Table 3.
Pooled associations of dietary phytoestrogens and cause-specific mortality1
| CVD mortality | ||||||
|
Total phytoestrogens |
Q1 (Low) |
Q2 |
Q3 |
Q4 |
Q5 (High) |
Ptrend |
| Number of case/person y | 3144/681,423 | 2808/684,044 | 2461/685,743 | 2238/686,568 | 1841/689,379 | |
| Model 1 | 1 | 0.88 (0.84, 0.93) | 0.82 (0.78, 0.86) | 0.81 (0.77, 0.85) | 0.98 (0.92, 1.04) | <0.0001 |
| Model 2 | 1 | 0.98 (0.93, 1.03) | 0.95 (0.90, 1.00) | 0.93 (0.88, 0.99) | 0.86 (0.81, 0.92) | <0.0001 |
| Model 3 | 1 | 0.98 (0.93, 1.04) | 0.95 (0.90, 1.01) | 0.95 (0.90, 1.01) | 0.90 (0.85, 0.96) | 0.0006 |
|
Isoflavones |
Q1 |
Q2 |
Q3 |
Q4 |
Q5 |
Ptrend |
| Numebr of case/person y | 3211/681,594 | 2736/684,822 | 2403/686,157 | 2273/685,819 | 1869/688,763 | |
| Model 1 | 1 | 0.89 (0.84, 0.93) | 0.82 (0.78, 0.87) | 0.85 (0.81, 0.90) | 0.74 (0.70, 0.79) | <0.0001 |
| Model 2 | 1 | 0.97 (0.92, 1.03) | 0.94 (0.89, 0.99) | 0.96 (0.91, 1.02) | 0.87 (0.82, 0.92) | <0.0001 |
| Model 3 | 1 | 0.97 (0.92, 1.03) | 0.94 (0.89, 0.99) | 0.97 (0.91, 1.02) | 0.90 (0.84, 0.95) | 0.0008 |
|
Lignans |
Q1 |
Q2 |
Q3 |
Q4 |
Q5 |
Ptrend |
| Number of case/person y | 2883/682,662 | 2526/684,633 | 2475/685,908 | 2331/686,626 | 2277/687,326 | |
| Model 1 | 1 | 0.81 (0.77, 0.86) | 0.79 (0.74, 0.83) | 0.71 (0.68, 0.76) | 0.67 (0.63, 0.71) | <0.0001 |
| Model 2 | 1 | 0.90 (0.86, 0.96) | 0.93 (0.88, 0.98) | 0.88 (0.83, 0.93) | 0.84 (0.80, 0.89) | <0.0001 |
| Model 3 | 1 | 0.92 (0.87, 0.98) | 0.96 (0.90, 1.01) | 0.92 (0.87, 0.98) | 0.91 (0.85, 0.97) | 0.002 |
|
Coumarins |
Q1 |
Q2 |
Q3 |
Q4 |
Q5 |
Ptrend |
| Number of case/person y | 2848/681,517 | 2324/687,127 | 2259/686,496 | 2333/686,484 | 2728/685,531 | |
| Model 1 | 1 | 0.82 (0.78, 0.87) | 0.76 (0.72, 0.80) | 0.73 (0.69, 0.77) | 0.74 (0.70, 0.78) | <0.0001 |
| Model 2 | 1 | 0.93 (0.88, 0.98) | 0.89 (0.85, 0.95) | 0.88 (0.83, 0.93) | 0.88 (0.83, 0.93) | <0.0001 |
| Model 3 | 1 | 0.95 (0.89, 1.00) | 0.92 (0.87, 0.97) | 0.91 (0.86, 0.96) | 0.91 (0.86, 0.96) | 0.002 |
|
Cancer mortality | ||||||
|
Total phytoestrogens |
Q1 (Low) |
Q2 |
Q3 |
Q4 |
Q5 (High) |
Ptrend |
| Number of case/person y | 2789/681,423 | 2881/684,044 | 2912/685,743 | 2829/686,568 | 2315/689,379 | |
| Model 1 | 1 | 0.99 (0.94, 1.04) | 1.03 (0.97, 1.08) | 1.04 (0.99, 1.10) | 0.89 (0.84, 0.94) | <0.0001 |
| Model 2 | 1 | 1.04 (0.99, 1.10) | 1.07 (1.01, 1.13) | 1.06 (1.00, 1.12) | 0.95 (0.90, 1.01) | 0.003 |
| Model 3 | 1 | 1.05 (0.99, 1.10) | 1.08 (1.02, 1.13) | 1.07 (1.01, 1.13) | 0.97 (0.92, 1.03) | 0.04 |
|
Isoflavones |
Q1 |
Q2 |
Q3 |
Q4 |
Q5 |
Ptrend |
| Number of case/person y | 2833/681,594 | 2826/684,822 | 2901/686,157 | 2854/685,819 | 2312/688,763 | |
| Model 1 | 1 | 0.99 (0.94, 1.05) | 1.04 (0.99, 1.10) | 1.08 (1.02, 1.14) | 0.91 (0.86, 0.96) | <0.0001 |
| Model 2 | 1 | 1.04 (0.98, 1.09) | 1.08 (1.02, 1.14) | 1.07 (1.02, 1.13) | 0.95 (0.89, 1.00) | 0.001 |
| Model 3 | 1 | 1.04 (0.98, 1.09) | 1.08 (1.02, 1.14) | 1.08 (1.02, 1.14) | 0.96 (0.91, 1.02) | 0.02 |
|
Lignans |
Q1 |
Q2 |
Q3 |
Q4 |
Q5 |
Ptrend |
| Number of case/person y | 2956/682,662 | 2820/684,633 | 2617/685,908 | 2567/686,626 | 2766/687,326 | |
| Model 1 | 1 | 0.91 (0.86, 0.95) | 0.82 (0.78, 0.87) | 0.79 (0.75, 0.83) | 0.81 (0.77, 0.86) | <0.0001 |
| Model 2 | 1 | 0.98 (0.93, 1.03) | 0.93 (0.88, 0.98) | 0.91 (0.86, 0.96) | 0.94 (0.89, 0.99) | 0.003 |
| Model 3 | 1 | 0.99 (0.94, 1.04) | 0.94 (0.89, 1.00) | 0.94 (0.88, 0.99) | 0.98 (0.92, 1.04) | 0.23 |
|
Coumarins |
Q1 |
Q2 |
Q3 |
Q4 |
Q5 |
Ptrend |
| Number of case/person y | 3164/681,517 | 2626/687,127 | 2607/686,496 | 2490/686,484 | 2839/685,531 | |
| Model 1 | 1 | 0.84 (0.80, 0.88) | 0.81 (0.77, 0.85) | 0.74 (0.70, 0.78) | 0.77 (0.73, 0.81) | <0.0001 |
| Model 2 | 1 | 0.95 (0.90, 1.00) | 0.95 (0.90, 1.00) | 0.87 (0.83, 0.92) | 0.90 (0.85, 0.95) | 0.0001 |
| Model 3 | 1 | 0.95 (0.90, 1.00) | 0.95 (0.90, 1.01) | 0.88 (0.84, 0.93) | 0.91 (0.86, 0.96) | 0.001 |
|
Other mortality | ||||||
|
Total phytoestrogens |
Q1 (Low) |
Q2 |
Q3 |
Q4 |
Q5 (High) |
Ptrend |
| Number of case/person y | 6350/681,423 | 5469/684,044 | 4806/685,743 | 4348/686,568 | 3543/689,379 | |
| Model 1 | 1 | 0.85 (0.82, 0.88) | 0.78 (0.75, 0.81) | 0.76 (0.73, 0.79) | 0.66 (0.63, 0.69) | <0.0001 |
| Model 2 | 1 | 0.97 (0.93, 1.01) | 0.93 (0.89, 0.96) | 0.90 (0.86, 0.93) | 0.81 (0.78, 0.85) | <0.0001 |
| Model 3 | 1 | 0.98 (0.94, 1.02) | 0.94 (0.90, 0.97) | 0.92 (0.88, 0.96) | 0.86 (0.82, 0.90) | <0.0001 |
|
Isoflavones |
Q1 |
Q2 |
Q3 |
Q4 |
Q5 |
Ptrend |
| Number of case/person y | 6360/681,594 | 5349/684,822 | 4740/686,157 | 4402/685,819 | 3665/688,763 | |
| Model 1 | 1 | 0.87 (0.84, 0.90) | 0.81 (0.78, 0.84) | 0.80 (0.77, 0.83) | 0.71 (0.68, 0.74) | <0.0001 |
| Model 2 | 1 | 0.98 (0.94, 1.01) | 0.94 (0.91, 0.98) | 0.93 (0.89, 0.97) | 0.84 (0.81, 0.88) | <0.0001 |
| Model 3 | 1 | 0.97 (0.94, 1.01) | 0.94 (0.91, 0.98) | 0.94 (0.90, 0.98) | 0.88 (0.84, 0.92) | <0.0001 |
|
Lignans |
Q1 |
Q2 |
Q3 |
Q4 |
Q5 |
Ptrend |
| Number of case/person y | 5616/682,622 | 5157/684,633 | 4785/685,908 | 4647/686,626 | 4311/687,326 | |
| Model 1 | 1 | 0.86 (0.82, 0.89) | 0.78 (0.75, 0.81) | 0.73 (0.70, 0.76) | 0.66 (0.64, 0.69) | <0.0001 |
| Model 2 | 1 | 0.95 (0.92, 0.99) | 0.92 (0.89, 0.96) | 0.90 (0.87, 0.94) | 0.83 (0.79, 0.86) | <0.0001 |
| Model 3 | 1 | 0.98 (0.94, 1.02) | 0.97 (0.93, 1.01) | 0.97 (0.93, 1.01) | 0.92 (0.87, 0.96) | 0.03 |
|
Coumarins |
Q1 |
Q2 |
Q3 |
Q4 |
Q5 |
Ptrend |
| Number of case/person y | 5634/681,517 | 4652/687,127 | 4488/686,496 | 4612/686,484 | 5130/685,531 | |
| Model 1 | 1 | 0.82 (0.79, 0.85) | 0.76 (0.73, 0.79) | 0.73 (0.71, 0.76) | 0.73 (0.71, 0.76) | <0.0001 |
| Model 2 | 1 | 0.97 (0.93, 1.01) | 0.93 (0.89, 0.97) | 0.91 (0.88, 0.95) | 0.90 (0.86, 0.93) | <0.0001 |
| Model 3 | 1 | 0.99 (0.95, 1.03) | 0.97 (0.93, 1.01) | 0.96 (0.92, 1.00) | 0.95 (0.91, 0.99) | 0.004 |
Values are hazard ratios (95% CIs).
Model 1: adjustment for age and race (Caucasians/other races).
Model 2: model 1 + smoking status (never, former, current [1–14, 15–24, or ≥25 cigarettes/d], or missing), alcohol intake (0, 0.1–4.9, 5.0–14.9, and ≥15.0 g/d for females; 0, 0.1–4.9, 5.0–29.9, and ≥30.0 g/d for males; or missing), physical activity (metabolic equivalents of task-hour/week), multivitamin use (yes/no), aspirin use (yes/no), history of hypertension (yes/no) and hypercholesterolemia (yes/no), family history of myocardial infarction (yes/no), family history of cancer (yes/no), family history of diabetes (yes/no), menopausal status and postmenopausal hormone use (premenopause, postmenopause [never, former, or current hormone use], or missing; for females), body mass index (<23, 23–24.9, 25–29.9, 30–34.9, >35 kg/m2, or missing), and total energy intake (kcal/d).
Model 3: model 2 + modified alternative health eating index score.
Results from Nurses’ Health Study and Health Professionals Follow-Up Study were calculated using the fixed-effects model. Ptrend < 0.05 was considered statistically significant.
2The number of case/person-years was pooled from Nurses’ Health Study and Health Professionals Follow-Up Study.
The median values of total phytoestrogen, isoflavones, lignans, and coumarins within each quintile in Nurses’ Health Study and Health Professionals Follow-Up Study were the same with those in Table 1.