Yvonne T. van der Schouw

Prospective Study on Usual Dietary Phytoestrogen Intake and Cardiovascular Disease Risk in Western Women

Background—Phytoestrogens have been suggested to lower cardiovascular disease risk, but existing research focused on non-Western high intake levels and on risk factors. We investigated whether habitual low phytoestrogen intake is associated with manifest cardiovascular disease risk. Methods and Results—Between 1993 and 1997, 16 165 women 49 to 70 years old and free from cardiovascular disease were enrolled in the Dutch Prospect-EPIC cohort (European Prospective study Into Cancer and nutrition) and followed up for a median period of 75 months. At enrollment, women filled in questionnaires on chronic disease risk factors and nutrition. Intake of phytoestrogens was estimated using the food frequency questionnaire covering regular dietary intake of 178 food items in the year before enrollment. Cox regression analysis was used to estimate hazard ratios of cardiovascular disease for quartiles of phytoestrogen intake adjusted for age at intake, body mass index, smoking, physical activity, hypertension, hypercholesterolemia, use of hormone replacement therapy, menopausal status, and intake of total energy, total fiber, vegetables, fruit, and alcohol. In total, 372 women experienced a coronary event (CHD) (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9], 410 to 414, 427.5) and 147 women a cerebrovascular event (CVD) (ICD-9, 430 to 438) during follow-up. Overall, neither isoflavones nor lignans were associated with decreased cardiovascular disease risk. When stratifying for ever versus never smokers, CHD risk decreased with increasing lignan intake for ever smokers. Conclusions—Our results do not support the presence of a protective effect of higher intake of phytoestrogens in low doses on cardiovascular disease risk, although a small risk reduction with higher lignan intake cannot be excluded for smokers.

Soy Protein Containing Isoflavones and Mammographic Density in a Randomized Controlled Trial in Postmenopausal Women

Background: The relatively high dietary intake of soy in Asian countries has been hypothesized to, at least partly, explain the lower breast cancer incidence patterns in these countries compared with the Western world. The aim of the present study was to determine the effect of daily soy supplementation on mammographic density, one of the strongest known risk factors for breast cancer. Methods: A double-blind, randomized, controlled trial was conducted to compare the effects of soy protein intake containing 99 mg isoflavones daily with intake of milk protein (placebo) for the duration of 1 year. Two hundred and two Dutch postmenopausal women ages 60 to 75 years were randomized. Mammographic density was assessed using a quantitative computer-assisted method on digitized mammograms. Equol producer status was assessed in plasma provided at the final visit (soy group) or after a 3-day challenge with soy after the trial was finished (placebo group). Results: A total of 175 women completed the baseline visits and at least one follow-up visit and were included in the intention-to-treat analyses. For 126 women, both pre- and post-trial mammograms were available. Mammographic density decreased in both study arms, but the decrease did not differ significantly between intervention and placebo groups. Equol producer status did not modify the results. Conclusion: The results of this trial do not support the hypothesis that a diet high in soy protein among postmenopausal women decreases mammographic density. (Cancer Epidemiol Biomarkers Prev 2008;17(10):2632–8)

PS3 - 1. Validation of Cardiovascular Risk Scores Among Patients with Type 2 Diabetes Mellitus

Several cardiovascular prediction models have been developed for application in patients with type 2 diabetes. Their predictive performance in a new set of patients is mostly not established. All available cardiovascular prediction models, identified by a systematic review, were validated in three different cohorts of patients with type 2 diabetes.

Voedingspatronen en het risico op type 2 diabetes in personen met overgewicht en obesitas

SamenvattingVoeding, leefstijl en overgewicht spelen een belangrijke rol in de ontwikkeling van type 2 diabetes. Daarom vormen het voorkomen van gewichtstoename en overgewicht de belangrijkste pijlers van type 2 diabetespreventie. Voedingsinname beïnvloedt het risico op diabetes waarschijnlijk vooral door veranderingen in gewicht. Echter, er zijn aanwijzingen dat voeding ook onafhankelijk van (over)gewicht het risico op diabetes beïnvloedt.