review of clinical and epidemiological studies showing different results regarding effects of phytoestrogens on menopausal symptoms. In our study there was a significant reduction of somatic-vegetative and psychological symptoms under the influence of phytoestrogens, while urogenital symptomatology was not significantly changed. We recommend the use of phytoestrogens in early postmenopausal women with moderate symptoms.

Effects of phyto-oestrogens on tissues

Recent investigations on the effects of phyto-oestrogens on various tissues have revealed that these diverse molecules may improve human health, particularly by protecting against certain chronic diseases. After a brief examination of the food sources, structures, and general cellular actions of the major phyto-oestrogens, current research findings on cardiovascular disease, skeletal tissues, and reproductive cancers are reviewed. Phyto-oestrogen concentrations in blood may be maintained at high levels in those consuming soyabean (Glycine max)-based food daily at several meals and exert their effects on target cells through either genomic effects via the classical oestrogen receptors or non-genomic effects mediated by membrane-bound oestrogen receptors or other cellular proteins. The expression of oestrogen receptor (OR) subtypes alpha (a) and beta (beta) varies across tissues, and cells that preferentially express OR-beta, which may include bone cells, are more likely to respond to phyto-oestrogens. Conversely, reproductive tissues contain relatively more OR-a and may, thus, be differently affected by phyto-oestrogens. Soyabean phyto-oestrogens appear to prevent the progression of atherosclerosis through multiple interactions, including lowering of plasma lipids and lipoproteins, increased vasodilatation and, possibly, decreased activation of blood platelets and vascular smooth muscle cells. However, a favourable impact on cardiovascular disease morbidity and mortality by a soyabean-enriched western-type diet remains to be shown, and unresolved questions remain regarding dose and form of the phyto-oestrogens in relation to risks and benefits. The isoflavones of soyabean have been shown consistently to have bone-retentive effects in animal studies by several investigators using rodent models, although intakes must be above a relatively high threshold level for a lengthy period of time, and little or no extra benefit is observed with intakes above this threshold level. The reports of modest or no effects on prevention of bone loss in human and non-human primate studies respectively, may be due to the limited doses tested so far. The relationship between soyabean-food intake and cancer risk has been more extensively investigated than for any other disease, but with less certainty about the benefits of long-term consumption of phyto-oestrogen-containing foods on prevention of cancer. The observations that breast and prostate cancer rates are lower in Asian countries, where soyabean foods are consumed at high levels, and the high isoflavone content of soyabeans have led to examination of the potential protective effects of phyto-oestrogens. Establishing diet-cancer relationships has proved difficult, in part because of the conflicting data from various studies of effects of soyabean-diets on cancer. Epidemiological evidence, though not impressive, does suggest that soyabean intake reduces breast cancer risk. The isoflavone genistein has a potent effect on breast cancer cells in vitro, and early exposure of animals to genistein has been effective in reducing later development of mammary cancer. Thus, continuous consumption of soyabean foods in early life and adulthood may help explain the low breast cancer mortality rates in Asian countries. Although the evidence for a protective effect against prostate cancer may be slightly more supportive, more research is needed before any firm conclusions can be made about the phyto-oestrogen-cancer linkages.

Determination of phytoestrogens in dietary supplements by LC-MS/MS

Labelling data quantifying the exact content of individual phytoestrogen analytes in dietary supplements are generally poor. As these products are commonly used in the management of menopause symptoms, any clinical benefits would be dependent on the exact dosage of isoflavones received. Well-established extraction procedures and updated isotope dilution mass spectrometry liquid chromatography coupled with tandem mass spectrometry detection (LC-MS/MS) have been used to accurately quantify the concentrations of ten common isoflavones in 35 dietary supplement samples on sale in the UK, Canada and Italy. Concentration-specific ionization suppression is described for biochanin A and formononetin. All supplements contained phytoestrogens. The soya isoflavones (genistein, daidzein, glycitein) were present in all products and the majority also contained the red clover isoflavones (biochanin A, formononetin) and some the Kudzu isoflavones (daidzein, puerarin). The content of total isoflavones per dose ranged from <1 to 53 mg. Trace amounts of coumestrol were found in six products. Other less common analytes, the prenylnaringenins (6-prenylnaringenin, 8-prenylnaringenin, 6,8-diprenylnaringenin) were not found in any of the products. Only 14 of 35 supplements were found to deliver more than or equal to 40 mg day(-1) of aglycone isoflavones, a consensus dose value recognized as delivering therapeutic benefit. Eleven did not match label claims. Six delivered less than 10 mg day (-1) of isoflavones. There has been little improvement in the overall quality of industry labelling in the five years since this was last investigated. Consequently, the public, retailers and healthcare professionals should consider using standardized isoflavone supplements, which are supported by analytical measurements.

DNA damage, a biomarker of carcinogenesis: its measurement and modulation by diet and environment

Free radicals and other reactive oxygen or nitrogen species are constantly generated in vivo and can cause oxidative damage to DNA. This damage has been implicated to be important in many diseases, including cancer. The assessment of damage in various biological matrices, such as tissues, cells, and urine, is vital to understanding this role and subsequently devising intervention strategies. During the last 20 years, many analytical techniques have been developed to monitor oxidative DNA base damage. High-performance liquid chromatography-electrochemical detection and gas chromatography-mass spectrometry are the two pioneering contributions to the field. Currently, the arsenal of methods available include the promising high-performance liquid chromatography-tandem mass spectrometry technique, capillary electrophoresis, 32P-postlabeling, antibody-base immunoassays, and assays involving the use of DNA repair glycosylases such as the comet assay. The objective of this review is to discuss the biological significance of oxidative DNA damage, evaluate the effectiveness of several techniques for measurement of oxidative DNA damage in various biological samples and review current research on factors (dietary and non-dietary) that influence DNA oxidative damage using these techniques.

Estimated Asian adult soy protein and isoflavone intakes

There is substantial interest in the possible anticancer effects of soy foods. In part, this is because of the historically low incidence rates of breast and prostate cancer in Asia. Of the several putative soybean chemopreventive agents, isoflavones have received the most attention. Awareness of this research has led increasing numbers of consumers to use soy foods, isoflavone-fortified foods, and isoflavone supplements. Therefore, there is a need for guidance regarding appropriate isoflavone intake levels. To this end, this article analyzed soy protein (as a surrogate for isoflavones) and isoflavone intake of the major soy food-consuming countries using individual dietary surveys for the bulk of the information. In total, 24 surveys from 4 countries that met the inclusion criteria were identified: Japan (n = 11), China (n = 7), Hong Kong (n = 4), and Singapore (n = 2). The results indicate that older Japanese adults consume approximately 6-11 g of soy protein and 25-50 mg of isoflavones (expressed as aglycone equivalents) per day. Intake in Hong Kong and Singapore is lower than in Japan, whereas significant regional intake differences exist for China. Evidence suggests that < or =10% of the Asian population consumes as much as 25 g of soy protein or 100 mg of isoflavones per day. The applicability of these findings for making soy intake recommendations for non-Asians is discussed.

SULT1E1 genetic polymorphisms modified the association between phytoestrogen consumption and bone mineral density in healthy Korean women

Sulfotransferase 1E1 (SULT1E1) catalyze estrogen into sulfate conjugation and is involved in the metabolism of phytoestrogen. A community-based cross-sectional study was conducted on 397 Korean women, to evaluate the association between genetic polymorphisms of SULT1E1 and bone mineral density (BMD) and the combined effect of the genetic polymorphism and phytoestrogen intake for BMD in Korean women. BMDs of the distal radius and the calcaneus were measured by dual-energy X-ray absorptiometry. Genotypes of SULT1E1 IVS1-447 C>A, IVS4-1653 T>C, and *959 G>A were determined by the 5'-nuclease assay (TaqMan). Phytoestrogen intake was estimated by a food-frequency questionnaire validated against multiple 24-hour recalls. Women with the SULT1E1 *959 GG genotype had a 4.5% lower BMD at the distal radius (P (trend )= 0.05) and a 7.9% lower BMD at the calcaneus compared to those with AA genotype (P (trend) < 0.01), whereas the SULT1E1 IVS1-447 CC genotype and IVS4-1653 TT genotype were not associated with BMD. There was no significant trend of BMD with the numbers of CTG-containing haplotypes, but calcaneal BMDs significantly differed between SULT1E1 CTA-CTA haplotype and CTG-CCA haplotype (P < 0.05). When stratified by SULT1E1 genotype, the correlation between phytoestrogen consumption and BMD at the calcaneus was noteworthy in women with SULT1E1 *959 GG genotype (r = 0.25, P = 0.01) or SULT1E1 IVS 4-1653 TT genotype (r = 0.15, P = 0.02). This trend remained significant only in postmenopausal women (r = 0.36, P = 0.01) after multiple testing was corrected by the false discovery rate method. In conclusion, the genetic polymorphism of SULT1E1 *959 G > A was associated with BMD at the distal radius and calcaneus, and the association between phytoestrogen consumption and calcaneal BMD might be modified by this genetic polymorphism.

Phytoestrogens and colorectal cancer prevention

Because colorectal cancer (CRC) is a leading cause of cancer mortality in the Western industrialized world, future chemopreventive strategies will be of high socioeconomic importance. Lower CRC incidences in Far Eastern countries in part may be attributed to high nutritional intake of soy and its abundance in phytoestrogens. Phytoestrogens are plant-derived substances which, due to molecular similarities to endogenous estrogens, distinctly interact with estrogen receptors ERalpha and ERbeta. Both genomic and nongenomic mechanisms have been shown to be responsible for possible anticarcinogenic properties of phytoestrogens, such as induction of apoptosis and inhibition of tyrosine kinases and DNA topoisomerases. This chapter provides a comprehensive review of a variety of studies exploring possible relations between phytoestrogen uptake and CRC risk. While in vitro and animal studies in general are somewhat supportive of a protective role of phytoestrogens against CRC, epidemiological work so far performed does not allow any conclusion on this issue. Studies about mechanisms of phytoestrogenic action against CRC development have been evaluated as well. Because estrogens, vitamin D, and calcium are frequently suggested to be important in CRC prevention, studies concentrating on interactions of phytoestrogens with these substances have been performed. Although support in evidence for a protective effect of phytoestrogens against CRC has increased over the last decade, it is still too early to give a definite recommendation, especially in view of enduring inconsistencies about concentrations most likely to be effective. Further experimental, and particularly epidemiological, studies are required to advance our understanding of the role of phytoestrogens against colon carcinogenesis.

Determination of unusual soya and non-soya phytoestrogen sources in beer, fish products and other foods

Fish and fish products (14 samples), Indian foods and meals (10 samples), spices (30 samples) and beers (10 samples) were analysed for their phytoestrogen content, and a number of significant non-soya sources of dietary phytoestrogens were identified. No isoflavones were detected in unprocessed, farmed or ocean fish, but some samples of processed fish products contained soya isoflavones, which are assumed to come from coatings or protein addition. Additionally, some processed fish products contained, genistein glycocongugates not derived from soya. Genistein was detected in Indian meals such that, for example, a single portion of a vindalooo curry contained 11 mg genistein. The origin was most likely from the spices used, since the analysis of curry powders, chilli powder, crushed red chillies, garam masala and tandoori powder revealed that some contained genistein at more than 100 mg kg(-1). Cumin was the most likely source material, although not all individual samples of cumin tested contained high levels of genistein. Prenylnaringenin phytoestrogens were determined in UK hop-based beers at mean concentrations of 0.21 mg(-1) 6-prenylnaringenin and 0.06mg(-1) 8-prenylnaringenin. The beers also contained traces of daidzein, genistein and biochanin A. The significance of 'hidden soya' in processed foods and these non-soya sources of phytoestrogens is that UK dietary intake of phytoestrogens must be assumed to be higher than estimated previously and that some sources of phytoestrogens remain poorly characterized.

Dietary phytoestrogen intake and premenopausal breast cancer risk in a German case-control study

A diet high in isoflavonoids (soy) is associated with lower breast cancer risk in Asian populations. Due to the low soy intake, dietary lignans may be the more important phytoestrogen class in Western populations. We used a population-based case-control study of breast cancer by age 50 in southern Germany to evaluate the association between dietary intake of different phytoestrogens and premenopausal breast cancer risk. Dietary information was collected from 278 premenopausal cases and 666 age-matched controls, using a validated FFQ. Using multivariate logistic regression, the highest vs. lowest intake quartiles of daidzein and genistein yielded significantly reduced ORs (95% CI) for breast cancer risk of 0.62 (0.40-0.95) and 0.47 (0.29-0.74), respectively. The protective effects of daidzein and genistein were found only for hormone receptor-positive tumors. High intake of other isoflavonoids, e.g., formononetin and biochanin A, as well as the sum of isoflavonoids were not associated with a decrease in risk. Breast cancer risk significantly decreased with a high intake of the plant lignan matairesinol (OR = 0.58, 95% CI 0.37-0.94) but not secoisolariciresinol or the sum of plant lignans. However, both estimated mammalian lignans, enterodiol and enterolactone, were inversely associated with breast cancer risk, with ORs (95% CI) of 0.61 (0.39-0.98) and 0.57 (0.35-0.92), respectively. No effect was found for total phytoestrogen intake. Our results suggest an important role of dietary intake of daidzein and genistein, despite low levels, as well as of matairesinol and mammalian lignans to reduce premenopausal breast cancer risk in this study population.

Soy Isoflavones Do Not Modulate Prostate-Specific Antigen Concentrations in Older Men in a Randomized Controlled Trial

Mortality rates for prostate cancer are low in Asia but high in the West. One explanation is the high level of soy consumption in Asia. Soy isoflavones reduce prostate tumor growth in many, but not all, animal models. Elevated levels of serum prostate-specific antigen (PSA) are a marker of prostate tumor growth. Our objective was to determine whether 12-month soy isoflavone supplementation would alter serum PSA concentrations in healthy, older men. The parent study was a double-blinded, parallel-arm, randomized trial in which participants were assigned to consume either a soy protein drink providing 83 mg/day isoflavones (+ISO) or a similar drink with isoflavones removed (−ISO). Participants in the parent study were 85% men. Of the 128 men enrolled in the trial, 112 completed. These men were later contacted for consent to allow their stored sera to be analyzed for PSA and 81 men consented. We measured PSA in serum collected at 0 and 12 months using a commercial radioimmunometric assay. Serum PSA concentrations increased in both groups over the 12-month intervention, but the changes were similar: Geometric mean PSA concentration increased 0.5% more in the +ISO group than in the −ISO group (P = 0.94; 95% confidence interval = −17.3 to 22.2). The proportion of participants having a serum PSA velocity greater than 1 ng/ml/year was similar in the +ISO and −ISO groups (17.6% versus 12.8%; P = 0.54). We found no evidence that a 12-month 83 mg/day isoflavone treatment alters serum PSA concentration or velocity in seemingly healthy men aged 50–80 years.

Dietary exposure estimates of isoflavones from the 1998 UK Total Diet Study

The phyto-oestrogen contents of the 1998 UK Total Diet Study (TDS) food group composites were determined. Each TDS set consisted of composite samples, one for each of the 20 designated food groups. These composites then represented the average consumption of all the individual food elements in each group, processed into the form in which they were consumed. In the TDS, individual composites of the bread, processed meat and fish food groups contained >5 mg kg(-1) of the individual isoflavones (daidzein, genistein and glycitein). Individual composites from the groups, miscellaneous cereals, other vegetables, fruit products and nuts contained >1 mg kg(-1). After weighting for average consumption of food from each TDS food group, an estimated daily intake of 3 mg day(-1) of combined isoflavone aglycones was obtained from the TDS sample collection model for the average (adult) consumer. The UK dietary intake of phyto-oestrogens is higher than previously estimated due in part to the use of soya in processed foods.

Phyto-oestrogens and osteoporosis: what is a safe dose?

Hormone replacement therapy (HRT) for preventing loss of bone following the menopause is utilised by only 8-10 % of possible users, largely due to a fear of increased risk of breast cancer. Plant oestrogen-like compounds (phyto-oestrogens) have been proposed as an alternative to HRT to prevent osteoporosis. One class of phyto-oestrogens (the isoflavones) is found in soya foods and red clover. The food industry is developing a wide variety of new foods containing soya to substantially increase isoflavone intake, as well as extracting isoflavones from soya and clover to use as additives to non-soya foods. Pharmaceutical companies are also preparing isoflavone extracts to be used in pill form. In each case the targeted delivery is approximately 50 mg of isoflavones/d. Is this dose of isoflavones safe? In this review of the current literature, it is concluded that isoflavones consumed orally and in doses below 2 mg/kg body weight per d should be considered safe for most population groups. Whether these doses are sufficient to prevent osteoporosis is a separate matter.

Inhibitory effects of isoflavones on nitric oxide- or peroxynitrite-mediated DNA damage in RAW 264.7 cells and phiX174 DNA

The inhibitory effects of isoflavones (genistin, daidzin and their aglycones genistein, daidzein) on sodium nitroprusside (SNP; nitric oxide donor)- or peroxynitrite-mediated DNA damage in intact cells and in plasmid DNA was investigated. RAW 264.7 cells, a murine macrophage cell line, are capable of producing nitric oxide and superoxide anion. However, macrophages themselves are also shown to be more sensitive to nitric oxide or peroxynitrite, and were therefore used in these studies. Results from single-cell gel electrophoresis (the comet assay) showed that these isoflavones, at the concerning of 25-200 microM, inhibited the induction of nitric oxide- or peroxynitrite-mediated macrophage genotoxicity, with genistein showing the greatest inhibition. Genistein and daidzein, at a concentration of 1-25 microm, dose-dependently inhibited peroxynitrite-induced phiX174 DNA degradation based on the results of agarose gel electrophoretic analysis. Although SNP could increase the cellular GSH level, no significant differences in the glutathione content or the GSH:GSSG ratio were observed for genistein and daidzein in the presence or absence of SNP as compared with SNP-only treated RAW 264.7 cells. Exposure of RAW 264.7 cells to SNP caused the enzyme activities of GSH peroxidase, GSH reductase and catalase decrease to 44, 20 and 34% of that of untreated cells, respectively. On the contrary, exposure of RAW 264.7 cells to SNP in the presence of 100 microm of genistein or daidzein caused the enzyme activities of GSH peroxidase, GSH reductase and catalase decrease to 18, 9 and 12% (genistein) or 13, 9 and 19% (daidzein) of that of untreated cells, respectively. These results suggest that the inhibition by isoflavones of SNP- or peroxynitrite- mediated DNA damage could be attributed to their nitric oxide or peroxynitrite scavenging activities and their prevention of antioxidant enzyme inactivation.

Isoflavone aglycon and glucoconjugate content of high- and low-soy U.K. foods used in nutritional studies

The isoflavone aglycon and glucoconjugate content of commercially prepared and "home-prepared" high- and low-soy foods selected for use in an on-going nutritional study were measured by LC-MS. The daidzin, daidzein, 6"-O-malonyldaidzin, 6"-O-acetyldaidzin, genistein, genistin, 6"-O-malonylgenistin, 6"-O-acetylgenistin, glycitin, glycitein, 6"-O-malonylglycitin, and 6"-O-acetylglycitin content are expressed in terms of individual isoflavones, total isoflavone equivalents, and milligrams of isoflavones per portion served. Soybeans (774 mg x kg(-1) total isoflavones) and soybean-containing foods had the highest isoflavone content of the foods examined. The low-soy foods all contained very low concentrations (<8 mg x kg(-1) total isoflavones) of the isoflavone aglycons and glucoconjugates. High- and low-soy 11 day rotating menus were constructed from the analyzed foods to deliver 100.0 and 0.5 mg of isoflavones per day, respectively.

Soya intake and plasma concentrations of daidzein and genistein: validity of dietary assessment among eighty British women (Oxford arm of the European Prospective Investigation into Cancer and Nutrition)

Soya products contain high levels of the isoflavones genistein and daidzein, and their glucosides, and may lower the risk of cardiovascular disease, osteoporosis and cancer. The present cross-sectional study investigated plasma concentrations of daidzein and genistein and their correlations with dietary soya consumption in four groups of twenty premenopausal British women. The women were selected from the Oxford arm of the European Prospective Investigation into Cancer and Nutrition using data from food-frequency questionnaires (FFQ) to guarantee a wide variation in soya consumption, and to investigate the utility of the question related to soya milk consumption compared with the utility of the question related to other soya foods. Dietary intakes of isoflavones were additionally assessed by 7 d food diaries. Plasma concentrations of daidzein and genistein were measured by time-resolved fluoroimmunoassay. Geometric mean plasma concentrations (nmol/l) were for the four groups, which were based on increasing soya intake, 4.9, 8.4, 39.2 and 132 for daidzein and 14.3, 16.5, 119 and 378 for genistein. The Spearman correlation coefficients for plasma isoflavone concentrations with estimated dietary intakes were between 0.66 and 0.80 for the diary-based estimates and between 0.24 and 0.74 for the FFQ-based estimates. The correlations for soya milk intakes were clearly higher than the correlations for intakes of other soya foods. We conclude that both the food diary and the FFQ estimate dietary soya isoflavone intakes sufficiently well to use them in epidemiological studies, and that plasma concentrations of daidzein and genistein in Western women who consumed soya products as a part of their regular diet were close to those in Asian populations.

Soy isoflavone supplementation in healthy men prevents NF-kappa B activation by TNF-alpha in blood lymphocytes

Dietary intake of soy has been associated with a decreased risk of cancer. Soy isoflavones have been postulated to be the protective compounds in soybeans; however, the precise mechanism by which soy isoflavones prevent human cancer is not known. The major soy isoflavones, genistein and daidzein, are antioxidant compounds, therefore one possible mechanism of action is through their antioxidant effect. We have previously demonstrated that the soy isoflavone, genistein, inhibits the activation of the redox-sensitive transcription factor, NF-kappa B, in prostate cancer cells in vitro. In this study, we have demonstrated that genistein, but not daidzein, inhibits TNF-alpha-induced NF-kappa B activation in cultured human lymphocytes. Additionally, we investigated the in vivo effect of soy isoflavone supplementation on NF-kappa B activation induced by TNF-alpha in vitro in peripheral blood lymphocytes of six healthy men. We show that healthy male subjects receiving 50 mg isoflavone mixture (Novasoy) twice daily for 3 weeks are protected from TNF-alpha induced NF-kappa B activation. Additionally, we observed a reduction of 5-hydroxymethyl-2'-deoxyuridine (5-OHmdU), a marker for oxidative DNA damage, following isoflavone supplementation. The inhibitory effect of soy isoflavones was no longer present 3 months after the supplementation. This preliminary study demonstrates that soy isoflavone supplementation may protect cells from oxidative stress-inducing agents by inhibiting NF-kappa B activation and decreasing DNA adduct levels.

Soy milk intake and plasma sex hormones: a cross-sectional study in pre- and postmenopausal women (EPIC-Oxford)

Soy beans contain high levels of the isoflavones genistein and daidzein and their glucosides. We investigated the relationship between soy milk intake and plasma concentrations of estradiol, sex hormone-binding globulin, and, in premenopausal women, follicle-stimulating hormone, luteinizing hormone, and progesterone in a cross-sectional study of 636 premenopausal and 456 postmenopausal British women. Sixty-five percent of the women were vegetarians or vegans. Data on soy milk intake and other factors were obtained from a validated food frequency questionnaire, hormone concentrations were measured by immunoassays, and variations in geometric means were compared using analysis of covariance. We observed no statistically significant trends or meaningful associations between soy milk intake and circulating sex hormones. Adjusting for factors possibly affecting circulating hormone concentrations did not materially alter the results. We conclude that soy milk intake does not change plasma concentrations of sex hormones in pre- or postmenopausal British women who consume soy milk as a part of their regular diet.

Isoflavonoids do not inhibit in vivo lipid peroxidation in subjects with high-normal blood pressure

The isoflavonoids genistein and daidzein have been shown to have antioxidant activity in vitro, but their effects on in vivo oxidation have not been assessed. The newly described F2-isoprostanes are believed to currently represent the best available marker of in vivo lipid peroxidation. Therefore we have assessed the effects of a 55 mg daily isoflavonoid supplement on urinary F2-isoprostane concentrations in subjects with high-normal blood pressure (BP). A total of 59 subjects completed an 8-week parallel design, randomized, double blind, and placebo-controlled study. F2-isoprostanes, isoflavonoids and creatinine were measured in 24-h urine samples taken at baseline and at the end of the intervention. There were significant increases in urinary excretion of genistein (5.22+/-0.75 mg/day, P < 0.0001) and daidzein (2.53+/-0.43 mg/day, P < 0.0001) in the group taking the isoflavonoid supplement. Creatinine excretion was significantly correlated with F2-isoprostanes at baseline (r = 0.45, P < 0.01). After adjustment for baseline values, there was no significant difference between groups in creatinine adjusted post-intervention F2-isoprostane concentrations (P = 0.74). In addition, changes in genistein and daidzein excretion were not significantly correlated with changes in F2-isoprostanes in the isoflavonoid treatment group. These results are not consistent with the suggestion that the two soy derived isoflavonoids have in vivo antioxidant activity at a level of intake achievable by dietary means and in subjects with high-normal BP.

Development of a soy food frequency questionnaire to estimate isoflavone consumption in US adults

OBJECTIVE

To develop a dietary assessment instrument to measure soy food consumption and isoflavone intake and test it for reliability.

DESIGN

A soy food frequency questionnaire, designed for use in this study, was administered twice to participants, separated by a 2-week interval. The questionnaire was tested for reproducibility of estimates of soy food consumption and isoflavone (genistein and daidzein) intake.

SUBJECTS/SETTING

A convenience sample of 51 faculty, staff, and students was recruited from a naturopathic university.

STATISTICAL ANALYSES PERFORMED

Intraclass correlation coefficients were used to assess reproducibility of estimates of soy food intake and genistein and daidzein intake.

RESULTS

Correlation coefficients comparing mean soy food servings per month between the 2 administrations of the questionnaire ranged from 0.50 for soy yogurt to 0.89 for tempeh. Correlation coefficients for genistein and daidzein intake estimated by the 2 administrations of the questionnaire were the same: 0.89. Mean intake (+/- standard deviation) of genistein and daidzein was 7 +/- 10 and 4 +/- 6 mg/day, respectively. Fifteen soy foods contributed 95% of the total genistein and daidzein intake: tofu, soy yogurt, tempeh, soy milk, low-fat tofu, soy flour, miso, soy protein isolate, low-fat soy milk, veggie soy burger, textured vegetable protein, miso soup, cooked soybeans, soy hot dogs, and natto (fermented soy beans).

APPLICATIONS

The soy food frequency questionnaire developed in this study provided highly reproducible estimates of soy food consumption and isoflavone intake. This instrument may be a useful tool in studies of the associations between isoflavone exposure and risk for chronic disease.

Dietary intake and sources of isoflavones among Japanese

We examined the dietary intake and sources of isoflavones (daidzein and genistein) among Japanese subjects based on dietary records (DRs). The subjects comprised two groups: 1,232 who completed one-day DRs (Group 1) and 88 men and women who kept four four-day (16-day) DRs. For quantitative data on the level of daidzein and genistein in soy foods, we extensively reviewed the literature, particularly for Japanese soy foods, and adopted the median value for each food. The median intake of daidzein was 12.1 and 9.5 mg/day among Groups 1 and 2, respectively, while the corresponding values for genistein were 19.6 and 14.9 mg/day. The top four foods (tofu, miso, natto, and fried tofu) covered about 90% of the population intake of daidzein and genistein. It did not seem feasible to estimate one's intake of isoflavones by using dietary recording/recall in epidemiological studies, since the day-to-day variation in intake was too large, the within-person coefficient of variation being 89.1% for daidzein and genistein. Therefore, we should use other methods, such as food-frequency questionnaires, focusing on the four major sources of isoflavones, to assess individual isoflavone intake.

Phyto-oestrogens: where are we now?

Phyto-oestrogens have emerged from their esoteric role in animal husbandry following the hypothesis that the human Western diet is relatively deficient in these substances compared with societies where large amounts of plant foods and legumes are eaten. Evidence is beginning to accrue that they may begin to offer protection against a wide range of human conditions, including breast, bowel, prostate and other cancers, cardiovascular disease, brain function, alcohol abuse, osteoporosis and menopausal symptoms. Of the two main classes of these weak oestrogens, the isoflavones are under intensive investigation due to their high levels in soyabean. Like the 'anti-oestrogen' Tamoxifen, these seem to have oestrogenic effects in human subjects in the cardiovascular system and bone. Although previously only available from food, isoflavones are now being marketed in health-food supplements or drinks, and tablets may soon be available over the counter as 'natural' hormone-replacement therapy. In cancer, anti-oestrogenic effects are thought to be important, although genistein especially has been shown to induce wide-ranging anti-cancer effects in cell lines independent of any hormone-related influence. There are few indications of harmful effects at present, although possible proliferative effects have been reported. In infants, the effects of high levels in soya milk formulas are uncertain. The second group, lignans, have been less investigated despite their known antioestrogenic effects and more widespread occurrence in foods. Investigation of the possible benefits of phyto-oestrogens is hampered by lack of analytical standards and, hence, inadequate methods for the measurement of low levels in most foods. This problem may prove to be a major dilemma for regulatory authorities, clinicians and others wishing to advise the general public on whether these compounds really do have the health benefits attributed to them.

Supplementation with isoflavonoid phytoestrogens does not alter serum lipid concentrations: a randomized controlled trial in humans

Isoflavonoids are a class of flavonoids that are derived in the human diet mainly from soybean-based foods. The major dietary isoflavonoids, genistein and daidzein, have estrogen-like activity and are classed as phytoestrogens. Because estrogens can lower serum LDL cholesterol and raise HDL cholesterol, the objective of this study was to determine if isoflavonoids could improve serum lipids in healthy subjects. Forty-six men and 13 postmenopausal women not receiving hormone replacement therapy completed a randomized, double-blind, placebo-controlled trial of two-way parallel design and 8 wk duration. One tablet containing 55 mg of isoflavonoids (predominantly in the form of genistein) or one placebo tablet was taken daily with the evening meal. Subjects maintained their usual diet and physical activity, which were unchanged throughout the intervention. Measurement of isoflavonoids and their metabolites in 24-h urine samples provided an assessment of compliance and of isoflavonoid metabolism. Serum total, LDL, HDL and HDL subclass cholesterol, triglycerides and lipoprotein (a) were assessed at baseline and during the last week of intervention. After adjustment for baseline values, no significant differences in postintervention serum lipid and lipoprotein (a) concentrations between groups were identified. Further adjustment for age, gender and weight change did not alter the results. In addition, changes in urinary isoflavonoids were not significantly correlated with changes in serum lipids and lipoprotein (a). Therefore, this study does not support the hypothesis that isoflavonoid phytoestrogens can improve the serum lipids, at least in subjects with average serum cholesterol concentrations.

Exposure of infants to phyto-oestrogens from soy-based infant formula

BACKGROUND

The isoflavones genistein, daidzein, and their glycosides, found in high concentrations in soybeans and soy-protein foods, may have beneficial effects in the prevention or treatment of many hormone-dependent diseases. Because these bioactive phyto-oestrogens possess a wide range of hormonal and non-hormonal activities, it has been suggested that adverse effects may occur in infants fed soy-based formulas.

METHODS

To evaluate the extent of infant exposure to phyto-oestrogens from soy formula, the isoflavone composition of 25 randomly selected samples from five major brands of commercially available soy-based infant formulas were analysed, and the plasma concentrations of genistein and daidzein, and the intestinally derived metabolite, equol, were compared in 4-month-old infants fed exclusively soy-based infant formula (n = 7), cow-milk formula (n = 7), or human breast-milk (n = 7).

FINDINGS

All of the soy formulas contained mainly glycosides of genistein and daidzein, and the total isoflavone content was similar among the five formulas analysed and was related to the proportion of soy isolate used in their manufacture. From the concentrations of isoflavones in these formulas (means 32-47 micrograms/mL), the typical daily volume of milk consumed, and average bodyweight, a 4-month-old infant fed soy formula would be exposed to 28-47 per day, or about 4.5-8.0 mg/kg bodyweight per day, of total isoflavones. Mean (SD) plasma concentrations of genistein and daidzein in the seven infants fed soy-based formulas were 684 (443) ng/mL and 295 (60) ng/mL, respectively, which was significantly greater (p < 0.05) than in the infants fed either cow-milk formulas (3.2 [0.7] and 2.1 [0.3] ng/mL), or human breast-milk (2.8 [0.7] and 1.4 [0.1] ng/mL), and an order of magnitude higher per bodyweight than typical plasma concentrations of adults consuming soy foods.

INTERPRETATION

The daily exposure of infants to isoflavones in soy infant-formulas is 6-11 fold higher on a bodyweight basis than the dose that has hormonal effects in adults consuming soy foods. Circulating concentrations of isoflavones in the seven infants fed soy-based formula were 13000-22000 times higher than plasma oestradiol concentrations in early life, and may be sufficient to exert biological effects, whereas the contribution of isoflavones from breast-milk and cow-milk is negligible.

Phyto-oestrogens and Western diseases

Incidences of breast, colorectal and prostate cancer are high in the Western world compared to countries in Asia. We have postulated that the Western diet compared to the semivegetarian diet in some Asian countries may alter hormone production, metabolism or action at the cellular level by some biochemical mechanisms. Our interest has been focused on two groups of hormone-like diphenolic phyto-oestrogens of dietary origin, the lignans and isoflavonoids abundant in plasma of subjects living in areas with low cancer incidence. The precursors of the biologically active compounds detected in man are found in soybean products, whole-grain cereal food, seeds, and berries. The plant lignan and isoflavonoid glycosides are converted by intestinal bacteria to hormone-like compounds. The weakly oestrogenic diphenols formed influence sex-hormone production, metabolism and biological activity, intracellular enzymes, protein synthesis, growth factor action, malignant cell proliferation, differentiation, cell adhesion and angiogenesis in such a way as to make them strong candidates for a role as natural cancer-protective compounds. Their effect on some of the most important steroid biosynthetic enzymes may result in beneficial modulation of hormone concentrations and action in the cells preventing development of cancer. Owing to their oestrogenic activity they reduce hot flushes and vaginal dryness in postmenopausal women and may to some degree inhibit osteoporosis, but alone they may be insufficient for complete protection. Soy intake prevents oxidation of the low-density lipoproteins in vitro when isolated from soy-treated individuals and affect favourably plasma lipid concentrations. Animal experiments provide evidence suggesting that both lignans and isoflavonoids may prevent the development of cancer as well as atherosclerosis. However, in some of these experiments it has not been possible to separate the phyto-oestrogen effect from the effect of other components in the food. The isoflavonoids and lignans may play a significant inhibitory role in cancer development particularly in the promotional phase of the disease, but recent evidence points also to a role in the initiation stage of carcinogenesis. At present, however, no definite recommendations can be made as to the dietary amounts needed for prevention of disease. This review deals with all the above-mentioned aspects of phyto-oestrogens.