CME / CE

Dietary Soy May Improve Features of Metabolic Syndrome in Postmenopausal Women

Authors: News Author: Laurie Barclay, MD
CME Author: Penny Murata, MD
CME / CE Released: 3/19/2007; Reviewed and Renewed: 3/19/2008
THIS ACTIVITY HAS EXPIRED
Valid for credit through: 3/19/2009

Target Audience and Goal Statement

This article is intended for primary care clinicians, endocrinologists, and other specialists who provide care to postmenopausal women with metabolic syndrome.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

Compare the effects of soy-nut vs soy-protein intake on glycemic control in postmenopausal women with metabolic syndrome.
Compare the effects of soy-nut vs soy-protein intake on lipid profiles in postmenopausal women with metabolic syndrome.

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Author(s)

Laurie Barclay, MD

Laurie Barclay, MD is a freelance reviewer and writer for Medscape.

Disclosures

Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

CME Author(s)

Penny Murata, MD

Penny Murata is a freelancer for Medscape.

Disclosures

Penny Murata, MD, has disclosed no relevant financial relationships.

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From Medscape Medical News

CME / CE

Dietary Soy May Improve Features of Metabolic Syndrome in Postmenopausal Women

Authors: News Author: Laurie Barclay, MD CME Author: Penny Murata, MDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED

CME / CE Released: 3/19/2007; Reviewed and Renewed: 3/19/2008

Valid for credit through: 3/19/2009

processing....

March 19, 2007 — Short-term soy-nut consumption improves glycemic control and lipid profiles in postmenopausal women with metabolic syndrome, according to the results of a small randomized crossover trial reported in the March issue of the American Journal of Clinical Nutrition.

"Little evidence exists regarding the effects of soy consumption on the metabolic syndrome in humans," write Leila Azadbakht, MSC, from the Shaheed Beheshti University of Medical Sciences in Tehran, Iran, and colleagues. "Soy consumption could reduce the risk of the metabolic syndrome through its beneficial components, including complex carbohydrates, unsaturated fatty acids, vegetable protein, soluble fiber, oligosaccharides, vitamins, minerals, inositol-derived substances such as lipintol and pinitol, and phytoestrogens, particularly the isoflavones genistein, diadzein, and glycitein. However, the amount and kind of these components may vary in different kinds of soy products; ie, textured soy-protein or soy-nut."

In a crossover design, 42 postmenopausal women with metabolic syndrome were randomized to consume a control diet (Dietary Approaches to Stop Hypertension [DASH]), a soy-protein diet, or a soy-nut diet, each for 8 weeks. Red meat in the DASH period was replaced by soy protein in the soy-protein period and by soy nut in the soy-nut period.

The homeostasis model of assessment-insulin resistance (HOMA-IR) score was significantly decreased with the soy-nut regimen compared with the soy-protein (difference in percentage change, -7.4 ± 0.8; P < .01) or control (-12.9 ± 0.9; P < .01) diets.

Fasting plasma glucose level was also reduced more significantly during consumption of the soy-nut diet compared with the soy-protein (-5.3% ± 0.5%; P < .01) or control diet (-5.1% ± 0.6%; P < .01). Low-density lipoprotein (LDL) cholesterol level was decreased more during the soy-nut diet than during the soy-protein diet (-5.0% ± 0.6%; P < .01) or the control diet (-9.5% ± 0.6%; P < .01). Compared with the control diet, soy-nut but not soy-protein consumption significantly reduced serum C-peptide concentrations (-8.0 ± 2.1; P < .01).

Study limitations include failure to evaluate the effects of soy protein or soy nut according to estrogen-receptor genotype or based on "equol producer" or "equol nonproducer" status.

"Short-term soy-nut consumption improved glycemic control and lipid profiles in postmenopausal women with the metabolic syndrome," the authors write. "Soy as a replacement for red meat in a DASH eating plan had beneficial effects on features of the metabolic syndrome, soy-nut being more effective than soy-protein."

The National Nutrition and Food Technology Research Institute, Shaheed Beheshti University of Medical Sciences supported this study. None of the authors have disclosed any financial relationships.

Am J Clin Nutr. 2007;85:735-741.

Clinical Context

Soy intake has been found to have beneficial effects on lipid levels, for example, as reported in a meta-analysis by Anderson and colleagues in the August 1995 issue of The New England Journal of Medicine. An animal-based study by Dyrskog and colleagues in the October 2005 issue of Metabolism noted a soy-based diet had preventive effects for metabolic syndrome, but the effects of a soy-based diet in humans with metabolic syndrome are not clear.

This randomized, crossover study compares the effects of soy-nut and soy-protein diets on metabolic syndrome components, including plasma lipids, lipoproteins, insulin resistance, and glycemic control in postmenopausal women with metabolic syndrome.

Study Highlights

120 women in Tehran were screened for study inclusion if they were postmenopausal, defined by no menstruation for more than 1 year and correlation of follicle-stimulating hormone, luteinizing hormone, testosterone, and estradiol results.
42 women who had at least 3 features of metabolic syndrome were enrolled and completed the study.
Metabolic syndrome was defined per Adult Treatment Panel III guidelines: abdominal adiposity; serum high-density lipoprotein (HDL) cholesterol level less than 50 mg/dL; triglyceride level at least 150 mg/dL; systolic blood pressure at least 130 mm Hg and diastolic blood pressure at least 85 mm Hg; and glucose level at least 110 mg/dL.
Exclusion criteria included secondary cause of hyperglycemia, estrogen therapy up to 6 months prior, insulin or oral hypoglycemic medication, untreated hypothyroidism, smoking, kidney or liver disease, and breast malignancy.
After 3 weeks of usual diet, all women were randomly assigned to receive 1 of 3 diets for 8 weeks in random order with 4-week washout periods between diet regimens.
Control diet consisted of 50% to 60% carbohydrate, 15% to 20% protein, and less than 30% fat; 1 serving of red meat; high intake of fruit, vegetables, whole grains, and low-fat dairy products; low intake of total fat, saturated fat, cholesterol, refined grains, and sweets; and sodium intake of 2400 mg/day.
Soy-nut diet replaced red meat serving with 30 g of soy nut; soy isoflavones were 102 mg/day.
Soy-protein diet replaced red meat serving with 30 g of soy protein; soy isoflavones were 84 mg/day.
Women received instruction on meal preparation and contacted nutritionist daily.
At 45- to 60-minute study visits conducted every 2 weeks, 3-day diet records and physical activity records were reviewed.
Patient adherence was assessed by monthly review of diet records and attendance at monthly group discussions.
Baseline data obtained at the beginning of each diet were similar: weight, waist circumference, blood pressure, fasting blood glucose, triacylglycerols, and levels of HDL cholesterol, LDL cholesterol, total cholesterol, fasting insulin, C-peptide, apolipoprotein AI, and apolipoprotein B100 (apoB-100) and HOMA-IR.
Soy-protein diet vs control diet significantly improved levels of total cholesterol, LDL cholesterol, fasting insulin, and apoB-100 and HOMA-IR.
Soy-nut vs control diet also significantly improved levels of total cholesterol, LDL cholesterol, fasting insulin, and apoB-100 and HOMA-IR, in addition to fasting glucose and C-peptide levels.
HOMA-IR score decreased more on soy-nut diet vs soy-protein diet (difference in percentage change, -7.4; P < .01) vs control diet (-12.9; P < .01).
Fasting plasma glucose level decreased more on soy-nut diet vs soy-protein diet (-5.3%; P < .01) vs control (-5.1; P < .01).
LDL cholesterol level decreased more on soy-nut diet vs soy-protein diet (-5.0%; P < .01) vs control (-9.5%; P < .01).
C-peptide decreased more on soy-nut diet vs control (-8.0; P < .01); soy-protein diet had no significant effect.
Systolic and diastolic blood pressures did not change significantly.
Activity level did not change during study.
1 person reported bloated feeling during soy-protein diet.
Order of diet regimen did not affect results.
Plasma phytoestrogen increased on soy-nut diet (by 64%; P < .01) and on soy-protein diet (48%; P < .01) vs control diet.

Pearls for Practice

In postmenopausal women with metabolic syndrome, intake of soy nuts improved HOMA-IR score and reduced fasting plasma glucose and serum C-peptide levels more than intake of soy protein.
In postmenopausal women with metabolic syndrome, intake of soy nuts decreased LDL cholesterol, total cholesterol, and apoB-100 levels more than intake of soy protein.

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