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Nutritional Epidemiology

Variations in Plasma Phytoestrogen Concentrations in European Adults^1,2

³ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands; ⁴ IARC International Agency for Research on Cancer (IARC-WHO), Lyon, France; ⁵ HFL, Fordham, Cambridgeshire, UK; ⁶ Epidemiology Department, Murcia Health Council, Murcia, Spain; ⁷ Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark; ⁸ INSERM ERI-20, Institut Gustave-Roussy, Villejuif, France; ⁹ German Cancer Research Center, Clinical Epidemiology, C020, Nutritional Epidemiology, Heidelberg, Germany; ¹⁰ University of Athens, School of Medicine, Department of Hygiene and Epidemiology, Athens, Greece; ¹¹ Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrucke, Germany; ¹² Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark; ¹³ Nutritional Epidemiology Unit, National Cancer Institute, Milan, Italy; ¹⁴ Molecular and Nutritional Epidemiology Unit, CSPO-Scientific Institute of Tuscany, Florence, Italy; ¹⁵ Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy; ¹⁶ Cancer Registry, Azienda Ospedaliera "Civile M.P. Arezzo", Ragusa, Italy; ¹⁷ Environmental Epidemiology, Imperial College, London, UK; ¹⁸ Center for Nutrition and Health, National Institute of Public Health and the Environment, Bilthoven, the Netherlands; ¹⁹ Institute of Community Medicine, University of Tromso, Norway; ²⁰ Epidemiology Department (ICO-IDIBELL), Catalan Institute of Oncology, Barcelona, Spain; ²¹ Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden; ²² Department of Medicine, Lund University, Malmö, Sweden; ²³ Cancer Research UK, Epidemiology Unit, University of Oxford, Oxford, UK; and ²⁴ MRC Dunn Human Nutrition Unit, Welcome Trust/MRC Building, Cambridge, UK

^* To whom correspondence should be addressed. E-mail: p.h.m.peeters{at}umcutrecht.nl.

Dietary phytoestrogens may play a role in chronic disease occurrence. The aim of our study was to assess the variability of plasma concentrations in European populations. We included 15 geographical regions in 9 European countries (Denmark, France, Germany, Greece, Italy, Spain, Sweden, The Netherlands, and UK) and a 16th region, Oxford, UK, where participants were recruited from among vegans and vegetarians. All subjects were participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). Plasma concentrations of 3 isoflavones (daidzein, genistein, and glycitein), 2 metabolites of daidzein [O-desmethylangolensin (O-DMA) and equol] and 2 mammalian lignans (enterodiol and enterolactone) were measured in 1414 participants. We computed geometric means for each region and used multivariate regression analysis to assess the influence of region, adjusted for gender, age, BMI, alcohol intake, smoking status, and laboratory batch. Many subjects had concentrations below the detection limit [0.1 µg/L (0.4 nmol/L)] for glycitein (80%), O-DMA (73%) and equol (62%). Excluding subjects from Oxford, UK, the highest concentrations of isoflavones were in subjects from the Netherlands and Cambridge, UK [2–6 µg/L (7–24 nmol/L); P < 0.05], whereas concentrations for lignans were highest in Denmark [8 µg/L (27 nmol/L); P < 0.05]. Isoflavones varied 8- to 13-fold, whereas lignans varied 4-fold. In the vegetarian/vegan cohort of Oxford, concentrations of isoflavones were 5–50 times higher than in nonvegetarian regions. Region was the most important determinant of plasma concentrations for all 7 phytoestrogens. Despite the fact that plasma concentrations of phytoestrogens in Europe were low compared with Asian populations, they varied substantially among subjects from the 16 different regions.