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American Journal of Clinical Nutrition, Vol. 84, No. 3, 587-593, September 2006
© 2006 American Society for Nutrition

ORIGINAL RESEARCH COMMUNICATION

Lignan and isoflavone excretion in relation to uterine fibroids: a case-control study of young to middle-aged women in the United States 1,2,3

Charlotte Atkinson, Johanna W Lampe, Delia Scholes, Chu Chen, Kristiina Wähälä and Stephen M Schwartz

1 From the Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (CA, JWL, CC, and SMS); the Department of Epidemiology, University of Washington, Seattle, WA (JWL, DS, CC, and SMS); the Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA (DS); and the University of Helsinki, Helsinki, Finland (KW).

Background: Uterine fibroids are hormonally responsive; estradiol and progesterone stimulate their growth, and gonadotrophin-releasing hormone agonists shrink them. Phytoestrogens, including isoflavones and lignans, can act as weak estrogens or antiestrogens.

Objective: The objective of this case-control study was to evaluate the relation between uterine fibroid risk and phytoestrogen exposure.

Design: Two overnight urine collections (48 h apart) from 170 uterine fibroid cases and 173 controls were analyzed for isoflavonoids (ie, daidzein, genistein, equol, and O-desmethylangolensin) and lignans (enterodiol and enterolactone). Logistic regression was used to determine associations between the mean excretion of the 2 collections and the risk of uterine fibroids.

Results: Unadjusted isoflavone excretion did not differ significantly between cases and controls (2.33 ± 5.82 and 2.60 ± 5.90 nmol/mg Cr, respectively; P = 0.68), but cases excreted significantly less lignans than did controls (2.86 ± 3.45 and 4.57 ± 6.67 nmol/mg Cr, respectively; P < 0.01). The trend for a reduced risk of uterine fibroids with increasing quartiles of lignan excretion was significant (odds ratio for highest versus lowest quartile = 0.31; 95% CI: 0.17, 0.58; P for trend < 0.01). When adjusted for age, BMI, race, family history of uterine fibroids, and isoflavone excretion, this trend remained but was attenuated (P = 0.07).

Conclusions: Our findings suggest a modest inverse association between lignan excretion and uterine fibroid risk. Whether this relation represents an effect of lignans per se or of other constituents of lignan-containing foods on the development of uterine fibroids remains to be determined. No association was found between isoflavone excretion and uterine fibroids; however, the intake of soy foods, the primary source of isoflavones, was low in this population.

Key Words: Isoflavone • leiomyomata • lignan • phytoestrogen • uterine fibroid • women






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