1
|
Wang S, Hu Y, Liu B, Li Y, Wang M, Sun Q. Lignan Intake and Type 2 Diabetes Incidence Among US Men and Women. JAMA Netw Open 2024; 7:e2426367. [PMID: 39110458 PMCID: PMC11307137 DOI: 10.1001/jamanetworkopen.2024.26367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 06/09/2024] [Indexed: 08/10/2024] Open
Abstract
Importance Lignans are phytoestrogens abundant in Western diets and may be associated with type 2 diabetes (T2D) risk. Objective To prospectively investigate associations between lignan intake and T2D incidence. Design, Setting, and Participants Population-based cohort study of US men and women enrolled in the Nurses' Health Study (NHS, 1984-2018), NHSII (1991-2019), and Health Professionals Follow-Up Study (HPFS, 1986-2020), as well as 496 participants from the Men's Lifestyle Validation Study (MLVS). Participants were free of T2D, cardiovascular disease, and cancer at baseline. Data were analyzed from November 2022 to July 2023. Exposures Total and individual lignans were assessed using a validated food frequency questionnaire, which was updated every 2 to 4 years. In the MLVS, lignan intake was measured using 2 sets of 7-day diet records (7DDRs). Main Outcomes and Measures Incident T2D cases were confirmed using American Diabetes Association diagnostic criteria. Cox proportional hazards models were used to assess multivariable-adjusted associations. Results The current study included 201 111 participants (mean [SD] age, 44.7 [10.1] years; 161 169 female participants [80.2%]; 2614 African American participants [1.3%], 1609 Asian participants [0.8%], 2414 Hispanic and other race or ethnicity participants [1.2%], and 194 474 White participants [96.7%]) from the HPFS, NHS, and NHSII studies. The median (IQR) total lignan intake of the highest quintile ranged from 355.1 (330.2-396.9) μg/d in NHS to 459.9 (422.2-519.5) μg/d in HPFS at the median follow-up time. Over 5 068 689 person-years, 20 291 incident cases of T2D were identified. Higher lignan intake was inversely associated with T2D incidence, except for lariciresinol. The multivariable-adjusted pooled hazard ratios (HRs) for the highest vs lowest quintiles were 0.87 (95% CI, 0.83-0.91) for total lignans, 0.72 (95% CI, 0.69-0.76) for secoisolariciresinol, 0.92 (95% CI, 0.87-0.96) for pinoresinol, 0.93 (95% CI, 0.89-0.98) for matairesinol, and 0.99 (95% CI, 0.94-1.04) for lariciresinol. Secoisolariciresinol intake exhibited a significant inverse association with T2D risk among individuals with obesity (HR, 0.75 for body mass index [BMI] ≥30; 95% CI, 0.71-0.79 vs HR, 0.82 for BMI <25; 95% CI, 0.81-0.83; P < .001 for interaction) and premenopausal women (HR, 0.67 for premenopausal women; 95% CI, 0.65-0.69 vs HR, 0.82 for the past use of hormones; 95% CI, 0.76-0.88; P = .003 for interaction). Dietary lignan assessed with 7DDRs was associated with lower HbA1c levels (percentage change range from -0.92% to 1.50%), as well as lower C-reactive protein levels and better lipid profiles. Conclusions and Relevance This cohort study found that long-term lignan consumption was associated with a lower T2D risk, particularly among individuals with obesity and premenopausal women.
Collapse
Affiliation(s)
- Siyue Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yang Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Binkai Liu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Yanping Li
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Molin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Joslin Diabetes Center, Boston, Massachusetts
| |
Collapse
|
2
|
Messina M, Mejia SB, Cassidy A, Duncan A, Kurzer M, Nagato C, Ronis M, Rowland I, Sievenpiper J, Barnes S. Neither soyfoods nor isoflavones warrant classification as endocrine disruptors: a technical review of the observational and clinical data. Crit Rev Food Sci Nutr 2021; 62:5824-5885. [PMID: 33775173 DOI: 10.1080/10408398.2021.1895054] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Soybeans are a rich source of isoflavones, which are classified as phytoestrogens. Despite numerous proposed benefits, isoflavones are often classified as endocrine disruptors, based primarily on animal studies. However, there are ample human data regarding the health effects of isoflavones. We conducted a technical review, systematically searching Medline, EMBASE, and the Cochrane Library (from inception through January 2021). We included clinical studies, observational studies, and systematic reviews and meta-analyses (SRMA) that examined the relationship between soy and/or isoflavone intake and endocrine-related endpoints. 417 reports (229 observational studies, 157 clinical studies and 32 SRMAs) met our eligibility criteria. The available evidence indicates that isoflavone intake does not adversely affect thyroid function. Adverse effects are also not seen on breast or endometrial tissue or estrogen levels in women, or testosterone or estrogen levels, or sperm or semen parameters in men. Although menstrual cycle length may be slightly increased, ovulation is not prevented. Limited insight could be gained about possible impacts of in utero isoflavone exposure, but the existing data are reassuring. Adverse effects of isoflavone intake were not identified in children, but limited research has been conducted. After extensive review, the evidence does not support classifying isoflavones as endocrine disruptors.
Collapse
Affiliation(s)
- Mark Messina
- Department of Nutrition, Loma Linda University, Loma Linda, California, USA
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Aedin Cassidy
- Nutrition and Preventive Medicine, Queen's University, Belfast, Northern Ireland, UK
| | - Alison Duncan
- College of Biological Sciences, University of Guelph, Guelph, Canada
| | - Mindy Kurzer
- Department of Food Science and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Chisato Nagato
- Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Martin Ronis
- Health Sciences Center, Louisiana State University Health Sciences Center, Baton Rouge, New Orleans, USA
| | - Ian Rowland
- Human Nutrition, University of Reading, Reading, England, UK
| | | | - Stephen Barnes
- Department of Pharmacology and Toxicology, University of Alabama, Alabama, USA
| |
Collapse
|
3
|
Domínguez-López I, Yago-Aragón M, Salas-Huetos A, Tresserra-Rimbau A, Hurtado-Barroso S. Effects of Dietary Phytoestrogens on Hormones throughout a Human Lifespan: A Review. Nutrients 2020; 12:E2456. [PMID: 32824177 PMCID: PMC7468963 DOI: 10.3390/nu12082456] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/31/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023] Open
Abstract
Dietary phytoestrogens are bioactive compounds with estrogenic activity. With the growing popularity of plant-based diets, the intake of phytoestrogen-rich legumes (especially soy) and legume-derived foods has increased. Evidence from preclinical studies suggests these compounds may have an effect on hormones and health, although the results of human trials are unclear. The effects of dietary phytoestrogens depend on the exposure (phytoestrogen type, matrix, concentration, and bioavailability), ethnicity, hormone levels (related to age, sex, and physiological condition), and health status of the consumer. In this review, we have summarized the results of human studies on dietary phytoestrogens with the aim of assessing the possible hormone-dependent outcomes and health effects of their consumption throughout a lifespan, focusing on pregnancy, childhood, adulthood, and the premenopausal and postmenopausal stages. In pregnant women, an improvement of insulin metabolism has been reported in only one study. Sex hormone alterations have been found in the late stages of childhood, and goitrogenic effects in children with hypothyroidism. In premenopausal and postmenopausal women, the reported impacts on hormones are inconsistent, although beneficial goitrogenic effects and improved glycemic control and cardiovascular risk markers have been described in postmenopausal individuals. In adult men, different authors report goitrogenic effects and a reduction of insulin in non-alcoholic fatty liver patients. Further carefully designed studies are warranted to better elucidate the impact of phytoestrogen consumption on the endocrine system at different life stages.
Collapse
Affiliation(s)
- Inés Domínguez-López
- Department of Nutrition, Food Science and Gastronomy, XaRTA, INSA, School of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain; (I.D.-L.); (M.Y.-A.); (S.H.-B.)
| | - Maria Yago-Aragón
- Department of Nutrition, Food Science and Gastronomy, XaRTA, INSA, School of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain; (I.D.-L.); (M.Y.-A.); (S.H.-B.)
| | - Albert Salas-Huetos
- Andrology and IVF Laboratory, Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84108, USA;
| | - Anna Tresserra-Rimbau
- Department of Nutrition, Food Science and Gastronomy, XaRTA, INSA, School of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain; (I.D.-L.); (M.Y.-A.); (S.H.-B.)
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Unitat de Nutrició, Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, 43204 Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), 43201 Reus, Spain
| | - Sara Hurtado-Barroso
- Department of Nutrition, Food Science and Gastronomy, XaRTA, INSA, School of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain; (I.D.-L.); (M.Y.-A.); (S.H.-B.)
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| |
Collapse
|
4
|
Wong RLY, Walker CL. Molecular pathways: environmental estrogens activate nongenomic signaling to developmentally reprogram the epigenome. Clin Cancer Res 2013; 19:3732-7. [PMID: 23549878 DOI: 10.1158/1078-0432.ccr-13-0021] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Exposure to environmental xenoestrogens is a major health concern because of the ability of these compounds to perturb estrogen receptor (ER) signaling and act as endocrine disrupting compounds (EDC). Inappropriate exposure to EDCs during development, even at low doses, can predispose individuals to an increased lifetime risk of disease, including cancer. Recent data indicate that perinatal exposure to EDCs increases cancer risk by (re)programming the epigenome via alterations in DNA and histone methylation. We and others have begun to dissect the mechanisms by which xenoestrogens disrupt the epigenetic machinery to reprogram the epigenome and induce developmental reprogramming. Our studies revealed that xenoestrogens induce nongenomic ER signaling to activate PI3K/AKT, resulting in AKT phosphorylation and inactivation of the histone methyltransferase EZH2, thus providing a direct link to disruption of the epigenome. Other epigenetic "readers, writers, and erasers" may also be targeted by nongenomic signaling, suggesting this is a central mechanism by which xenoestrogens and other EDCs disrupt the epigenome to induce developmental reprogramming. Elucidating mechanisms of developmental reprogramming of the epigenome is important for understanding how environmental exposures increase cancer risk, and provides a rationale for developing epigenetic interventions that can reverse the effects of environmental exposures to reduce cancer risk.
Collapse
Affiliation(s)
- Rebecca Lee Yean Wong
- Center for Translational Cancer Research, Institute of Biosciences and Technology, The Texas A&M University System Health Science Center, Houston, Texas 77030, USA.
| | | |
Collapse
|
5
|
Tucker KL, Qiao N, Maras JE. Simulation with soy replacement showed that increased soy intake could contribute to improved nutrient intake profiles in the U.S. population. J Nutr 2010; 140:2296S-2301S. [PMID: 20980640 DOI: 10.3945/jn.110.123901] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Katherine L Tucker
- Department of Health Sciences, Northeastern University, Boston, MA 02115, USA.
| | | | | |
Collapse
|
6
|
Jefferson WN, Williams CJ. Circulating levels of genistein in the neonate, apart from dose and route, predict future adverse female reproductive outcomes. Reprod Toxicol 2010; 31:272-9. [PMID: 20955782 DOI: 10.1016/j.reprotox.2010.10.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 09/08/2010] [Accepted: 10/04/2010] [Indexed: 11/16/2022]
Abstract
Developmental exposure to estrogenic compounds can disrupt sexual differentiation and adult reproductive function in many animals including humans. Phytoestrogens (plant estrogens) in the diet comprise a significant source of estrogenic exposure to humans, particularly in infants who are fed soy-based infant formula. Animal models have been developed to test the effects of phytoestrogen exposure on the developing fetus and neonate. Here we review studies quantifying the amount of phytoestrogen exposure in human adults and infants and discuss the few available epidemiological studies that have addressed long-term consequences of developmental phytoestrogen exposure. We then describe in detail rodent models of developmental exposure to the most prevalent phytoestrogen in soy products, genistein, and the effects of this exposure on female reproductive function. These models have used various dosing strategies to mimic the phytoestrogen levels in human populations. Serum circulating levels of genistein following each of the models and their correlation to reproductive outcomes are also discussed. Taken together, the studies clearly demonstrate that environmentally relevant doses of genistein have significant negative impacts on ovarian differentiation, estrous cyclicity, and fertility in the rodent model. Additional studies of reproductive function in human populations exposed to high levels of phytoestrogens during development are warranted.
Collapse
Affiliation(s)
- Wendy N Jefferson
- Laboratory of Reproductive and Developmental Toxicology, National Institute of Environmental Health Sciences, NIH, DHHS, Research Triangle Park, NC 27709, United States.
| | | |
Collapse
|
7
|
Fuhrman BJ, Pfeiffer R, Xu X, Wu AH, Korde L, Gail MH, Keefer LK, Veenstra TD, Hoover RN, Ziegler RG. Soy intake is associated with increased 2-hydroxylation and decreased 16alpha-hydroxylation of estrogens in Asian-American women. Cancer Epidemiol Biomarkers Prev 2009; 18:2751-60. [PMID: 19789363 DOI: 10.1158/1055-9965.epi-09-0388] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION In Asian and Asian-American women, soy consumption is associated with reduced breast cancer risk, perhaps due to its effects on estrogen production or metabolism. In a sample of Asian-American women, we investigated the associations of usual adult soy intake with the urinary concentrations of 15 estrogens and estrogen metabolites (EM) measured using liquid chromatography-tandem mass spectrometry. METHODS Participants included 430 Chinese-American, Japanese-American, and Filipino-American women, ages 20 to 55 years, and living in San Francisco-Oakland (California), Los Angeles (California), or Oahu (Hawaii). They were postmenopausal (n = 167) or premenopausal in luteal phase (n = 263) when 12-hour urine samples were collected. Robust linear regression was used to assess soy tertiles as predictors of log-transformed EM measures. Individual and grouped EM were considered as concentrations (pmol/mg creatinine) and as percentages of total EM (%EM). RESULTS Factor analysis confirmed that EM groups defined by metabolic pathways appropriately captured covariation in EM profiles. Total EM concentrations were not significantly associated with soy in premenopausal or postmenopausal women. Among all women, %2-hydroxylated EM and %4-hydroxylation pathway EM were 16% higher (P(trend) = 0.02) and 19% higher (P(trend) = 0.03) in the highest versus lowest soy tertiles, respectively. In contrast, 16% hydroxylated EM were 11% lower (P(trend) < 0.01). Results were consistent across ethnic and menopausal groups and after adjustment for westernization measured by birthplace (Asia or United States). DISCUSSION Findings suggest that regular soy intake is associated with increased ratios of 2:16-pathway EM and with higher relative levels of 4-hydroxylated EM. The observed variations in estrogen metabolism might modify breast cancer risk.
Collapse
Affiliation(s)
- Barbara J Fuhrman
- Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, Room 5003, Rockville, MD 20852-7246, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
BACKGROUND Missing data are a common problem in nutritional epidemiology. Little is known of the characteristics of these missing data, which makes it difficult to conduct appropriate imputation. METHODS We telephoned, at random, 20% of subjects (n = 2091) from the Adventist Health Study-2 cohort who had any of 80 key variables missing from a dietary questionnaire. We were able to obtain responses for 92% of the missing variables. RESULTS We found a consistent excess of "zero" intakes in the filled-in data that were initially missing. However, for frequently consumed foods, most missing data were not zero, and these were usually not distinguishable from a random sample of nonzero data. Older, black, and less-well-educated subjects had more missing data. Missing data are more likely to be true zeroes in older subjects and those with more missing data. Zero imputation for missing data may create little bias except for more frequently consumed foods, in which case, zero imputation will be suboptimal if there is more than 5%-10% missing. CONCLUSIONS Although some missing data represent true zeroes, much of it does not, and data are usually not missing at random. Automatic imputation of zeroes for missing data will usually be incorrect, although there is [corrected] little bias unless the foods are frequently consumed. Certain identifiable subgroups have greater amounts of missing data, and require greater care in making imputations.
Collapse
|
9
|
Song WO, Chun OK, Hwang I, Shin HS, Kim BG, Kim KS, Lee SY, Shin D, Lee SG. Soy isoflavones as safe functional ingredients. J Med Food 2007; 10:571-80. [PMID: 18158825 DOI: 10.1089/jmf.2006.0620] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In recent years, isoflavones have increased in popularity as an alternative to estrogen therapy, particularly after the Women's Health Initiative demonstrated an increased risk of breast cancer, stroke, and heart attacks in response to estrogen and progesterone intervention. Isoflavones are heterocyclic phenols with structural similarity to estradiol-17beta and selective estrogen receptor modulators. Actions at the cellular level depend on the target tissue, receptor status of the tissue, and the level of endogenous estrogen. Clinical studies of soy-based diets evaluating the relation between soy consumption and serum lipid concentrations revealed that soy consumption significantly decreased total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels. Epidemiological studies suggest a protective effect of soy protein on breast tissue as evidenced by the lower rates of breast cancer in East Asian countries where soy is a predominant part of the diet. Soy products also alleviate menopausal symptoms by reducing hot flashes. However, whether these biological effects of soy products originated from isoflavones is not clear. Furthermore, data available from human studies on the effect of isoflavones on osteoporosis are limited, and additional studies are needed to support a role in osteoporosis prevention. To date, no adverse effects of short- or long-term use of soy proteins are known in humans, and the only adverse effects known are those reported in animals. In conclusion, isoflavones are biologically active compounds, and current data are insufficient to draw definitive conclusions regarding the use of isoflavones as an alternative to estrogen for hormone replacement in postmenopausal women. Large, long-term intervention studies examining adverse effects and disease outcomes are needed before definitive conclusion can be drawn.
Collapse
Affiliation(s)
- Won O Song
- Department of Food Science and Human Nutrition, Michigan State University, MI 48824, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Low YL, Dunning AM, Dowsett M, Folkerd E, Doody D, Taylor J, Bhaniani A, Luben R, Khaw KT, Wareham NJ, Bingham SA. Phytoestrogen exposure is associated with circulating sex hormone levels in postmenopausal women and interact with ESR1 and NR1I2 gene variants. Cancer Epidemiol Biomarkers Prev 2007; 16:1009-16. [PMID: 17507630 DOI: 10.1158/1055-9965.epi-06-0899] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In this large cross-sectional study, we investigated the relationship between phytoestrogen exposure and circulating sex hormones and sex hormone-binding globulin (SHBG) levels in 1988 healthy postmenopausal women and their interactions with polymorphisms in genes involved in estrogen signaling. Plasma estradiol, testosterone, androstenedione, estrone, and SHBG were measured. Urinary levels of five isoflavones (daidzein, genistein, glycitein, O-desmethylangolensin, and equol) and two lignans (enterodiol and enterolactone) were measured and used as biomarkers for dietary intakes. Eighteen polymorphisms in ESR1, ESR2, and NR1I2 genes were genotyped. Results showed that lignans were positively associated with plasma SHBG levels (eta(p)(2) = 1.2%; P < 0.001) and negatively associated with plasma testosterone (eta(p)(2) = 0.2%; P = 0.042). Equol was negatively associated with plasma estradiol levels (eta(p)(2) = 0.3%; P = 0.028), whereas O-desmethylangolensin was positively associated with plasma estradiol level (eta(p)(2) = 0.3%; P = 0.010). There were significant phytoestrogen interactions with polymorphisms in ESR1 and NR1I2 genes in affecting estrone levels. We conclude that phytoestrogens modulate sex hormone and SHBG levels in postmenopausal women and interact with gene variants involved in estrogen signaling. Such phytoestrogen-gene interactions may explain the conflicting literature on the hormonal effects of phytoestrogens.
Collapse
Affiliation(s)
- Yen-Ling Low
- Medical Research Council Dunn Human Nutrition Unit, Wellcome Trust/Medical Research Council Dunn Human Nutrition Unit Building, Hills Road, Cambridge CB2 2XY, United Kingdom
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Kendall A, Folkerd EJ, Dowsett M. Influences on circulating oestrogens in postmenopausal women: relationship with breast cancer. J Steroid Biochem Mol Biol 2007; 103:99-109. [PMID: 17088056 DOI: 10.1016/j.jsbmb.2006.07.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Accepted: 07/31/2006] [Indexed: 10/23/2022]
Abstract
Sex hormones are intrinsically linked to the development and treatment of the majority of breast cancers. High oestradiol levels are associated with elevated breast cancer risk in the postmenopausal setting and are given increasing importance in determining chemoprevention target groups. This review aims to evaluate the impact of various lifestyle factors including body mass index, diet, smoking, and alcohol on normal physiological sex hormone profiles. The role of genetic polymorphisms is also discussed, and all are placed within the context of designing future epidemiological studies and breast cancer risk algorithms.
Collapse
Affiliation(s)
- Anne Kendall
- Academic Department of Biochemistry, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, United Kingdom
| | | | | |
Collapse
|
12
|
Folkerd EJ, Martin LA, Kendall A, Dowsett M. The relationship between factors affecting endogenous oestradiol levels in postmenopausal women and breast cancer. J Steroid Biochem Mol Biol 2006; 102:250-5. [PMID: 17049846 DOI: 10.1016/j.jsbmb.2006.09.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Breast cancer accounts for 1 in 4 of all female cancers worldwide; approaching 13,000 women dying per year in the UK alone. Seventy five per cent of all diagnosed breast cancers are oestrogen receptor (ER) positive. Ovarian synthesis of oestrogens ceases at menopause and as breast cancer is more prevalent in postmenopausal women the non-ovarian sources of oestrogen are important in disease progression. There is now considerable evidence that associates increased breast cancer risk with prolonged exposure to oestrogens hence greater attention is now being given to determining whether the measurement of plasma oestrogen may assist in identifying chemoprevention target groups. Studies suggest that in most postmenopausal patients the intra-tumoural concentrations of oestrogens are up to 20-fold higher than those present in the plasma however, while the extent of biosynthesis of oestrogens within breast tissue is a major determinant of local exposure, plasma levels are a useful indicator of overall metabolism in peripheral tissues. As such it is important to understand factors that influence these measurements. This review summarises the impact of lifestyle such as body mass index, together with the role of genetic polymorphisms placed within the context of designing future epidemiological studies and breast cancer risk algorithms.
Collapse
Affiliation(s)
- Elizabeth J Folkerd
- Academic Department of Biochemistry, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
| | | | | | | |
Collapse
|
13
|
Low YL, Dunning AM, Dowsett M, Luben RN, Khaw KT, Wareham NJ, Bingham SA. Implications of gene-environment interaction in studies of gene variants in breast cancer: an example of dietary isoflavones and the D356N polymorphism in the sex hormone-binding globulin gene. Cancer Res 2006; 66:8980-3. [PMID: 16982738 DOI: 10.1158/0008-5472.can-06-2432] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies to identify common genetic variants contributing to breast cancer risk often yield inconsistent results. Breast cancer is a complex disease involving both genetic and environmental determinants. Dietary isoflavones are thought to reduce breast cancer risk by stimulating circulating sex hormone-binding globulin (SHBG) levels. The SHBG gene contains a D356N polymorphism and the N variant is associated with reduced SHBG clearance compared with the D variant. In this study, we show a significant gene-environment interaction between SHBG D356N polymorphism and dietary isoflavone exposure on circulating SHBG levels in 1,988 postmenopausal women. SHBG levels were positively associated with isoflavones in women carrying the N variant (etap2 = 1.9%; P = 0.006) but not in women carrying only the D variant (etap2 = 0.0%; P = 0.999; P(interaction) = 0.019). This finding shows that the subtle effects of some genetic variants may be magnified and only become detectable in the presence of certain exposures. This gene-environment interaction might explain heterogeneity in studies associating SHBG gene variants and soy consumption with breast cancer risk in Far East population exposed to high isoflavone levels compared with populations with lower levels.
Collapse
Affiliation(s)
- Yen-Ling Low
- Medical Research Council Dunn Human Nutrition Unit, Department of Oncology, Cancer Research-UK, London, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
14
|
Yang M, Park MS, Lee HS. Endocrine disrupting chemicals: human exposure and health risks. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, ENVIRONMENTAL CARCINOGENESIS & ECOTOXICOLOGY REVIEWS 2006; 24:183-224. [PMID: 17114110 DOI: 10.1080/10590500600936474] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Endocrine disrupting chemicals (EDCs) have been emphasized due to their threats in fertility, intelligence, and survival. For the last decade, many researchers have investigated EDC-health outcome. However, EDC responses in human were not clearly clarified through experimental and epidemiological data. Therefore, considering particular status of EDC endpoints, we suggest that one of the best ways to prevent unknown health risks from EDCs is to perform exposure monitoring or to do surveillance for EDC release into the environment. For this purpose, this review considers exposure status of EDCs, and EDC-related health risks, focusing on the mainly highlighted EDCs, such as dioxins/PCBs, DDT/DDE, bisphenol A, phthalates, alkylphenols, and phytoestrogens. We also reviewed tobacco, a mixed source of EDC-related endocrine disorders.
Collapse
Affiliation(s)
- Mihi Yang
- Department of Toxicology, College of Pharmacy, Sookmyung Women's University, Yongsan-Ku, Seoul, Republic of Korea.
| | | | | |
Collapse
|
15
|
Ho SC, Guldan GS, Woo J, Yu R, Tse MM, Sham A, Cheng J. A prospective study of the effects of 1-year calcium-fortified soy milk supplementation on dietary calcium intake and bone health in Chinese adolescent girls aged 14 to 16. Osteoporos Int 2005; 16:1907-16. [PMID: 16133646 DOI: 10.1007/s00198-005-1963-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Accepted: 05/24/2005] [Indexed: 11/26/2022]
Abstract
The Chinese diet is low in calcium, including among adolescent girls, with an average intake around 500 mg per day. In this study, we compared the percentage change in bone mineral density and content of the spine and hip region in a 1-year follow-up study between 104 adolescent girls aged 14 to 16 years receiving 375 ml calcium-fortified soymilk supplementation and 95 girls in the control group. The mean percentage changes of bone mineral density/content (BMD/BMC) and standard deviation (SD) at 1 year for the supplementation and control groups were as follows: neck of the femur BMD 2.7+/-2.94%, 1.8+/-3.49% (P = 0.08); trochanter BMD 3.3+/-3.27%, 1.6+/-2.94% (P < or = 0.001); intertrochanter BMD 3.6+/-3.05%, 2.32+/-2.95% (P = 0.002); total hip BMD 3.1+/-2.39%, 2.05+/-2.22% (P = 0.001); total hip BMC 3.8+/-3.05%, 2.6+/-2.96% (P = 0.006). The percent difference between the percentage of bone changes in the supplementation and control groups [100x (soymilk-control)/control] ranged from 45 to 113%. We observed no differences in the spine BMD/C and no differences in changes of height and weight between the soymilk supplementation and control groups, which yielded similar results. Stepwise multivariate regression analysis including height, weight, growth stage, dietary energy, protein, calcium from usual diet and physical activity also showed that supplementation was significantly associated with a percentage increase in BMD/C at the hip. We conclude that 375 ml calcium-fortified soymilk supplementation, or an equivalent of about two glasses, is among the effective strategies for bone acquisition and the optimization of peak bone mass in adolescent girls.
Collapse
Affiliation(s)
- Suzanne C Ho
- Department of Community and Family Medicine, Centre of Research and Promotion of Women's Health, School of Public Health, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong SAR.
| | | | | | | | | | | | | |
Collapse
|
16
|
Nagel G, Altenburg HP, Nieters A, Boffetta P, Linseisen J. Reproductive and dietary determinants of the age at menopause in EPIC-Heidelberg. Maturitas 2005; 52:337-47. [PMID: 16011884 DOI: 10.1016/j.maturitas.2005.05.013] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2005] [Revised: 05/04/2005] [Accepted: 05/24/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of the study was to explore the influence of reproductive and dietary factors on the age at menopause. METHODS During follow-up of the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort in Heidelberg (median duration 5.8 years), 1009 women experienced natural menopause. They were compared to 3798 women who did not experience menopause. Baseline dietary intake was obtained by means of validated food frequency questionnaires. Data on reproductive history and medication was collected by means of questionnaires. Cox' proportional hazard models were applied in order to identify determinants of the age at natural menopause. RESULTS Increasing age at first full term pregnancy and a longer time interval until occurrences of regular menses are associated with later onset of natural menopause. Compared to never smokers, current smokers have the risk of younger age at menopause. High carbohydrate consumption and high intake of vegetable, fibre and cereal products are inversely related to the age at natural menopause. Women with higher intake of total fat, protein and meat experienced a delayed onset of natural menopause. CONCLUSION Age at natural menopause is influenced by lifestyle and dietary factors. Further studies including biological markers are needed to clarify these associations.
Collapse
Affiliation(s)
- Gabriele Nagel
- Division of Clinical Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | | | | | | | | |
Collapse
|
17
|
Goldin BR, Brauner E, Adlercreutz H, Ausman LM, Lichtenstein AH. Hormonal Response to Diets High in Soy or Animal Protein Without and With Isoflavones in Moderately Hypercholesterolemic Subjects. Nutr Cancer 2005; 51:1-6. [PMID: 15749623 DOI: 10.1207/s15327914nc5101_1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Consumption of soy protein has been associated with altered risk of developing endocrine-regulated cancers. This study was designed to assess the independent effect of soy relative to animal protein and soy-derived isoflavones on circulating estrogen and androgen concentrations in postmenopausal women and older men. Forty-two subjects (> 50 yr) with low-density lipoprotein cholesterol levels of > or = 3.36 mmol/l were fed each of 4 diets in randomized order for 6 wk/phase. All food and drink were provided. Diets contained 25 g soy or common sources of animal protein/4.2 MJ containing trace or 50 mg isoflavones/4.2 MJ. At the end of each diet phase, concentrations of estrone sulfate, estrone, estradiol, testosterone, androstendione, dihydrotestosterone, dehydroepiandrosterone, and dehydroepiandrosterone sulfate were measured. In postmenopausal women, concentrations of estrone were higher and its precursor, dehydroepiandrosterone, lower after consuming the soy compared with animal protein diets (P = 0.0396 and 0.0374, respectively). There was no significant effect of isoflavones on any of the hormones measured. In older men, dehydroepiandrosterone sulfate concentrations were lower after consuming the isoflavone (P = 0.0106) and higher after soy, compared with the animal protein diets (P = 0.0118). These data suggest that relatively large amounts of soy protein or soy-derived isoflavones had modest and limited sex-specific effects on circulating hormone levels.
Collapse
Affiliation(s)
- Barry R Goldin
- Department of Family Medicine and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA
| | | | | | | | | |
Collapse
|
18
|
Low YL, Taylor JI, Grace PB, Dowsett M, Scollen S, Dunning AM, Mulligan AA, Welch AA, Luben RN, Khaw KT, Day NE, Wareham NJ, Bingham SA. Phytoestrogen Exposure Correlation with Plasma Estradiol in Postmenopausal Women in European Prospective Investigation of Cancer and Nutrition-Norfolk May Involve Diet-Gene Interactions. Cancer Epidemiol Biomarkers Prev 2005. [DOI: 10.1158/1055-9965.213.14.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Cross-sectional studies investigating the relationship between phytoestrogens in diet, urine, or blood with plasma estradiol and sex hormone binding globulin (SHBG) have been inconclusive. We investigated the relationship among phytoestrogen exposure, polymorphisms in the ESR1, COMT, CYP19, and SHBG genes, and plasma estradiol and SHBG levels in 125 free-living postmenopausal women taking part in a cohort study (European Prospective Investigation of Cancer and Nutrition-Norfolk) using three different markers: dietary, urinary, and serum phytoestrogens. Phytoestrogen levels (daidzein, genistein, glycitein, O-desmethylangolensin, equol, enterodiol, and enterolactone) in spot urine and serum were analyzed by gas chromatography/mass spectrometry and liquid chromatography/tandem mass spectrometry, respectively. Plasma estradiol and SHBG were measured by immunoassays. Adjusting for age and body mass index, urinary daidzein, genistein, glycitein, and serum daidzein and glycitein were negatively correlated with plasma estradiol (R = −0.199 to −0.277, P <0.03), with particularly strong associations found in the 18 women with CC genotype for ESR1 PvuII polymorphism (R = −0.597 to −0.834, P < 0.03). The negative correlations observed between isoflavones and estradiol in women as a whole became no longer significant when we excluded women with ESR1 PvuII CC genotype, indicating that the correlations observed were due mainly to this group of women. There was no relationship between dietary isoflavones and plasma estradiol and no association was found between any of the dietary, urinary, and serum phytoestrogen and plasma SHBG or between these factors and polymorphisms in CYP19, SHBG, and COMT. We conclude that higher isoflavone exposure is associated with lower plasma estradiol in postmenopausal women and that this preliminary study is suggestive of the involvement of diet-gene interactions.
Collapse
Affiliation(s)
- Yen-Ling Low
- 1Medical Research Council Dunn Human Nutrition Unit
| | | | | | - Mitch Dowsett
- 2Institute of Cancer Research, London, United Kingdom and
| | - Serena Scollen
- 3Cancer Research UK, Department of Oncology, Strangeways Research Laboratory and European Prospective Investigation of Cancer and Nutrition, Institute of Public Health and Strangeways Research Laboratory, Cambridge, United Kingdom
| | | | - Angela A. Mulligan
- 3Cancer Research UK, Department of Oncology, Strangeways Research Laboratory and European Prospective Investigation of Cancer and Nutrition, Institute of Public Health and Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Ailsa A. Welch
- 3Cancer Research UK, Department of Oncology, Strangeways Research Laboratory and European Prospective Investigation of Cancer and Nutrition, Institute of Public Health and Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Robert N. Luben
- 3Cancer Research UK, Department of Oncology, Strangeways Research Laboratory and European Prospective Investigation of Cancer and Nutrition, Institute of Public Health and Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Kay-Tee Khaw
- 3Cancer Research UK, Department of Oncology, Strangeways Research Laboratory and European Prospective Investigation of Cancer and Nutrition, Institute of Public Health and Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Nick E. Day
- 3Cancer Research UK, Department of Oncology, Strangeways Research Laboratory and European Prospective Investigation of Cancer and Nutrition, Institute of Public Health and Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Nick J. Wareham
- 3Cancer Research UK, Department of Oncology, Strangeways Research Laboratory and European Prospective Investigation of Cancer and Nutrition, Institute of Public Health and Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Sheila A. Bingham
- 1Medical Research Council Dunn Human Nutrition Unit
- 3Cancer Research UK, Department of Oncology, Strangeways Research Laboratory and European Prospective Investigation of Cancer and Nutrition, Institute of Public Health and Strangeways Research Laboratory, Cambridge, United Kingdom
| |
Collapse
|
19
|
Rosell MS, Appleby PN, Spencer EA, Key TJ. Soy intake and blood cholesterol concentrations: a cross-sectional study of 1033 pre- and postmenopausal women in the Oxford arm of the European Prospective Investigation into Cancer and Nutrition. Am J Clin Nutr 2004; 80:1391-6. [PMID: 15531691 DOI: 10.1093/ajcn/80.5.1391] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Clinical trials have suggested that the intake of soy protein reduces blood cholesterol. Few studies have explored this relation in subjects who consume soy as part of their regular diet. OBJECTIVE In this study, we investigated whether blood cholesterol concentrations are related to the intake of soyfoods in a cohort comprising subjects with a wide variation in soy intake. DESIGN This cross-sectional study included 1033 pre- and postmenopausal women selected from the Oxford arm of the European Prospective Investigation into Cancer and Nutrition. The sample included 361 nonvegetarians, 570 vegetarians, and 102 vegans. Their dietary intake was assessed by using a food-frequency questionnaire. Anthropometric data, medical history, and lifestyle information were obtained with the use of a questionnaire, blood samples were obtained, and plasma total, LDL-, and HDL-cholesterol concentrations were measured. RESULTS Soy-protein intake was inversely associated with total and LDL-cholesterol concentrations and with the ratio of total to HDL cholesterol but not with HDL-cholesterol concentrations. Mean plasma LDL-cholesterol concentrations in women with a soy-protein intake >/=6 g/d was 12.4% lower than that in women who consumed <0.5 g/d (P < 0.001). CONCLUSION Moderate intakes of soyfoods as part of a regular diet are associated with favorable blood cholesterol concentrations.
Collapse
Affiliation(s)
- Magdalena S Rosell
- Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, United Kingdom.
| | | | | | | |
Collapse
|
20
|
Davey GK, Spencer EA, Appleby PN, Allen NE, Knox KH, Key TJ. EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33 883 meat-eaters and 31 546 non meat-eaters in the UK. Public Health Nutr 2003; 6:259-69. [PMID: 12740075 DOI: 10.1079/phn2002430] [Citation(s) in RCA: 356] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe the lifestyle characteristics and nutrient intakes of the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN Cohort of men and women recruited through general practices or by post to include a high proportion of non meat-eaters. Dietary, anthropometric and lifestyle data were collected at baseline and four diet groups were defined. SETTING United Kingdom. PARTICIPANTS In total, 65 429 men and women aged 20 to 97 years, comprising 33 883 meat-eaters, 10 110 fish-eaters, 18 840 lacto-ovo vegetarians and 2596 vegans. RESULTS Nutrient intakes and lifestyle factors differed across the diet groups, with striking differences between meat-eaters and vegans, and fish-eaters and vegetarians usually having intermediate values. Mean fat intake in each diet group was below the UK dietary reference value of 33% of total energy intake. The mean intake of saturated fatty acids in vegans was approximately 5% of energy, less than half the mean intake among meat-eaters (10-11%). Vegans had the highest intakes of fibre, vitamin B1, folate, vitamin C, vitamin E, magnesium and iron, and the lowest intakes of retinol, vitamin B12, vitamin D, calcium and zinc. CONCLUSIONS The EPIC-Oxford cohort includes 31 546 non meat-eaters and is one of the largest studies of vegetarians in the world. The average nutrient intakes in the whole cohort are close to those currently recommended for good health. Comparisons of the diet groups show wide ranges in the intakes of major nutrients such as saturated fat and dietary fibre. Such variation should increase the ability of the study to detect associations of diet with major cancers and causes of death.
Collapse
Affiliation(s)
- Gwyneth K Davey
- Cancer Research UK Epidemiology Unit, University of Oxford, Gibson Building, Radcliffe Infirmary, Oxford OX2 6HE, UK.
| | | | | | | | | | | |
Collapse
|