Phytoestrogen status in relation to sociodemographic factors and biomarkers of bone health in older Brisbane women

Hanna, Katherine Lavina (2006) Phytoestrogen status in relation to sociodemographic factors and biomarkers of bone health in older Brisbane women. PhD thesis, Queensland University of Technology.


Background: Phytoestrogens are diphenolic compounds found in plants with a structure and molecular weight similar to oestradiol which enables them to bind to the oestrogen receptor. Isoflavonoids occur mainly within the legume family with highest concentration in soybeans. Lignans are found in a range of plant foods and the richest known source is linseed. Few studies have been published on intake of isoflavonoids and none were located on intake of lignans in Australian women. The validity of methods designed to estimate intake can be assessed using urinary excretion of isoflavonoids and lignans as studies have found an association between intake and excretion of isoflavonoids and lignans. It has been proposed that, through their ability to act like oestrogen, phytoestrogens could decrease bone turnover and attenuate the loss of bone mineral density (BMD) at menopause.

The aims of this research were to determine the pattern of intake of isoflavonoids and lignans in 500 women from food and supplements and to assess a questionnaire used to estimate intake using excretion in a sub-sample of 141 women. Associations between usual intake or excretion of isoflavonoids and lignans and biomarkers of bone health were also examined.

Methods: A cross-sectional study was conducted involving 500 women aged 40-80 years participating in the Longitudinal Assessment of Ageing in Women (LAW), a 5 year study being conducted in the Betty Byrne Henderson Centre at the Royal Brisbane and Women's Hospital. Subjects were randomly selected from the electoral role and stratified into ten year age groups. Intake of isoflavonoids and lignans from food and supplements was assessed using a specially designed questionnaire containing 110 items. Values for individual items were obtained from published literature and summed to provide average daily intakes of isoflavonoids and lignans (mg/d).

A sub-sample of 141 women was recruited to take part in the assessment of the association between phytoestrogen intake and excretion. Participants collected three 24-h urine samples spaced over one week. Samples were analysed using high performance liquid chromatography MS/MS for seven isoflavonoids and four lignans. Bone mineral densities (BMD) of the femur neck, total hip and lumbar spine were measured by dual energy x-ray absorptiometry. Bone formation was assessed using serum bone alkaline phosphatase (bone ALP) and osteocalcin (OC) and bone resorption was assessed using deoxypyridinoline (DPD) and urinary excretion of N-terminal cross-linking telopeptide of type-I collagen (NTX). Potential confounding factors were also evaluated.

Statistical analyses were conducted using SPSS for windows (version 10). Participants were defined as consumers if they reported intake of one or more serves of soy or linseed in the prior month. Differences in socio-demographic and lifestyle characteristics between groups were assessed using ANOVA and Chi Square tests. Associations between intake and excretion of phytoestrogens were assessed using Spearman's rank-order correlations () for non-normal data. Phytoestrogen intake was categorised into four groups for the assessment of the association with markers of bone health. Associations between phytoestrogen excretion and markers of bone health were assessed using Pearson's product moment correlations for normal data (r) and Spearman's rank-order correlations for non-normal data. A value of P < 0.05 was taken as statistically significant.

Results: Consumption of soy food was reported by 40% and consumption of linseed by 34% of women. Median (range) intakes among soy/linseed consumers for isoflavonoids, 3.87 (0-173) mg/d, and lignans, 2.40 (0.1-33) mg/d, were significantly higher than corresponding intakes among non consumers of 0.005 (0-2.6) and 1.57 (0.4-4.7) mg/d, respectively (P < 0.001). Soy/linseed consumers reported higher intakes of energy (P=0.043), dietary fibre (P=0.003) and polyunsaturated fat (P=0.004); and a higher level of physical activity (P=0.006), SEP (P < 0.001), education (P < 0.001) and supplement use (P < 0.001). Use of non-prescription supplements for menopause in the previous month was reported by 13% of women. A review of supplements available for treatment of menopause indicated that use of soy, red clover, black cohosh and sage could have a role in treatment of menopause symptoms. Evidence supporting the presence of oestrogenic components was available for soy and red clover isoflavonoids only.

There was a significant association between intake and excretion of isoflavonoids within the total group (r=0.207, P < 0.05), with a stronger association in soy consumers (r=0.364, P < 0.01). Excretion of isoflavonoids was detected in women who did not report known intake of soy foods, suggesting isoflavonoids could be derived in small amounts from other plant foods or use of soy as an ingredient in processed foods. There was no significant association between intake and excretion of lignans, however both intake and excretion were associated with dietary fibre (r=0.303 and r=0.230, respectively, P < 0.01 for both).

Bone ALP was higher among the very low isoflavonoid intake group (P=0.005) for the total sample (P=0.005) and women with BMI≤25 kg/m2 (P=0.002). Data also demonstrated an inverse association between excretion of isoflavonoids and NTX within women with BMI≤25 kg/m2 (r=-0.33, P < 0.05). There was a positive association between lignan excretion and bone ALP in the total sample (r=0.21, P < 0.05) which was strengthened in women with osteoporosis/osteopenia (r=0.41, P < 0.05) and a positive association between lignan excretion and DPD among women with BMI≤25 kg/m2 (ρ=0.28, P < 0.05) All associations remained significant after adjustment for confounding.

Conclusions: Few women who chose phytoestrogen-rich foods consumed amounts similar to women with traditional soy-based diets although some achieved high intakes with supplements. Women who consumed soy or linseed foods differed in lifestyle and sociodemographic characteristics that could influence the association with disease in epidemiological studies. Results indicated that the phytoestrogen questionnaire was useful for assessment of isoflavonoids but was not acceptably precise for measurement of lignans. Findings suggest that there is an inverse association between isoflavonoid status and bone ALP and NTX although the precise mechanism of action has not been clarified. The association between lignan intake and bone is less well understood; however findings of a positive association with bone ALP indicate that further research on the lignan content of foods and the inclusion of lignans in studies is warranted.

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ID Code: 16246
Item Type: QUT Thesis (PhD)
Supervisor: Lyons-Wall, Philippa & Newman, Beth
Keywords: phytoestrogens, isoflavonoids, lignans, soy, linseed, food intake, dietary supplements, urine, bone mineral density, bone remodelling, menopause, osteoporosis
Divisions: Current > Research Centres > Centre for Health Research
Current > QUT Faculties and Divisions > Faculty of Health
Department: Faculty of Health
Institution: Queensland University of Technology
Copyright Owner: Copyright Katherine Lavina Hanna
Deposited On: 03 Dec 2008 03:59
Last Modified: 22 Feb 2013 01:44

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