title: Urinary phytoestrogens and depression in perimenopausal US women: NHANES 2005-2008.
abstract: BACKGROUND
  Fluctuating hormonal levels observed during the menopausal transition may increase vulnerability to depression in susceptible women. Thus, it is of interest to examine the effect of natural estrogens such as phytoestrogens on the risk of depression in perimenopausal women.
  
  
  METHODS
  Our analysis included 193 perimenopausal women of the National Health and Nutrition Survey (NHANES) 2005-2008 aged 45-55 years. Urinary concentrations of phytoestrogens (isoflavones and lignans) were measured by HPLC-APPI-MS/MS. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Logistic regression models examined the association of phytoestrogens concentrations (creatinine-standardized and log-transformed) with depression (yes/no).
  
  
  RESULTS
  Unadjusted odds ratios (OR) of the associations between urinary phytoestrogen concentrations and perimenopausal depression were below 1; however, only lignans were significantly inversely associated with depression. The latter findings were not attenuated in multivariate analysis including age, race, body mass index, poverty income ratio, smoking, alcohol consumption, cancer, diabetes, and cardiovascular disease (lignans: OR=0.66; 95% confidence intervals (CI) 0.50-0.87, enterodiol: OR=0.63; 95% CI 0.51-0.78, enterolactone: OR=0.75; 95% CI 0.60-0.93).
  
  
  CONCLUSIONS
  Our cross-sectional study design does not allow for causal inferences. Because information to precisely assess perimenopausal symptoms was missing, we defined perimenopause based on women's age.
  
  
  CONCLUSIONS
  Lower lignans but not isoflavones concentrations were statistically significantly associated with an increased risk of depression in perimenopausal women. Because of medical risks associated with the use of hormone therapy, further investigation on the effect of lignans on the risk of depression in perimenopausal women is warranted.
authors.affiliation: Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, CH-8001 Zürich, Switzerland. Electronic address: aline.barbir@ifspm.uzh.ch.
authors.forename: Aline
authors.initials: A
authors.lastname: Richard
authors.affiliation: Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, CH-8001 Zürich, Switzerland.
authors.forename: Sabine
authors.initials: S
authors.lastname: Rohrmann
authors.affiliation: Mental Health and Social Epidemiology, Institute of Social and Preventive Medicine, University of Zurich, Switzerland.
authors.forename: Meichun
authors.initials: M
authors.lastname: Mohler-Kuo
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Rodgers
authors.affiliation: University Hospital Basel, Women's Hospital, Switzerland.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Moffat
authors.affiliation: Cantonal Hospital Winterthur, Department of Gynecology and Obstetrics, Switzerland.
authors.forename: Uwe
authors.initials: U
authors.lastname: Güth
authors.affiliation: Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, CH-8001 Zürich, Switzerland.
authors.forename: Monika
authors.initials: M
authors.lastname: Eichholzer
mesh_terms: D003430:Cross-Sectional Studies; D003863:Depression / Q000503:physiopathology / Q000652:urine*; D003866:Depressive Disorder / Q000503:physiopathology / Q000652:urine*; D005260:Female; D006801:Humans; D007529:Isoflavones / Q000652:urine; D017705:Lignans / Q000652:urine; D016015:Logistic Models; D008875:Middle Aged; D009749:Nutrition Surveys; D047648:Perimenopause / Q000523:psychology* / Q000652:urine*; D048789:Phytoestrogens / Q000652:urine*; D014481:United States
chemical_list: D007529:Isoflavones; D017705:Lignans; D048789:Phytoestrogens
keywords: Cross-sectional study; Depression; Isoflavones; Lignans; Perimenopause