Soy Misinformation Nutr Cancer 55: 1, 2006 10 Nutr. Cancer 55: - PDF document

4/6/2017 Soyfoods, Soy Isoflavones & Health: Soyfoods, Soy Isoflavones & Health: Where Does the Science Stand? Where Does the Science Stand? Mark Messina, PhD, MS • United Soybean Board Soy Nutrition Institute • Soyfoods Council Loma Linda University Nutrition Matters, Inc. • Vitasoy Consult for: • Pharmavite • Alpro April 10, 2017 Soyfoods, Soy Isoflavones & Health: Where Does the Science Stand? • Perception of soyfoods Disconnect between • Asian soy intake Nutrition Professionals • Macronutrient composition and the Public about • Health attributes of soy protein • Isoflavones the Healthfulness • Breast cancer of Specific Foods • Hot flashes • Bone health • Concerns Disconnect between Nutrition Disconnect between Nutrition Professionals and the Public about the Professionals and the Public about the Healthfulness of Specific Foods Healthfulness of Specific Foods (% viewing as healthful) (% viewing as healthful) Food Food Professionals Public Professionals Public Granola bars 28 71  43 Coconut oil 37 72 Why does 43% of the public  35 Frozen yogurt 32 66  34 think tofu isn’t healthful? Quinoa 89 58  31 Humus 90 66  24 Tofu 85 57 Tofu 85 57  28  28 Poll conducted by Morning Consult for the NYT. July 2016. Nutritionists = ASN members Poll conducted by Morning Consult for the NYT. July 2016. Nutritionists = ASN members 1

4/6/2017 Soy Misinformation Nutr Cancer 55: 1, 2006 10 Nutr. Cancer 55: 1-12, 2006 Asian Soyfood Consumption 1 Traditional Asian Soyfoods Location Serv./d 2 Type of soyfood Shanghai 1 – 2 Unfermented Unfermented Fermented Singapore ½ – ¾ Unfermented Hong Kong ½ Unfermented Edamame China ½ Unfermented Miso Tofu Japan 1 – 2 50% fermented Natto Korea ½ – 1 30% fermented Soy milk Tempeh 1 Among older adults 2 Servings: 240 ml milk, 85-100 g tofu Rarely used in clinical trials Nutr. Cancer 55: 1-12, 2006 2

4/6/2017 Food Chemistry 229: 663, 2017 14 Soy protein products Isolate: ~90% protein Concentrate: ~70% protein Flour: ~50% protein • Routinely used in clinical studies • Widely used by the food industry:  Functional purposes  Western (second generation) soyfoods Macronutrient Composition vs. 3

4/6/2017 Protein Digestibility Corrected AA Scores Macronutrient (% calories) Egg white 1.00 Composition of Soybeans in Milk (casein) 1.00 Comparison to Common Beans Soy 1.00 Beef 0.92 Pea protein 0.73 Soybeans Common Macronutrient Kidney beans 0.68 beans Pinto beans 0.63 Rolled oats 0.57 * Carbohydrate 27 70 Rice 0.53 Protein 33 27 Peanut meal 0.52 Whole wheat 0.40 Fat 40 3 Wheat gluten 0.25 Highest score = 1.0 (truncated) Almond 0.23 *Mostly oligosaccharides (indigestible) Capable of functioning as prebiotics AJCN 70: 439S, 1999 J Agric Food Chem. 59: 12707, 2011 “25 grams of soy protein DEPARTMENT OF HEALTH AND HUMAN SERVICES per day … may reduce Food and Drug Administration risk of heart disease” December 6, 2007 J. Nutr. 138, 1244S, 2008 Countries with approved health claims Reevaluating • United States (1999) • Malaysia evidence in • Indonesia • Philippines support of the • Japan • Brazil • Korea • Columbia health claim • Chile • South Africa • Turkey • Canada (2014) • Lowers LDL-C ~3% (22 studies) • Lowers LDL-C 4.3% (22 studies) • Doesn’t warrant health claim • Lowers LDL-C 5.2% (11 studies) • Didn’t conduct a meta-analysis • Warrants health claim 23 24 . J Nutr. 140, 2302S, 2010. 4

4/6/2017 Soy products & Serum Lipids: A Meta ‐ analysis of 50 Randomized Controlled Trials Product Subjects (n) Percent Percent Percent or group  LDL  TG  HDL Cont. Soy All 1 1687 1679 4.83 4.92 1.40 Sub-analysis Comprehensive approach that At risk 2 32 studies 7.47 3.91 1.15 dramatically lowers cholesterol Healthy 18 studies 2.96 5.13 1.96 W. soy 3 12 studies 11.06 1.03 1.06 LDL (-6.97%) & TG (-9.39%)  more in 1 All products and subjects 2 Elevated LDL, non-casein/milk control trials (n=22) hypertensive or diabetic 3 Nuts, milk, oil, whole bean flour BJN. 114, 831-843, 2015 Metabolism 51: 1596, 2002 Percent Reduction in LDL ‐ Cholesterol Components of the Portfolio Diet in 13 Hypercholesterolemic Men and Women Consuming the Portfolio Diet • Almonds 15 • Low saturated fat High quality 5 protein • Soluble fiber -5 Protein is hypo- • Soyfoods -15 * cholesterolemic * * • Phytosterols -25 * High PUFA -35 Low saturated fat • Fruits/vegetables -1 0 1 2 3 4 Weeks on study Metabolism 51: 1596, 2002 Ana M. Cartagena; CMAJ 173: Br. J. Nutr. 106: 317, 2011 486, 2005 5

4/6/2017 Effects of Soy on Blood Pressure: Attributes of Soy Protein Meta ‐ analysis of 27 Clinical Trials* • High quality (PDCAAS, 0.9-1.0) Blood Similar to animal protein mmHg 95% CI pressure • Lowers LDL-cholesterol (4-5%) Systolic -2.21 -4.10, -0.33 Health claims in >10 countries Diastolic -1.44 -2.56, -0.31 • May lower blood pressure (~2 mmHg) Blinded trials (n=15) Systolic -2.90 -5.49, -0.31 All 4 meta-analysis show reductions Diastolic -1.93 -3.53, -0.34 • May favorably affect kidneys Possibly multiple benefits *Secondary endpoint in most trials Br. J. Nutr. 106: 317, 2011 AJCN 88:38, 2008; BJN 106:317, 2011; Nutr Metab CVC 22: 463, 2012; J Hypertens. 28: 1971, 2010; World J Nephrol 5: 233, 2016 Fatty Acid Composition of Soybean Oil Fatty acid Percent Saturated 12 Monounsaturated 29 Omega-6 PUFA (LA)* 53 Omega-3 PUFA (ALA)* 6 *Essential fatty acids: LA, linoleic acid; ALA,  -linolenic acid World J Nephrol 5: 233, 2016 J. Agric. Food Chem. 2004 52, 5322; 57: 11174, 2009 Contribution of Soybean Fatty Acid Oil to US Caloric and Essential Composition of Fatty Acid Intake Soybean Oil ● 7% of total calories Fatty acid Percent Saturated 12 ● 43% of linoleic acid Monounsaturated 29 Omega-6 PUFA (LA)* 53 9:1 ● 44% of  -linolenic acid Omega-3 PUFA (ALA)* 6 *Essential fatty acids: LA, linoleic acid; ALA,  -linolenic acid Am J Clin Nutr 93: 950-62, 2011 J. Agric. Food Chem. 2004 52, 5322; 57: 11174, 2009 6

4/6/2017 The Controversy over Dietary Fat “ … no evidence from randomized, controlled intervention studies … & Coronary Heart that LA … increases the concentration Disease of inflammatory markers.” 37 Effects of Replacing 5% of Calories from Saturated Fat with 5% of Calories from: Coronary heart Nutrient disease risk Refined carbohydrates  2% 2 2 Carbohydrates, whole grains  9%2 .J Am. Coll. Cardiol. 66: 1538, 2015 Monounsaturated fat  15% Polyunsaturated fat  25% Based on 127,536 study participants who were followed for up to 30 years .J Am. Coll. Cardiol. 66: 1538, 2015 39 OH O 1 Mean Daily Isoflavone Intake 2 7 Isoflavones A C R 1 4 B 5 O R 2 OH <3 mg 30-50 mg Naturally-occurring plant chemicals Int J Food Sci Nutr 65: 9, 2014 >20,000 peer-reviewed publications Traditional soyfoods: 3-4 mg/g protein One serving ~25 mg Nutr Cancer 55:1, 2006 7

4/6/2017 Cholesterol Soybean Isoflavone Aglycones (animal foods) O 1 OH  Blood Phytoestrogens 2 7 A C cholesterol R 1 4 B 5 O R 2 OH Genistein % of  Blood Isoflavone R 1 R 2 total cholesterol Genistein H OH 50 Daidzein H H 40 Phytosterols Glycitein OCH 3 H 10 Estradiol (plant foods) OH O 1 2 7 Isoflavones A C R 1 4 B 5 Soyfoods O R 2 OH ● Found primarily in soybeans and breast ● Phytoestrogens but different from estrogen cancer ● Sometimes effects opposite to estrogen prevention ● Sometimes no effects in estrogen-sensitive tissues ● Estrogen-independent effects Age ‐ Adjusted Breast Cancer Age ‐ Adjusted Breast Cancer Incidence Rates (per 100,000) for Incidence Rates (per 100,000) Miyagi Prefecture, Japan, 1959 ‐ 97 for Selected Countries 80 China 19.1 60 Japan 19.7 Westernization India 20.8 40 Finland 44.7 20 Sweden 60.7 Basle 72.1 0 USA 87.0 59-61 65-67 73-77 83-87 93-97 0 50 100 Year of diagnosis Int. J. Cancer: 108, BCa: Shanghai, Osaka, Madras, Geneva, San Francisco (W). 901–906 (2004) 8

4/6/2017 Early Soy (Isoflavone) Intake Decreases Breast Cancer Risk Asia Pac J Clin Nutr, 22: 118, 2013 Higher soy intake is associated with a one-third reduction in breast cancer risk 49 Early Soy Intake and BCa Risk: Early Soy (Isoflavone) Summary of Retrospective Studies Intake Decreases Breast Cancer Risk High vs low soy intake during adolescence Risk Statistically Author/Y Location (N) %  Significant? ● Rodent data Shu, 2001 China 3,015 49 Yes Support ● Epidemiologic data Wu, 2009 USA 345 28 Yes Korde, 2009 USA 250 60 Yes ● Proposed mechanisms * Baglia, 2016 China 36,297 44 Not quite *Premenopausal only Ref.: Shu: CEBP;10:483, 2001; Wu: AJCN 89: 1145, 2009; Korde: CEBP 18: 1050, 2009; Int J Cancer 139: 742, 2016 *(95% CI: 0.31, 1.00) Young Can girls should soyfoods be sure be safely 100 g to eat ≥ 1 consumed by 240 ml serving of breast cancer 245 g patients? soy per day 100 g 100 g 9