title: Urinary phytoestrogens and cancer, cardiovascular, and all-cause mortality in the continuous National Health and Nutrition Examination Survey.
abstract: OBJECTIVE
  Experimental studies suggest that phytoestrogen intake alters cancer and cardiovascular risk. This study investigated the associations of urinary phytoestrogens with total cancer (n = 79), cardiovascular (n = 108), and all-cause (n = 290) mortality among 5179 participants in the continuous National Health and Nutrition Examination Survey (1999-2004).
  
  
  METHODS
  Urinary phytoestrogens were measured using high-performance liquid chromatography with tandem mass spectrometric detection. Survival analysis was performed to evaluate hazard ratios (HRs) and 95 % confidence 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 1 0.48; 95 % CI 0.24, 0.97), whereas higher urinary concentrations of total isoflavones (HR for tertile 3 vs. tertile 1 2.14; 95 % CI 1.03, 4.47) and daidzein (HR for tertile 3 vs. tertile 1 2.05; 95 % CI 1.02, 4.11) were associated with an increased risk. A reduction in all-cause mortality was observed for elevated urinary concentrations of total enterolignans (HR for tertile 3 vs. tertile 1 0.65; 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 associated with cardiovascular and all-cause mortality in a representative sample of the US population. This is one of the first studies that used urinary phytoestrogens as biomarkers of their dietary intake to evaluate the effect of these bioactive compounds on the risk of death from cancer and cardiovascular disease.
authors.affiliation: Department of Epidemiology, Indiana University Richard M. Fairbanks School of Public Health, 714 N Senate Avenue, Suite EF250F, Indianapolis, IN, 46202, USA.|College of Health Professions, Ferris State University, Big Rapids, MI, USA.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Reger
authors.affiliation: Department of Epidemiology, Indiana University Richard M. Fairbanks School of Public Health, 714 N Senate Avenue, Suite EF250F, Indianapolis, IN, 46202, USA.
authors.forename: Terrell W
authors.initials: TW
authors.lastname: Zollinger
authors.affiliation: Department of Biostatistics, Indiana University Richard M. Fairbanks School of Public Health and School of Medicine, Indianapolis, IN, USA.
authors.forename: Ziyue
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Health Informatics, School of Informatics and Computing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
authors.forename: Josette
authors.initials: J
authors.lastname: Jones
authors.affiliation: Department of Epidemiology, Indiana University Richard M. Fairbanks School of Public Health, 714 N Senate Avenue, Suite EF250F, Indianapolis, IN, 46202, USA. JZ21@iu.edu.|Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA. JZ21@iu.edu.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Zhang
mesh_terms: D015107:4-Butyrolactone / Q000031:analogs & derivatives / Q000652:urine; D000328:Adult; D015415:Biomarkers / Q000652:urine; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000652:urine; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007529:Isoflavones / Q000008:administration & dosage / Q000652:urine; D017705:Lignans / Q000652:urine; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000401:mortality* / Q000652:urine; D009749:Nutrition Surveys; D048789:Phytoestrogens / Q000008:administration & dosage / Q000652:urine*; D016016:Proportional Hazards Models; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D007529:Isoflavones; D017705:Lignans; D048789:Phytoestrogens; C004742:daidzein; D015107:4-Butyrolactone; C029497:2,3-bis(3'-hydroxybenzyl)butyrolactone
keywords: Cancer; Cardiovascular disease; Cohort study; Mortality; Urinary phytoestrogens