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

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Abstract

Purpose

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 all-cause (n = 290) mortality among 5179 participants in the continuous National Health and Nutrition Examination Survey (1999–2004).

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. tertile 1 0.65; 95 % CI 0.43, 0.96) and enterolactone (HR for tertile 3 vs. tertile 1 0.65; 95 % CI 0.44, 0.97).

Conclusions

Some urinary phytoestrogens were associated with cardiovascular and all-cause mortality in a representative sample of the US 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.

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Acknowledgments

There was no specific funding for reported research.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The de-identified data analyzed in the present study are freely available in public domains, and the approval for such data analysis by the Institutional Review Board of Indiana University was sought but determined not to be applicable.

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  1. Michael K. Reger

    Present address: College of Health Professions, Ferris State University, Big Rapids, MI, USA

Authors and Affiliations

  1. Department of Epidemiology, Indiana University Richard M. Fairbanks School of Public Health, 714 N Senate Avenue, Suite EF250F, Indianapolis, IN, 46202, USA

    Michael K. Reger, Terrell W. Zollinger & Jianjun Zhang

  2. Department of Biostatistics, Indiana University Richard M. Fairbanks School of Public Health and School of Medicine, Indianapolis, IN, USA

    Ziyue Liu

  3. Department of Health Informatics, School of Informatics and Computing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA

    Josette Jones

  4. Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA

    Jianjun Zhang

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Correspondence to Jianjun Zhang.

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Reger, M.K., Zollinger, T.W., Liu, Z. et al. Urinary phytoestrogens and cancer, cardiovascular, and all-cause mortality in the continuous National Health and Nutrition Examination Survey. Eur J Nutr 55, 1029–1040 (2016). https://doi.org/10.1007/s00394-015-0917-y

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  • DOI: https://doi.org/10.1007/s00394-015-0917-y

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