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Carotenoids have antioxidant properties. Little is known about the relation of dietary carotenoid intake on metabolic syndrome risk. We examined whether dietary carotenoid intake was associated with metabolic syndrome and metabolic syndrome risk factors. We conducted a population-based, cross-sectional study in 374 men aged 40-80 y. Intakes of [beta]-carotene, [alpha]-carotene, [beta]-cryptoxanthin, lycopene, lutein, and zeaxanthin were estimated using a validated FFQ. Presence of metabolic syndrome was determined using fasting serum glucose, triglyceride, and HDL-cholesterol concentrations, waist circumference, and systolic and diastolic blood pressure. Metabolic syndrome was present in 22% of the men. After adjustment for confounders, total carotenoid and lycopene intakes were inversely associated with presence of metabolic syndrome [relative risk (RR) quartile 4 vs. quartile 1 (95% CI) 0.42 (0.20-0.87), P-trend 0.02; and 0.55 (0.28-1.11), P-trend 0.01, respectively]. For [beta]-carotene, a decreased risk was observed for each quartile of intake compared with the first [RR quartile 4 vs. quartile 1 (95% CI) 0.58 (0.33-1.02)]. Higher total carotenoid, [beta]-carotene, [alpha]-carotene, and lycopene intakes were associated with lower waist circumferences and visceral and subcutaneous fat mass. Higher lycopene intake was related to lower serum triglyceride concentrations. In conclusion, higher total carotenoid intakes, mainly those of [beta]carotene and lycopene, were associated with a lower prevalence of metabolic syndrome and with lower measures of adiposity and serum triglyceride concentrations in middle-aged and elderly men.

Associations between the glycemic index (GI) or glycemic load (GL) and diseases are heterogeneous in epidemiological studies. Differences in assigning GI values to food items may contribute to this inconsistency. Our objective was to address methodological issues related to the use of current GI and GL values in epidemiological studies. We performed ecological comparison and correlation studies by calculating dietary GI and GL from country-specific dietary questionnaires (DQ) from 422,837 participants from 9 countries participating in the European Prospective Investigation into Cancer and Nutrition study and single standardized 24-h dietary recalls (24-HDR) obtained from a representative sample (n = 33,404) using mainly Foster Powell's international table as a reference source. Further, 2 inter-rater and 1 inter-method comparison were conducted, comparing DQ GI values assigned by independent groups with values linked by us. The ecological correlation between DQ and 24-HDR was good for GL (overall r = 0.76; P < 0.005) and moderate for GI (r = 0.57; P < 0.05). Mean GI/GL differences between DQ and 24-HDR were significant for most centers. GL but not GI from DQ was highly correlated with total carbohydrate (r = 0.98 and 0.15, respectively; P < 0.0001) and this was higher for starch (r = 0.72; P < 0.0001) than for sugars (r = 0.36; P < 0.0001). The inter-rater and inter-method variations were considerable for GI (weighted [kappa] coefficients of 0.49 and 0.65 for inter-rater and 0.25 for inter- method variation, respectively) but only mild for G L (weighted [kappa] coefficients > 0.80). A more consistent methodology to attribute GI values to foods and validated DQ is needed to derive meaningful GI/GL estimates for nutritional epidemiology.

We examined the associations of intake of vegetables, legumes and fruit with all-cause and cause-specific morality in a population with prevalent diabetes in Europe. A cohort of 10,449 participants with self-reported diabetes within the European Prospective Investigation into Cancer and Nutrition study was followed for a mean of 9 y. Intakes of vegetables, legumes, and fruit were assessed at baseline between 1992 and 2000 using validated country-specific questionnaires. A total of 1346 deaths occurred. Multivariate relative risks (RR) for all-cause mortality were estimated in Cox regression models and RR for causespecific mortality were derived in a competing risk model. An increment in intake of total vegetables, legumes, and fruit of 80 g/d was associated with a RR of death from all causes of 0.94 [95% CI 0.9043.98]. Analyzed separately, vegetables and legumes were associated with a significantly reduced risk, whereas nonsignificant inverse associations for fruit intake were observed. Cardiovascular disease (CVD) mortality and mortality due to non-CVD/non-cancer causes were significantly inversely associated with intake of total vegetables, legumes, and fruit (RR 0.88 [95% CI 0.81-0.95] and 0.90 [0.82-0.99], respectively) but not cancer mortality (1.08 [0.99-1.17]). Intake of vegetables, legumes, and fruit was associated with reduced risks of allcause and CVD mortality in a diabetic population. The findings support the current state of evidence from general population studies that the protective potential of vegetable and fruit intake is larger for CVD than for cancer and suggest that diabetes patients may benefit from a diet high in vegetables and fruits.

Dietary phytoestrogens may play a role in chronic disease occurrence. The aim of our study was to assess the variability of plasma concentrations in European populations. We included 15 geographical regions in 9 European countries (Denmark, France, Germany, Greece, Italy, Spain, Sweden, The Netherlands, and UK) and a 16th region, Oxford, UK, where participants were recruited from among vegans and vegetarians. All subjects were participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). Plasma concentrations of 3 isoflavones (daidzein, genistein, and glycitein), 2 metabolites of daidzein [O-desmethylangolensin (O-DMA) and equol] and 2 mammalian lignans (enterodiol and enterolactone) were measured in 1414 participants. We computed geometric means for each region and used multivariate regression analysis to assess the influence of region, adjusted for gender, age, BMI, alcohol intake, smoking status, and laboratory batch. Many subjects had concentrations below the detection limit [0.1 [micro]g/L (0.4 nmol/L)] for glycitein (80%), O-DMA (73%) and equol (62%). Excluding subjects from Oxford, U K, the highest concentrations of isoflavones were in subjects from the Netherlands and Cambridge, U K [2-6[micro]g/L (7-24 nmol/L); P < 0.05], whereas concentrations for lignans were highest in Denmark [8 [micro]g/L (27 nmol/L); P < 0.05]. Isofiavones varied 8- to 13-fold, whereas lignans varied 4-fold. In the vegetarian/vegan cohort of Oxford, concentrations of isoflavones were 5-50 times higher than in nonvegetarian regions. Region was the most important determinant of plasma concentrations for all 7 phytoestrogens. Despite the fact that plasma concentrations of phytoestrogens in Europe were low compared with Asian populations, they varied substantially among subjects from the 16 different regions.

Data on the relation between phytoestrogens and cognitive function are still sparse. The purpose of this study was to examine the relation between the dietary intake of phytoestrogens and cognitive function in healthy postmenopausal women consuming a Western diet. We conducted a community-based survey among 394 postmenopausal women. Isoflavone and lignan intake was calculated from a validated FFQ. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE). Data were analyzed using logistic regression with intact cognitive function defined as a score [greater than or equal to] 26 as the outcome variable. After adjustment for confounders, increasing dietary lignans intake was associated with better performance on the MMSE [OR and (95%CI): 1.49 (0.94-2.38)]. Results were most pronounced in women who were 20-30 y postmenopausal [2.02 (1.11-3.71)]. Isoflavone intake was not related to cognitive function. From our results we conclude that higher dietary intake of lignans is associated with better cognitive function in postmenopausal women. KEY WORDS: * diet * lignans * global cognitive performance * postmenopausal women

Isoflavone supplementation in the form of soy protein-containing isoflavones is associated with beneficial lipid changes. Information on usual isoflavone and lignan intakes in the diet of Western men and their associations with cardiovascular risk factors is not available. From the Health Professionals Follow-up Study, we selected 468 men, aged 47-83 y, who were free of cardiovascular disease, diabetes, and cancer, and who had provided a blood sample in 1994. We measured circulating total, LDL, and HDL cholesterol, triacylglycerol, lipoprotein(a), apolipoprotein (apo)A1, apoB, hemoglobin (Hb)A1c, insulin, C-peptide, and leptin concentrations. Isoflavone and lignan intakes were calculated from a FFQ. We used multivariate linear regression. None of the cardiovascular risk factors was strongly associated with isoflavone intake. Blood levels of LDL cholesterol and apoB tended to increase with increasing lignan intake [for LDL cholesterol, quartile 4 - quartile 1 = 9% (95% CI 1%; 16%), P for trend = 0.01, and for apo B, quartile 4 - quartile 1 = 9% (95% CI 1%; 16%), P for trend = 0.02]. Fasting insulin and C-peptide tended to decrease with increasing lignan intake [for insulin, quartile 4 - quartile 1 = -11% (95% CI -55%; -8%), P for trend = 0.02, and for C-peptide, quartile 4 - quartile 1 = -25% (95% CI -44; -6%), P for trend = 0.01]. Our results suggest that intake of isoflavones within the range of Western diets is not associated with a cardiovascular risk profile among men. Diets high in lignan intake may increase apoB-containing lipoproteins and decrease fasting insulin secretion, but these findings require confirmation. KEY WORDS: * isoflavones, lignans * cardiovascular risk factors * men * cross-sectional study

Higher consumption of phytoestrogens might be protective against certain chronic diseases. Accurate quantification of habitual phytoestrogen intake is important for assessing associations between phytoestrogens and risk for certain diseases. The aim of this study was to estimate dietary intake of phytoestrogens in Dutch middle-aged and elderly women and to describe their main sources. Women were recruited between 1993 and 1997 and aged 50-69 y at enrollment (Prospect-EPIC; n = 17,357). A detailed food frequency questionnaire referring to the preceding year was filled in at recruitment. A literature search was conducted to obtain data regarding content of the isoflavones daidzein, genistein, formononetin, biochanin A, the coumestan coumesterol and the lignans matairesinol and secoisolariciresinol in relevant food items. Concentrations of each phytoestrogen in each food item were subsequently grouped by seven categories; group scores were multiplied by daily intakes of food items and then summed across food items to produce for each participant a total daily intake score for each phytoestrogen. Approximately 75% of participants were postmenopausal at recruitment. The mean age was 57 y. Geometric means of daily intake of daidzein, genistein, formononetin, biochanin A, coumesterol, matairesinol and secoisolariciresinol were 0.15, 0.16, 0.08, 0.001, KEY WORDS: * phytoestrogens * isoflavones * coumestans * lignans * food frequency questionnaire

Hypertension, central obesity and dyslipidemia are associated with high cardiovascular risk. Estrogen therapy in women has beneficial effects on some of these metabolic cardiovascular risk factors. It is not known whether dietary estrogens have similar effects, especially in Western populations. We studied the association between dietary phytoestrogen intake and metabolic cardiovascular risk factors in postmenopausal women. For this purpose, 939 postmenopausal women participating in the Framingham Offspring Study were included in this cross-sectional study. Mean blood pressure, waist-hip ratio (WHR) and lipoprotein levels were determined in quartile categories of dietary phytoestrogen (isoflavones and lignans) intake, determined by a food-frequency questionnaire. In addition, a metabolic syndrome score was defined according to WHO criteria (range 0-6). The WHR was lower in women in the highest quartile of intake of lignans compared with the lowest [-0.017; 95% confidence interval (Cl) -0.030 to -0.0016]. In the highest quartile of intake of isoflavones, plasma triglyceride levels were 0.16 mmol/L lower (95% CI, -0.30 to -0.02) compared with the lowest quartile of isoflavones; for lignan intake, this difference was 0.23 mmol/L (95% CI, -0.37 to -0.09). In the highest quartile of isoflavone intake, the mean cardiovascular risk factor metabolic score was 0.43 points lower (95% CI, -0.70 to -0.16) than the lowest quartile. The difference in this score between the extreme quartiles of intake of lignans was -0.55 points (95% CI, -0.82 to -0.28). In conclusion, high intake of phytoestrogens in postmenopausal women appears to be associated with a favorable metabolic cardiovascular risk profile. J. Nutr. 132: 276-282, 2002. KEY WORDS: * phytoestrogens * postmenopausal women * diet * cardiovascular disease * metabolic

The purpose of the study was to estimate the intake of dietary isoflavones, coumestans and lignans in healthy Western postmenopausal women. Many plant foods contain isoflavones, coumestans and lignans. Only a few published studies examined the dietary intake of phytoestrogens in the general Western population. The potentially positive health effects of phytoestrogens are most relevant to postmenopausal women. We studied 939 postmenopausal Caucasian women who entered the fifth examination of the Framingham Offspring Study (1991-1995) and completed the Willett Food Frequency Questionnaire (FFQ). By searching the medical and agricultural literature and contacting experts, we identified food sources of phytoestrogens. We determined the concentrations of the different isoflavones (daidzein, genistein, formononetin and biochanin A), coumestans and lignans (matairesinol and secoisolariciresinol) for each food item on the FFQ. We scored the concentration of phytoestrogens in each food item into seven categories and multiplied the score by the serving size of the food. The amounts in each food item were multiplied by the frequency of the consumption of that food and then summed across foods to obtain the total intake of each phytoestrogen. Median total daily intake of the phytoestrogens is presented with interquartile ranges in parentheses. The estimated daily median intake of the isoflavones was as follows: daidzein, 39 [micro]g (24-57 [micro]g); genistein, 70 [micro]g (28-120 [micro] g); formononetin, 31 [micro] g (13-44 [micro]g); and biochanin A, 6 [micro] g (2-11 [micro]g). The median total intake of isoflavones was 154 [micro] g (98-235 [micro]g), and the main source was beans and peas. The estimated daily intake of coumestans was 1 [micro]g (0-2 [micro]g), and the main source was broccoli. The estimated daily median intake of matairesinol was 25 [micro]g (16-36 [micro]g) and of secoisolariciresinol was 534 [micro]g (383-763 [micro]g). The median total intake of lignans was 565 [micro]g (407-788 [micro]g), and the main source was fruits other than citrus fruits or berries. Dietary intake of isoflavones, coumestans and lignans in healthy postmenopausal Caucasian women in the United States is low. Despite the low intakes, recommendations for changes in the diet of postmenopausal women to increase dietary phytoestrogens may be premature before the health benefits of phytoestrogens are clearly demonstrated.

The purpose of this study is to investigate prospectively whether urinary excretion of genistein and enterolactone, as a marker for phytoestrogen intake, is associated with fatal myocardial infarction risk. Estrogen replacement therapy has been associated with a reduced cardiovascular disease risk. Phytoestrogens are a family of plant compounds that have been shown to have both estrogenic and antiestrogenic properties. Accumulating evidence suggests that phytoestrogens may confer health benefits related to cardiovascular diseases. We studied the relation between phytoestrogen excretion and fatal myocardial infarction in a prospective cohort study of 12,239 women living in the city of Utrecht, who were initially aged between 52 and 67 y. The vital status of these women was followed between 1976 and 1995 (168,513 y). Concentrations of genistein and enterolactone in one overnight urine sample were determined in urine samples of 250 women who died of myocardial infarction and in a reference group of 250 women who did not. Concentrations of genistein and enterolactone were measured with time-resolved fluorescence immunoassays and adjusted for creatinine excretion. Data were analyzed by using a nested case-control analysis. With Poisson regression, we quantified the association between quartiles of genistein and enterolactone excretion and death caused by myocardial infarction. Higher urinary genistein excretion was not associated with reduced myocardial infarction mortality risk; the risk ratio for the highest compared with the lowest quartile was 0.29, 95% confidence interval 0.76-1.04. Results for enterolactone excretion were comparable. In conclusion, we were not able to detect a protective effect of phytoestrogen excretion on myocardial infarction mortality risk.

Phytoestrogens have been suggested to lower cardiovascular disease risk. We investigated whether habitual low phytoestrogen intake is associated with manifest cardiovascular disease. Between 1993 and 1997, a total of 16,111 women aged 49-70 y were enrolled in the Dutch Prospect-EPIC (European Prospective Study into Cancer and Nutrition) cohort. At enrollment, women completed a questionnaire on chronic disease risk factors. Intake of phytoestrogens was estimated using a food frequency questionnaire covering regular dietary intake of 178 food items in the year before enrollment. The concentrations of the different isoflavones and lignans in each food in the food frequency questionnaire were scored in seven categories and multiplied by the serving size of the food and the frequency of its consumption. During the 50.9 mo of follow-up, occurrences and causes of morbidity and mortality were ascertained. The study population was restricted to women free from cardiovascular disease at baseline. Cox regression was used to estimate hazard ratios for quartiles of phytoestrogen intake adjusted for age at intake; body mass index; smoking; and energy, fiber, fruit, and vegetable intake. In total, 830 women experienced a cardiovascular event during follow-up. Mean intake (SD; in mg/d) was 1.12 (0.51) of lignans and 0.88 (2.59) of isoflavones. Compared with the lowest quartile of lignan intake, the second, third, and fourth quartiles showed hazard ratios (95% CI) of 0.80 (0.66-0.97), 0.79 (0.65-0.97), and 0.72 (0.57-0.91), respectively. For isoflavones, the results were 0.97 (0.80-1.17), 0.92 (0.75-1.13), and 0.79 (0.630.99). Notwithstanding the low overall intake of phytoestrogens, higher intake of lignans is associated with decreased cardiovascular risk. The same holds, although not statistically significant, for isoflavones intake. Associations are small, but we have to remember that intake is also very low in Western societies.