Association between Spot urine Phytoestrogens as Biomarkers on Their Dietary Intake on the Risk of Death from Cancer and Cardiovascular Disease

Abstract

This study suggests that phytoestrogen intake alters cancer and cardiovascular risk. This study investigated the associations of urinary phytoestrogens with total cancer (n = 198), cardiovascular (n = 152), and all-cause (n = 363) mortality among 5179 participants in the continuous National Health and Nutrition Examination Survey Canada (2009–2014). Methods Urinary phytoestrogens were measured using high-performance liquid chromatography with tandem mass spectrometric detection. Survival analysis was per-formed to evaluate hazard ratios (HRs) and 95 % confi-dence 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 10.48; 95 % CI 0.24, 0.97), whereas higher urinary concentrations of total isoflavones (HR for tertile 3 vs. tertile 12.14; 95 % CI 1.03, 4.47) and daidzein (HR for tertile 3 vs. tertile 12.05; 95 % CI 1.02, 4.11) were associated with an increased risk death from Cardiovascular Disease. A reduction in all-cause mortality was observed for elevated urinary concentrations of total enterolignans (HR for tertile 3 vs. tertile 10.65; 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 associ-ated with cardiovascular and all-cause mortality in a rep-resentative sample of the Canadian population. This is one of the first studies that used urinary phytoestrogens as biomarkers of their dietary intake to evaluate the effect of these bioac-tive compounds on the risk of death from cancer and car-diovascular disease.