Urinary phytoestrogens and cancer, cardiovascular, and all-cause mortality in the continuous National Health and Nutrition Examination Survey

Abstract

2 AbstractPurpose: Experimental studies suggest that phytoestrogen intake alters cancer and cardiovascular risk. This study investigated the associations of urinary phytoestrogens with total cancer (n=79), cardiovascular (n=108), and allcause (n=290) mortality among 5,179 participants in the continuous National Health and Nutrition Examination Survey (1999Survey ( -2004.Methods: Urinary phytoestrogens were measured using high performance liquid chromatography with tandem mass spectrometric detection. Survival analysis was performed to evaluate hazard ratios (HRs) and 95% confidence intervals (CIs) for each of the three outcomes in relation to urinary phytoestrogens.Results: After adjustment for confounders, higher urinary concentrations of total enterolignans were associated with a reduced risk of death from cardiovascular disease (HR for tertile 3 vs. tertile 1: 0.48; 95% CI: 0.24, 0.97), whereas higher urinary concentrations of total isoflavones (HR for tertile 3 vs. tertile 1: 2.14; 95% CI: 1.03, 4.47) and daidzein (HR for tertile 3 vs. tertile 1: 2.05; 95% CI: 1.02, 4.11) were associated with an increased risk. A reduction in all-cause mortality was observed for elevated urinary concentrations of total enterolignans (HR for tertile 3 vs. Conclusions: Some urinary phytoestrogens were associated with cardiovascular and all-cause mortality in a representative sample of the U.S. population. This is one of the first studies that used urinary phytoestrogens as biomarkers of their dietary intake to evaluate the effect of these bioactive compounds on the risk of death from cancer and cardiovascular disease.

Risks and benefits related to alimentary exposure to xenoestrogens

“…The analysis of several cohorts studies, which evaluated the association between flavonoids intake and incidence or mortality from cardiovascular disease, revealed that small amounts of flavonoid-based PhyEs may lower the risk of coronary heart disease mortality (Petersin et al, 2012). The association between urinary PhyEs levels and cardiovascular mortality risk was also evaluated, and it was found that enterolignan urinary concentrations were associated with a reduced risk of death from cardiovascular disease, whereas an opposite association was found for urinary concentration of total isoflavones (Reger et al, 2015). These results are consistent with previously published results, which confirmed that enterolignan intake was correlated with elevated high-density lipoprotein (HDL) levels and reduced triglyceride concentrations in US adults (Penelalco et al, 2012).…”

Association between Dietary Share of Ultra-Processed Foods and Urinary Concentrations of Phytoestrogens in the US

“…Another study found an inverse association between urinary concentrations of total enterolignans and cardiovascular mortality and between urinary concentrations of both total enterolignans and enterolactone and all-cause mortality [65]. Interestingly, this study also found a direct association between urinary concentration of total isoflavones and daidzein and risk of death from cardiovascular disease and all causes [65]. …”

“…Also, another study carried with US NHANES 2001–2010, found an inverse association between urinary enterolactone levels and obesity, waist circumference, serum triacylglycerols (TAG) levels, fasting glucose levels, fasting insulin levels and metabolic syndrome in adult males, and a direct association with high-density lipoprotein HDL-cholesterol levels [64]. Another study found an inverse association between urinary concentrations of total enterolignans and cardiovascular mortality and between urinary concentrations of both total enterolignans and enterolactone and all-cause mortality [65]. Interestingly, this study also found a direct association between urinary concentration of total isoflavones and daidzein and risk of death from cardiovascular disease and all causes [65].…”

“…The advantage of urinary measurements is that they are free of recall bias inherent in self-reported dietary data and represent phytoestrogen intakes from all sources, including those that may be inadequately captured in food composition databases [10,16,65]. An additional advantage of using urinary phytoestrogen testing is that it also captures phytoestrogen metabolites (such as equol and O -desmethylangolensin) produced by intestinal bacteria [66].…”

“…A further limitation arises from the use of spot urine samples for the determination of phytoestrogen concentrations as these measurements might be different from those obtained using 24-h urine due to potential circadian rhythm [65]. Even though there have been no studies examining the correlation between spot and 24-h urinary phytoestrogen concentrations, the concentrations of phytoestrogens in spot urine have been reported to be statistically significantly correlated with their concentrations measured in serum [10,61] and with their dietary intake [16,17,18,19,20,21].…”