Association between Dietary Isoflavones in Soy and Legumes and Endometrial Cancer: A Systematic Review and Meta-Analysis

Dietary polyphenols as geroprotective compounds: From Blue Zones to hallmarks of ageing

Following the demographic shift towards an ageing population over the past century, particularly in developed countries, the concept of healthspan has gained increasing acceptance as a key framework for understanding the drivers of healthy ageing. Accordingly, long-lived individuals, such as nonagenarians and centenarians, who remain free from chronic diseases, provide a valuable model to investigate the complex interplay of biological, genetic, and environmental factors that contribute to exceptional longevity. Although there are other longevity hotspots worldwide, five regions, known as Blue Zones, are widely recognized for their exceptionally long-lived populations. Among the various determinants of healthy ageing, the eating patterns of long-lived individuals in Blue Zones include a variety of polyphenol-rich foods, which may contribute to their healthy phenotype. A significant body of evidence suggests that polyphenols, a large family of compounds ubiquitously found in plant-based foods, may exhibit geroprotective activity by influencing underlying biological mechanisms of ageing and promoting optimal longevity. While identifying several knowledge gaps that future investigations should address, the goal of this review is to provide an overview of how specific polyphenols found in foods commonly consumed by long-lived individuals residing in the Blue Zones may mitigate the risk of age-related diseases. Additionally, we discuss how these compounds, by acting on evolutionarily conserved mechanisms associated with ageing, have the potential to modulate the intricate network of the hallmarks of ageing.

Effect of Soy Isoflavones on Measures of Estrogenicity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Despite recommendations to increase plant food consumption for public and planetary health and the role that soy foods can play in plant-predominant diets, controversies around the effects of soy foods, especially soy isoflavones, are a barrier to their intake. Given their cardioprotective effects and ability to alleviate menopausal symptoms, addressing these concerns is particularly relevant to women. This systematic review and meta-analysis of randomized controlled trials aimed to determine the effect of soy isoflavones on measures of estrogenicity in postmenopausal women. MEDLINE, Embase, and Cochrane Library were searched through August 2024 for randomized trials ≥3-mo investigating soy isoflavones compared with non-isoflavone controls in postmenopausal women. Outcomes included endometrial thickness (ET), vaginal maturation index (VMI), follicle-stimulating hormone (FSH), and estradiol. Independent authors extracted data and assessed risk of bias. Grading of Recommendations, Assessment, Development and Evaluation was used to assess certainty of evidence. We included 40 trials (52 trial comparisons, n = 3285) assessing the effect of a median reported dose of 75 mg/d of soy isoflavones in substitution for non-isoflavone controls over a median of 24 wk. Soy isoflavones had no statistically significant effect on any measure of estrogenicity; ET [mean difference, -0.22 mm (95% confidence interval, -0.45, 0.01 mm), PMD = 0.059], VMI [2.31 (-2.14, 6.75), PMD = 0.310], FSH [-0.02 IU/L (-2.39, 2.35 IU/L), PMD = 0.987], and estradiol [1.61 pmol/L (-1.17, 4.38 pmol/L), PMD = 0.256]. The certainty of evidence was high to moderate for all outcomes. Current evidence suggests that soy isoflavones do not exhibit estrogenic effects compared with non-isoflavone controls on 4 measures of estrogenicity in postmenopausal women. This synthesis supports that soy isoflavones likely act as selective estrogen receptor modulators, differing clinically from the hormone estrogen. Addressing public health concerns may promote soy foods as high-quality plant protein sources with low environmental impact and cost, particularly benefiting postmenopausal women and aligning with sustainable dietary patterns and guidelines. This study was registered in PROSPERO as CRD42023439239.

Genistein and daidzein induce ferroptosis in MDA-MB-231 cells

OBJECTIVES

In recent years, there has been a growing interest in targeting ferroptosis for the treatment and prevention of multiple cancers. This study aimed to assess the contribution of ferroptosis to the antiproliferative effects of genistein (GN) and daidzein (DZ) in breast cancer cell lines.

METHODS

MDA-MB-231 and MCF-7 cells were employed as an in vitro model. The antiproliferative effects of GN and DZ were determined by WST-1 assay in the presence of specific inhibitors of different cell death pathways. The mRNA expressions of Gpx4 and Fsp-1, the levels of lipid peroxidation, glutathione (GSH)/glutathione disulfide (GSSG) ratio, and intracellular iron ion content were assessed in GN- or DZ-treated cells.

RESULTS

GN and DZ were found to cause ferroptotic cell death in MDA-MB-231, as confirmed by the reversal of viability when cells were pretreated with ferrostatin-1. Furthermore, both phytochemicals induced biochemical markers of ferroptosis, including lipid peroxidation and iron ions levels, and decreased GSH/GSSG levels. The mRNA expression levels of the main anti-ferroptotic genes, Gpx4 and Fsp-1, were diminished by the treatment of both phytochemicals. Surprisingly, ferroptosis did not play a role in GN- or DZ-induced cell death in MCF-7 cells.

CONCLUSION

Our findings highlight the potential of GN and DZ as ferroptosis inducers in triple-negative breast cancer cells.

Dietary Flavonoids Consumption and Health: An Umbrella Review

SCOPE

The current evidence between dietary flavonoids consumption and multiple health outcomes is inadequate and inconclusive. To summarize and evaluate the evidence for dietary flavonoids consumption and multiple health outcomes, an umbrella review of meta-analyses and systematic reviews is conducted.

METHODS AND RESULTS

PubMed, Ovid-EMBASE, and the Cochrane Database of Systematic Reviews are searched up to January 2024. The study includes a total of 32 articles containing 24 unique health outcomes in this umbrella review. Meta-analyses are recalculated by using a random effects model. Separate analyses are performed based on the kind of different flavonoid subclasses. The study finds some unique associations such as flavonol and gastric cancer, isoflavone and uterine fibroids and endometrial cancer, total flavonoids consumption and lung cancer, ovarian cancer, and prostate cancer. Overall, the study confirms the negative associations between dietary flavonoids consumption and type 2 diabetes mellitus, cardiovascular diseases, breast cancer, colorectal cancer, lung cancer, and mortality, while positive associations are observed for prostate cancer and uterine fibroids.

CONCLUSION

Although dietary flavonoids are significantly associated with many outcomes, firm generalizable conclusions about their beneficial or harmful effects cannot be drawn because of the low certainty of evidence for most of outcomes. More well-designed primary studies are needed.

Legume intake and cancer risk in a network of case-control studies

Evidence on the relationship between legume consumption and risk of specific cancer sites is inconclusive. We used data from a series of case-controls studies, conducted in Italy and in the Swiss Canton of Vaud between 1991 and 2009 to quantify the association between legume consumption and several cancer sites including oral cavity, esophagus, larynx, stomach, colorectum, breast, endometrium, ovary, prostate and kidney. Multiple logistic regression models controlled for sex, age, education, smoking, alcohol, body mass index, physical activity, comorbidities, and consumption of fruit, vegetables, processed meat and total calorie intake were used to estimate the odds ratios (OR) for different cancer sites and their corresponding 95% confidence intervals(CI). For female hormone-related cancers, the models also included adjustments for age at menarche, menopausal status and parity. Although most of the estimates were below unity, suggesting a protective effect, only colorectal cancer showed a significant association. Compared to no consumption, the OR for consuming at least one portion of legumes was 0.79 (95% CI: 0.68-0.91), the OR for consuming two or more portions was 0.68 (95% CI: 0.57-0.82) and the estimate for an increment of one portion per week was 0.87 (95% CI: 0.81-0.93). The inverse association between legume consumption and colorectal cancer suggests a possible role of legumes in preventing cancer risk.

Legumes and pulses - a scoping review for Nordic Nutrition Recommendations 2023

Consumption of legumes and pulses is associated with various health outcomes. Therefore, when updating the Nordic Nutrition Recommendations (NNR), summarizing the best available evidence on key health outcomes regarded as relevant for the Nordic and Baltics related to the consumption of legumes was essential. The aim of this scoping review was to evaluate the updated evidence on the effect of the consumption of legumes and pulses on various health outcomes, as well as their dose-response relationship in updated systematic reviews and meta-analyses. The scoping review is built on a de novo systematic review published in 2023 and additional searches on the consumption of legumes and pulses and its various health outcomes, including cardiovascular disease (CVD), cancer, type 2 diabetes, and obesity. Current available evidence shows that the consumption of legumes and pulses is associated with a lower risk of several cancers (evidence: low-moderate), and lower all-cause mortality (evidence: moderate). The associations with CVDs are neutral or inverse, with studies generally showing favourable changes in biomarkers for CVDs. Legume consumption is associated with a lower risk of obesity (evidence: low). For type 2 diabetes, no association was found with incidence, but trials on consumption of legumes and pulses and biomarkers generally indicated protective effects. Overall, the current evidence supports dietary recommendations to increase the consumption of legumes and pulses.

Effect of Adding Pulses to Replace Protein Foods and Refined Grains in Healthy Dietary Patterns

Pulses are dry seeds of legumes which are high in fiber and contain plant protein and several important macronutrients. Our aim was to model the nutritional effects of substituting servings of protein foods and/or refined grains with servings of beans and peas in the Healthy U.S.-Style Pattern identified in the Dietary Guidelines for Americans, 2020-2025. Dietary modeling was accomplished by substituting nutrients of protein foods and/or refined grains with nutrients of the USDA's beans and peas (pulses) composite in the 2000 kcal Healthy U.S.-Style Pattern. A 10% or more change was used as an indicator of meaningful differences. Cost implications were computed by adding the cost of pulses and subtracting the cost of protein foods/refined grains according to the modeling scenario. The substitution of 6-8 oz/week protein foods with 1.5-2.0 cups/week pulses increased fiber and decreased cholesterol. Higher amounts of pulses replacing refined grains or combinations of protein foods and refined grains generally increase fiber, iron, magnesium, potassium, and copper depending on the modeling scenarios. All modeling scenarios of substituting the servings of protein foods alone or in combination with refined grains with the servings of pulses were associated with cost savings. Our results suggest that encouraging increased pulse consumption may be an effective strategy for improving diet.

Health benefits of legume seeds

Pulses have been part of human nutrition for centuries. They are also used in folk medicine as products with multidirectional medicinal effects. They are annual plants representing the Fabaceae family. Their edible part is the fruit, i.e. the so-called pods. Whole pods or their parts can be eaten, depending on the species and fruit ripeness. Beans, peas, peanuts, chickpeas, lentils, broad beans and soybeans are edible legume species. Legume seeds are characterized by high nutritional value. Compared to seeds from other plants, they have high protein content ranging, on average, from 20% to 35%, depending on the type, growing conditions and maturity of the fruit. This review focuses on various health-promoting properties of legumes and presents their nutritional value and compounds exerting health-promoting effects. Many pulses have a low glycemic index, which is important for prevention and treatment of diabetes. In addition to their low glycemic index and high fiber content, pulses have α-amylase and α-glucosidase inhibitors, which reduce the absorption of glucose from the gastrointestinal tract. These compounds have antidiabetic and anti-inflammatory effects. Pulses have been shown to contain bioactive peptides with angiotensin-converting enzyme inhibitory properties; hence, they are useful in the treatment of cardiovascular diseases. Pulses used in the nutrition of obese individuals provide compounds with pancreatic lipase inhibitory properties, thus promoting weight reduction and control. © 2023 Society of Chemical Industry.

Phytoestrogens and Health Effects

Phytoestrogens are literally estrogenic substances of plant origin. Although these substances are useful for plants in many aspects, their estrogenic properties are essentially relevant to their predators. As such, phytoestrogens can be considered to be substances potentially dedicated to plant-predator interaction. Therefore, it is not surprising to note that the word phytoestrogen comes from the early discovery of estrogenic effects in grazing animals and humans. Here, several compounds whose activities have been discovered at nutritional concentrations in animals and humans are examined. The substances analyzed belong to several chemical families, i.e., the flavanones, the coumestans, the resorcylic acid lactones, the isoflavones, and the enterolignans. Following their definition and the evocation of their role in plants, their metabolic transformations and bioavailabilities are discussed. A point is then made regarding their health effects, which can either be beneficial or adverse depending on the subject studied, the sex, the age, and the physiological status. Toxicological information is given based on official data. The effects are first presented in humans. Animal models are evoked when no data are available in humans. The effects are presented with a constant reference to doses and plausible exposure.

Legume Consumption and Risk of All-Cause and Cause-Specific Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies

There is an equivocal and inconsistent association between legume consumption and health outcomes and longevity. The purpose of this study was to examine and quantify the potential dose-response relationship between legume consumption and all-cause and cause-specific mortality in the general population. We conducted a systematic literature search on PubMed/Medline, Scopus, ISI Web of Science, and Embase from inception to September 2022, as well as reference lists of relevant original papers and key journals. A random-effects model was used to calculate summary HRs and their 95% CIs for the highest and lowest categories, as well as for a 50 g/d increment. We also modeled curvilinear associations using a 1-stage linear mixed-effects meta-analysis. Thirty-two cohorts (31 publications) involving 1,141,793 participants and 93,373 deaths from all causes were included. Higher intakes of legumes, compared with lower intakes, were associated with a reduced risk of mortality from all causes (HR: 0.94; 95% CI: 0.91, 0.98; n = 27) and stroke (HR: 0.91; 95% CI: 0.84, 0.99; n = 5). There was no significant association for CVD mortality (HR: 0.99; 95% CI: 0.91, 1.09; n =11), CHD mortality (HR: 0.93; 95% CI: 0.78, 1.09; n = 5), or cancer mortality (HR: 0.85; 95% CI: 0.72, 1.01; n = 5). In the linear dose-response analysis, a 50 g/d increase in legume intake was associated with a 6% reduction in the risk of all-cause mortality (HR: 0.94; 95% CI: 0.89, 0.99; n = 19), but no significant association was observed for the remaining outcomes. The certainty of evidence was judged from low to moderate. A higher legume intake was associated with lower mortality from all causes and stroke, but no association was observed for CVD, CHD, and cancer mortality. These results support dietary recommendations to increase the consumption of legumes.

Risk Factors for Cancer Mortality in Spain: Population-Based Cohort Study

BACKGROUND

Cancer is considered a major public health problem due to its increasing incidence and high mortality. This study aims to identify risk factors for cancer mortality in Spain.

METHODS

Retrospective population-based cohort study in 20,397 participants of the 2011/2012 National Health Survey in Spain. Risk factors associated with mortality due to neoplasm from 2011 to 2017 were analyzed, and hazard ratios were calculated with a multivariate Cox model with competing risks for mortality from other causes.

RESULTS

Myocardial infarction, chronic obstructive pulmonary disease, cirrhosis, and mental disorders were associated with an increased risk of mortality due to neoplasm. Male sex, age over 50 years, history or current smoking habit, negligible intake of legumes, and poorer self-perceived health were also associated with increased cancer mortality.

CONCLUSIONS

Comorbidities, tobacco use, poor diet, and worse self-perceived health were the main risk factors for cancer mortality in Spain.

Genistein induces long-term expression of progesterone receptor regardless of estrogen receptor status and improves the prognosis of endometrial cancer patients

Progesterone is used to treat uterine endometrial cancer in young patients wishing to preserve their fertility as well as in advanced or recurrent patients, but its response rate is limited. The antitumor effect of progesterone is mediated by progesterone receptor (PR) binding. Hence, loss of progesterone’s therapeutic effect, i.e., development of progesterone resistance, is mainly due to decreased PR expression. However, little is known about underlying mechanisms that regulate PR expression. Immunohistochemistry analysis of specimens from 31 young, endometrial cancer patients showed that elevated PR expression significantly increased (P < 0.05) rates of progression-free and overall survival. We investigated mechanisms of regulating PR expression and suppressing cell proliferation using genistein, a chemotherapeutic agent against different cancers. Genistein inhibits cell growth by inducing cell cycle arrest in G2 and apoptosis; moreover, it upregulates prolonged expression of PR-B and forkhead box protein O1, regardless of estrogen receptor alpha expression in endometrial cancer cells. Genistein-induced PR expression decreases CCAAT/enhancer binding protein beta expression and activates c-Jun N-terminal kinase pathway, rather than causing epigenetic alterations of the PR promoter. Therefore, increased PR expression is an important antitumor effect of genistein. This may help to improve the response rates of fertility-sparing treatments for young patients.

Consumption of flavonoids and risk of hormone-related cancers: a systematic review and meta-analysis of observational studies

BACKGROUND

Flavonoids seem to have hormone-like and anti-hormone properties so that the consumption of flavonoids may have potential effects on hormone-related cancers (HRCs), but the findings have been inconsistent so far. This meta-analysis was aimed to explore the association between flavonoids intake and HRCs risk among observational studies.

METHODS

Qualified articles, published on PubMed, EMBASE, and China National Knowledge Infrastructure (CNKI) from January 1999 to March 2022 and focused on relationships between flavonoids (total, subclass of and individual flavonoids) and HRCs (breast, ovarian, endometrial, thyroid, prostate and testicular cancer), were retrieved for pooled analysis. Random effects models were performed to calculate the pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Funnel plots and Begg's/Egger's test were used to evaluate the publication bias. Subgroup analyses and sensitivity analyses were conducted to explore the origins of heterogeneity.

RESULTS

All included studies were rated as medium or high quality. Higher consumption of flavonols (OR = 0.85, 95% CI: 0.76-0.94), flavones (OR = 0.85, 95% CI: 0.77-0.95) and isoflavones (OR = 0.87, 95% CI: 0.82-0.92) was associated with a decreased risk of women-specific cancers (breast, ovarian and endometrial cancer), while the higher intake of total flavonoids was linked to a significantly elevated risk of prostate cancer (OR = 1.11, 95% CI: 1.02-1.21). A little evidence implied that thyroid cancer risk was augmented with the higher intake of flavones (OR = 1.24, 95% CI: 1.03-1.50) and flavanones (OR = 1.31, 95% CI: 1.09-1.57).

CONCLUSIONS

The present study suggests evidence that intake of total flavonoids, flavonols, flavones, flavanones, flavan-3-ols and isoflavones would be associated with a lower or higher risk of HRCs, which perhaps provides guidance for diet guidelines to a certain extent.

TRIAL REGISTRATION

This protocol has been registered on PROSPERO with registration number CRD42020200720 .

Executive Summary of the Uterine Cancer Evidence Review Conference

Evidence for uterine cancer prevention, diagnosis, and special issues from the Uterine Cancer Evidence Review Conference is summarized.

The Centers for Disease Control and Prevention recognized the need for educational materials for clinicians on the prevention and early diagnosis of gynecologic cancers. The American College of Obstetricians and Gynecologists convened a panel of experts in evidence review from the Society for Academic Specialists in General Obstetrics and Gynecology and content experts from the Society of Gynecologic Oncology to review relevant literature, best practices, and existing practice guidelines as a first step toward developing evidence-based educational materials for women's health care clinicians about uterine cancer. Panel members conducted structured literature reviews, which were then reviewed by other panel members and discussed at a virtual meeting of stakeholder professional and patient advocacy organizations in January 2021. This article is the evidence summary of the relevant literature and existing recommendations to guide clinicians in the prevention, early diagnosis, and special considerations of uterine cancer. Substantive knowledge gaps are noted and summarized to provide guidance for future research.

Impact of 18-Month Soy Protein Supplementation on Steroid Hormones and Serum Biomarkers of Angiogenesis, Apoptosis, and the Growth Hormone/IGF-1 Axis: Results of a Randomized, Placebo-Controlled Trial in Males Following Prostatectomy

Many studies have addressed the effects of dietary supplementation with soy protein on cancer risk and mortality, but there are only few randomized studies with soy in males. We used serum samples from a two-year trial of soy protein isolate supplementation in middle-aged to older males at risk of recurrence of prostate cancer after radical prostatectomy to determine soy effects on steroid hormones involved in prostate cancer (testosterone, SHBG, and estradiol) and explore the effects on biomarkers of the growth hormone/IGF-1 axis, apoptosis, and angiogenesis. Compared with a casein-based placebo, 18 mo, of consumption of 19.2 g/day of whole soy protein isolate containing 24 mg genistein-reduced circulating testosterone and SHBG, but not free testosterone, and did not affect serum concentrations of estradiol, VEGF, IGF-1, IGFBP-3, IGF-1/IGFBP-3 ratio, soluble Fas, Fas-ligand, and sFas/Fas-ligand ratio. Thus, soy protein supplementation for 18 mo, affected the androgen axis, but the effects on other cancer biomarkers remain to be more definitively determined. The study was registered at clinicaltrials.gov (NCT00765479).

Therapeutic Potential of Isoflavones with an Emphasis on Daidzein

Daidzein is a phytoestrogen isoflavone found in soybeans and other legumes. The chemical composition of daidzein is analogous to mammalian estrogens, and it could be useful with a dual-directional purpose by substituting/hindering with estrogen and estrogen receptor (ER) complex. Hence, daidzein puts forth shielding effects against a great number of diseases, especially those associated with the control of estrogen, such as breast cancer, diabetes, osteoporosis, and cardiovascular disease. However, daidzein also has other ER-independent biological activities, such as oxidative damage reduction acting as an antioxidant, immune regulator as an anti-inflammatory agent, and apoptosis regulation, directly linked to its potential anticancer effects. In this sense, the present review is aimed at providing a deepen analysis of daidzein pharmacodynamics and its implications in human health, from its best-known effects alleviating postmenopausal symptoms to its potential anticancer and antiaging properties.

A Narrative Review of the Role of Diet and Lifestyle Factors in the Development and Prevention of Endometrial Cancer

Simple Summary

The incidence and prevalence of endometrial cancer is increasing globally. The main factors involved in this increase have been the way women live today and what they eat and drink. In fact, the obesity pandemic that is sweeping across the planet is considered to be the main contributory feature. This review aims to introduce to a new audience, those that are not experts in the field, what is known about the different types of endometrial cancer and the mechanisms for their induction and protection. We also seek to summarise the existing knowledge on dietary and lifestyle factors that prevent endometrial development in susceptible populations and identify the main problem in this arena; the paucity of research studies and clinical trials that investigate the interaction(s) between diet, lifestyle and endometrial cancer risk whilst highlighting those areas of promise that should be further investigated.

Abstract

Endometrial cancer is the most common cancer affecting the reproductive organs of women living in higher-income countries. Apart from hormonal influences and genetic predisposition, obesity and metabolic syndrome are increasingly recognised as major factors in endometrial cancer risk, due to changes in lifestyle and diet, whereby high glycaemic index and lipid deposition are prevalent. This is especially true in countries where micronutrients, such as vitamins and minerals are exchanged for high calorific diets and a sedentary lifestyle. In this review, we will survey the currently known lifestyle factors, dietary requirements and hormonal changes that increase an individual’s risk for endometrial cancer and discuss their relevance for clinical management. We also examine the evidence that everyday factors and clinical interventions have on reducing that risk, such that informed healthy choices can be made. In this narrative review, we thus summarise the dietary and lifestyle factors that promote and prevent the incidence of endometrial cancer.

Polyphenols as a Diet Therapy Concept for Endometriosis-Current Opinion and Future Perspectives

Endometriosis represents an often painful, estrogen-dependent gynecological disorder, defined by the existence of endometrial glands and stroma exterior to the uterine cavity. The disease provides a wide range of symptoms and affects women’s quality of life and reproductive functions. Despite research efforts and extensive investigations, this disease’s pathogenesis and molecular basis remain unclear. Conventional endometriosis treatment implies surgical resection, hormonal therapies, and treatment with nonsteroidal anti-inflammatory drugs, but their efficacy is currently limited due to many side effects. Therefore, exploring complementary and alternative therapy strategies, minimizing the current treatments’ adverse effects, is needed. Plants are sources of bioactive compounds that demonstrate broad-spectrum health-promoting effects and interact with molecular targets associated with endometriosis, such as cell proliferation, apoptosis, invasiveness, inflammation, oxidative stress, and angiogenesis. Anti-endometriotic properties are exhibited mainly by polyphenols, which can exert a potent phytoestrogen effect, modulating estrogen activity. The available evidence derived from preclinical research and several clinical studies indicates that natural biologically active compounds represent promising candidates for developing novel strategies in endometriosis management. The purpose of this review is to provide a comprehensive overview of polyphenols and their properties valuable for natural treatment strategy by interacting with different cellular and molecular targets involved in endometriosis progression.

Nutrition in Gynecological Diseases: Current Perspectives

Diet and nutrition are fundamental in maintaining the general health of populations, including women's health. Health status can be affected by nutrient deficiency and vice versa. Gene-nutrient interactions are important contributors to health management and disease prevention. Nutrition can alter gene expression, as well as the susceptibility to diseases, including cancer, through several mechanisms. Gynecological diseases in general are diseases involving the female reproductive system and include benign and malignant tumors, infections, and endocrine diseases. Benign diseases such as uterine fibroids and endometriosis are common, with a negative impact on women's quality of life, while malignant tumors are among the most common cause of death in the recent years. In this comprehensive review article, a bibliographic search was performed for retrieving information about nutrients and how their deficiencies can be associated with gynecological diseases, namely polycystic ovary syndrome, infertility, uterine fibroids, endometriosis, dysmenorrhea, and infections, as well as cervical, endometrial, and ovarian cancers. Moreover, we discussed the potential beneficial impact of promising natural compounds and dietary supplements on alleviating these significant diseases.

Dietary flavonoid intake and risk of esophageal squamous cell carcinoma: A population-based case-control study

OBJECTIVES

The aim of this population-based case-control study was to investigate the association between dietary consumption of the total flavonoids, subclasses, and specific flavonoids and the risk of esophageal squamous cell carcinoma (ESCC) among adults in a high-risk area of China.

METHODS

We recruited 820 ESCC participants and 863 control participants from Yanting County. Dietary flavonoids were assessed using a validated 76-item food frequency questionnaire. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using logistic regression after considering potential confounders.

RESULTS

Comparing the highest and lowest intake quartiles, we observed a negative association of ESCC risk with consumption of isoflavones (OR = 0.34, 95% CI = 0.23-0.50, P for trend < 0.001), daidzein (OR = 0.31, 95% CI = 0.21-0.45, P for trend < 0.001), genistein (OR = 0.34, 95% CI = 0.23-0.50, P for trend < 0.001), and glycitein (OR = 0.32, 95% CI = 0.22-0.48, P for trend < 0.001) after adjustment for potential confounders. A more pronounced negative association was observed when comparing the third quartile, rather than the fourth, with the lowest quartile for consumption of anthocyanidins (OR = 0.58, 95% CI = 0.42-0.80, P for trend = 0.004), delphinidin (OR = 0.57, 95% CI = 0.41-0.78, P for trend = 0.004), and cyanidin (OR = 0.48, 95% CI = 0.35-0.66, P for trend = 0.003) after considering potential confounders. Consumption of total flavonoids, flavones, flavonols, and six other specific flavonoids (quercetin, myricetin, kaempferol, luteolin, apigenin, and peonidin) was not associated with ESCC risk.

CONCLUSIONS

The results suggest that increased dietary intake of isoflavones and moderate consumption of anthocyanidins were associated with a decreased risk of ESCC. Future nutritional guidelines may emphasize foods or supplements rich in specific isoflavones and anthocyanidins for ESCC chemoprevention.

Nut and legume consumption and human health: an umbrella review of observational studies

Consumption of nuts and legumes has been associated with several health benefits. The aim of this study was to systematically review existing meta-analyses of observational studies on nut and legume intake and non-communicable diseases, and assess the level of evidence. Out of the six meta-analyses focussed on legume and 15 on nut intake, a possible association with decreased risk of colorectal adenoma and coronary heart disease was found for higher legume consumption, and a decreased risk of cardiovascular and cancer mortality, colon cancer, hypertension and ischaemic stroke for higher nut consumption. The association between legume consumption and cardiovascular diseases (CVDs), as well as nut consumption and risk of cancer, CVD incidence and all-cause mortality, was deemed as "limited" due to heterogeneity between results and/or potential confounding factors. General benefit towards better health can be observed for nut and legume consumption. Further studies are needed to better elucidate potential confounding factors.

Phytochemicals in Gynecological Cancer Prevention

Gynecological cancer confers an enormous burden among women worldwide. Accumulating evidence points to the role of phytochemicals in preventing cervical, endometrial, and ovarian cancer. Experimental studies emphasize the chemopreventive and therapeutic potential of plant-derived substances by inhibiting the early stages of carcinogenesis or improving the efficacy of traditional chemotherapeutic agents. Moreover, a number of epidemiological studies have investigated associations between a plant-based diet and cancer risk. This literature review summarizes the current knowledge on the phytochemicals with proven antitumor activity, emphasizing their effectiveness and mechanism of action in gynecological cancer.

The effects of phytoestrogens on postmenopausal health

Phytoestrogens are a group of non-steroidal polyphenolic plant-based substances, commonly used for the treatment of menopause-related conditions. They have both genomic and non-genomic effects, displaying weak affinity for estrogen receptors (ER) and preferentially binding to ER-B over ER-A. However, evidence for the benefits of phytoestrogen consumption has been limited. We conducted a review of recent literature, focusing on systematic reviews and meta-analyses reporting on postreproductive health effects of phytoestrogens. While many trials concerning dietary and supplementary phytoestrogens have been conducted, evidence of clinical efficacy is heterogeneous and inconclusive. There appears to be reduction in the vasomotor symptoms of menopause with phytoestrogen intake; however, it is likely small and slow in onset. Phytoestrogens also appear to improve bone mineral density and markers of cardiovascular risk; however, there is inadequate research regarding long-term outcomes. There appear to be no harmful effects of phytoestrogens on breast, endometrial cancer or colorectal cancer and phytoestrogens intake may in fact be protective. Research regarding the effect of phytoestrogens on cognition is mixed, with most studies reporting no significant association. Overall, individual variations in the metabolism of phytoestrogens and age-related genomic effects may account for the considerable variability in the measured effects of phytoestrogens.

Scientific Evidence Supporting the Beneficial Effects of Isoflavones on Human Health

Isoflavones are phenolic compounds with a chemical structure similar to that of estradiol. They are present in several vegetables, mainly in legumes such as soy, white and red clover, alfalfa and beans. The most significant food source of isoflavones in humans is soy-derived products. Isoflavones could be used as an alternative therapy for pathologies dependent on hormonal disorders such as breast and prostate cancer, cardiovascular diseases, as well as to minimize menopausal symptoms. According to the results gathered in the present review, it can be stated that there is scientific evidence showing the beneficial effect of isoflavones on bone health and thus in the prevention and treatment of osteoporosis on postmenopausal women, although the results do not seem entirely conclusive as there are discrepancies among the studies, probably related to their experimental designs. For this reason, the results should be interpreted with caution, and more randomized clinical trials are required. By contrast, it seems that soy isoflavones do not lead to a meaningful protective effect on cardiovascular risk. Regarding cancer, scientific evidence suggests that isoflavones could be useful in reducing the risk of suffering some types of cancer, such as breast and endometrial cancer, but further studies are needed to confirm these results. Finally, isoflavones could be useful in reducing hot flushes associated with menopause. However, a limitation in this field is that there is still a great heterogeneity among studies. Lastly, with regard to isoflavone consumption safety, it seems that they are safe and that the most common adverse effect is mild and occurs at the gastrointestinal level.

Phytochemicals in Legumes: A Qualitative Reviewed Analysis

Legumes are an excellent source of nutrients and phytochemicals. They have been recognized for their contributions to health, sustainability, and the economy. Although legumes comprise several species and varieties, little is known about the differences in their phytochemical composition and the magnitude of these. Therefore, the aim of this review is to describe and compare the qualitative profile of phytochemicals contained in legumes and identified through LC-MS and GC-MS methods. Among the 478 phytochemicals reported in 52 varieties of legumes, phenolic compounds were by far the most frequently described (n = 405, 85%). Metabolomics data analysis tools were used to visualize the qualitative differences, showing beans to be the most widely analyzed legumes and those with the highest number of discriminant phytochemicals (n = 180, 38%). A Venn diagram showed that lentils, beans, soybeans, and chickpeas shared only 7% of their compounds. This work highlighted the huge chemical diversity among legumes and identified the need for further research in this field and the use of metabolomics as a promising tool to achieve it.

Fermented soy products intake and risk of cardiovascular disease and total cancer incidence: The Japan Public Health Center-based Prospective study

BACKGROUND/OBJECTIVES

The association of fermented soy products, separately from total soy products, with cardiovascular disease (CVD) and total cancer has not been reported. We examined this association in a population-based prospective cohort study in Japan.

SUBJECTS/METHODS

We studied 79,648 participants (42,788 women; 36,860 men) aged 45-74 years without a history of cancer, myocardial infarction, or stroke. Participants completed a food frequency questionnaire (1995-1998) and were followed to 2009-2012. Cox proportional hazards regression analysis was used to calculate the hazard ratios (HR) and 95% confidence intervals (CI) of incidence of CVD and total cancer according to quartiles of total soy products, nonfermented soy products, fermented soy products, miso soup, natto, total isoflavones from soy products, isoflavones from nonfermented soy products, and isoflavones from fermented soy products.

RESULTS

In women, we observed a significant inverse association between fermented soy product intake and the risk of CVD (multivariate HR in the highest compared with the lowest quartile of fermented soy product intake: 0.80; 95% CI: 0.68, 0.95; P for trend = 0.010), and also found significant inverse associations for natto and isoflavones among fermented soy products. In site-specific analysis, we observed a similar, significant inverse association between fermented soy product intake and the risk of stroke in women. We found no significant association between any soy product and risk of CVD in men or total cancer in both sexes.

CONCLUSIONS

Intake of fermented soy products such as natto was inversely associated with the risk of CVD in women.

Relationship between legume consumption and metabolic syndrome: A systematic review and meta-analysis of observational studies

AIMS

The prevalence of metabolic syndrome (MetS) has been increasing in recent years. Investigation of whether consumption of legumes as a part of healthy diet could reduce the odds of MetS has led to inconsistent conclusions. Here, we performed the first meta-analysis of observational studies to analyze the association between legume consumption and prevalence of MetS.

DATA SYNTHESIS

PubMed, EMBASE, and Web of Science databases were searched to identify observational studies up to June 1, 2019. We extracted data from the studies included and performed quality assessments. Summary odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Publication bias and subgroup and sensitivity analyses were also performed. We finally included four cross-sectional studies, two cohort studies, and one case-control study involving 56,028 participants. The summary OR revealed no statistically significant association between legume consumption and odds of MetS (OR = 0.93, 95% CI = 0.76-1.12, I² = 73.5%). Subgroup analysis of study characteristics and adjustment for confounding along with sensitivity analyses revealed no statistically significant differences. No evidence of publication bias was detected.

CONCLUSION

Legume consumption is not associated with the odds of MetS. These findings require validation in well-designed cohort studies and randomized clinical trials with accurate measurement of legume intake and strict control of confounders.

REGISTRATION

This study was registered with the International Prospective Register of Systematic Reviews (registration number: CRD42019131777).

Soy and Isoflavone Consumption and Multiple Health Outcomes: Umbrella Review of Systematic Reviews and Meta-Analyses of Observational Studies and Randomized Trials in Humans

SCOPE

To assess the existing evidence of associations between consumption of soy and isoflavone and multiple health outcomes.

METHODS AND RESULTS

This is an umbrella review of meta-analyses and systematic reviews of randomized trials and observational studies in humans. 114 Meta-analyses and systematic reviews are identified with 43 unique outcomes. Soy and isoflavone consumption seems more beneficial than harmful for a series of health outcomes. Beneficial associations are identified for cancers, cardiovascular disease, gynecological, metabolic, musculoskeletal, endocrine, neurological, and renal outcomes, particularly in perimenopausal women. Harmful association is only found for gastric cancer (RR: 1.17, 95% CI: 1.02-1.36) for high intake of miso soup (1-5 cups per day) in male.

CONCLUSION

Generally, soy and isoflavone consumption is more beneficial than harmful. The results herein support promoting soy intake as part of a healthy diet. Randomized controlled trials are necessary to confirm this finding.

Tofu intake is inversely associated with risk of breast cancer: A meta-analysis of observational studies

Observational studies on the association between tofu intake and breast cancer incidence have reported inconsistent results. We reviewed the current evidence and quantitatively assessed this association by conducting a dose-response meta-analysis. The electronic databases PubMed and EMBASE were searched for relevant studies published up to August, 2018. We included epidemiological studies that reported relative risks (RRs) or odds ratios (ORs) with 95% confidence intervals (CIs) for the association between tofu intake and breast cancer risk. A total of 14 studies (2 cohort studies, 12 case-control studies) were included in the meta-analysis. The overall OR of breast cancer for highest vs lowest intake of tofu was 0.78 (95% CI 0.69–0.88), with moderate heterogeneity (P = 0.011, I² = 49.7%). Dose-response analysis based on 5 case-control studies revealed that each 10 g/d increase in tofu intake was associated with 10% reduction in the risk of breast cancer (95% CI 7%–13%, P = 0.037, I² = 40.8%). In summary, our findings suggest an inverse dose-response association between tofu intake and risk of breast cancer. However, owing to the limitations of case-control studies, more properly designed prospective studies are warranted to confirm this association.

Endometrial cancer prevention in high-risk women

Endometrial cancer (EC) is the most common gynaecological malignancy, and its incidence is rising alongside the growing prevalence of obesity. Effective risk-reducing interventions hijacking the key mechanisms driving endometrial carcinogenesis may affect EC diagnoses if aimed at those at greatest risk. An understanding of the key risk factors and their role in tumourigenesis is critical in developing such prevention strategies. In this review, we summarise the major risk factors for EC and the evidence for available risk-reducing interventions in high-risk women. We suggest potential prevention strategies and make a case for the need for risk prediction models that identify specific groups of women at a particularly high risk of EC for whom risk-reducing interventions are likely to have a significant impact.

Dietary Phytoestrogen Intake and The Risk of Endometriosis in Iranian Women: A Case-Control Study

Background

Endometriosis is an important gynecologic disease affecting reproductive-age women. Based on the effect of phytoestrogens on inflammatory, immunological and hormonal factors, limited studies have suggested that phytoestrogen consumption could probably modulate endometriosis risk. The aim of this study was to evaluate the relationship between phytoestrogen intake and endometriosis risk.

Materials and Methods

In the present case-control study, 78 women with a laparoscopically confirmed endome- triosis and 78 normal pelvis women (as the control group), were recruited. Common dietary intake was recorded by a validated 147-item semi-quantitative food frequency questionnaire (FFQ). Type of phytoestrogen in each dietary item was analyzed by the database from the United States Department of Agriculture (USDA). A logistic regression model was used to determine the association between phytoestrogen intake and endometriosis risk.

Results

Higher intake of total phytoestrogen (P-trend=0.01), total isoflavones (P-trend=0.002) specially formononetin (P-trend=0.04) and glycitein (P-trend=0.04), total lignan (P-trend=0.01) specially secoisolariciresinol (P-trend=0.01) and lariciresinol (P-trend=0.02) and matairesinol (P-trend=0.003), and total coumestrol [third quartile odds ratios (OR): 0.38; 95% confidence intervals (CI): 0.15-0.96; P-trend=0.1] was related to reduced endometriosis risk. Among food groups, only isoflavin (OR: 0.48; 95% CI: 0.44-0.63), lignan (OR: 0.66; 95% CI: 0.62-0.94), coumestrol (OR: 0.64; 95% CI: 0.51-0.99), phytoestrogen (OR: 0.46; 95% CI: 0.38-0.83) in dairy products and coumestrol in fruits (OR: 0.69; 95% CI: 0.03-0.77) were negatively associated with endometriosis risk.

Conclusion

Phytoestrogens have a major impact on the level of hormones, and immune and inflammatory markers; thus, it can play an important role in the control and prevention of many diseases. Due to the inflammatory nature of endometriosis and the effect of hormones on the progression of the disease, the role of phytoestrogens consumption in the progression and regression of the disease should be assessed in future works.

Risk factors for endometrial cancer: An umbrella review of the literature

Although many risk factors could have causal association with endometrial cancer, they are also prone to residual confounding or other biases which could lead to over- or underestimation. This umbrella review evaluates the strength and validity of evidence pertaining risk factors for endometrial cancer. Systematic reviews or meta-analyses of observational studies evaluating the association between non-genetic risk factors and risk of developing or dying from endometrial cancer were identified from inception to April 2018 using PubMed, the Cochrane database and manual reference screening. Evidence was graded strong, highly suggestive, suggestive or weak based on statistical significance of random-effects summary estimate, largest study included, number of cases, between-study heterogeneity, 95% prediction intervals, small study effects, excess significance bias and sensitivity analysis with credibility ceilings. We identified 171 meta-analyses investigating associations between 53 risk factors and endometrial cancer incidence and mortality. Risk factors were categorised: anthropometric indices, dietary intake, physical activity, medical conditions, hormonal therapy use, biochemical markers, gynaecological history and smoking. Of 127 meta-analyses including cohort studies, three associations were graded with strong evidence. Body mass index and waist-to-hip ratio were associated with increased cancer risk in premenopausal women (RR per 5 kg/m2 1.49; CI 1.39-1.61) and for total endometrial cancer (RR per 0.1unit 1.21; CI 1.13-1.29), respectively. Parity reduced risk of disease (RR 0.66, CI 0.60-0.74). Of many proposed risk factors, only three had strong association without hints of bias. Identification of genuine risk factors associated with endometrial cancer may assist in developing targeted prevention strategies for women at high risk.

The Effects of the Dietary and Nutrient Intake on Gynecologic Cancers

The contribution of diet to cancer risk has been considered to be higher in advanced countries than in developing countries. In this paper, I review the current issues (a review of the relevant literature), and the effects of the dietary and nutrient intake on three types of gynecologic cancer (cervical, endometrial and ovarian cancers). In cervical cancer, the most important roles of diet/nutrition in relation to cancer are prophylaxis and countermeasures against human papillomavirus (HPV) infection. The main preventive and reductive factors of cervical cancer are antioxidants, such as vitamin A, C, D and E, carotenoids, vegetables and fruits. These antioxidants may have different abilities to intervene in the natural history of diseases associated with HPV infection. For endometrial cancer, the increase in peripheral estrogens as a result of the aromatization of androgens to estrogens in adipose tissue in obese women and insulin resistance are risk factors. Thus, we must mainly take care to avoid the continuous intake of fat energy and sugar. In ovarian cancer, the etiology has not been fully understood. To the best of our knowledge, the long-term consumption of pro-inflammatory foods, including saturated fat, carbohydrates and animal proteins is a risk factor. The intake of acrylamide is also a risk factor for both endometrial and ovarian cancer. Most papers have been epidemiological studies. Thus, further research using in vitro and in vivo approaches is needed to clarify the effects of the dietary and nutrient intake in detail.

WITHDRAWN: Soy isoflavones (from Glycine max) preserves hepatocellular free radical defense system potential and ameliorates inflammatory response in high fat fed ovariectomised Wistar rats: The molecular mechanisms

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Plant phenolics as functional food ingredients

Phenolic compounds have attracted much attention in recent times as their dietary intake has been associated with the prevention of some chronic and degenerative diseases that constitute major causes of death and incapacity in developed countries, such as cardiovascular diseases, type II diabetes, some types of cancers or neurodegenerative disorders like Alzheimer's and Parkinson's diseases. Nowadays it is considered that these compounds contribute, at least in part, for the protective effects of fruit and vegetable-rich diets, so that the study of their role in human nutrition has become a central issue in food research. This chapter reviews the current knowledge on the phenolic compounds as food components, namely their occurrence in the diet, bioavailability and metabolism, biological activities and mechanisms of action. Besides, the approaches for their extraction from plant matrices and technological improvements regarding their preparation, stability and bioavailability in order to be used as functional food ingredients are also reviewed, as well as their legal situation regarding the possibility of making "health claims" based on their presence in food and beverages.

An overview of the phytoestrogen effect on vaginal health and dyspareunia in peri- and post-menopausal women

OBJECTIVE

The aim of this overview was to evaluate the effectiveness of phytoestrogens on vaginal health and dyspareunia in peri- and post-menopausal women.

MATERIAL AND METHODS

Three databases including MEDLINE, Scopus and the Cochrane Central Register of Controlled Trials were from inception to August 2017.

RESULT

Two systematic reviews and 11 RCTs were included in the overview. According to the findings, isoflavones increased the maturation value and attenuated the vaginal atrophy in the post-menopausal women. Topical isoflavones had beneficial effects on the vaginal atrophy. Similar efficacy was found in Pueraria mirifica and conjugated estrogen cream on dryness ( p = 0.277), soreness ( p = 0.124) and irritation ( p = 0.469), as well as discharge ( p = 0.225) and dyspareunia ( p = 0.089). However, the conjugated estrogen cream was more effective compared to Pueraria mirifica ( p > 0.005) regarding maturation index improvement. Comparison of fennel 5% vaginal cream and placebo gel showed significant difference in superficial cells ( p < 0.01), parabasal cells ( p < 0.01) and intermediate cells ( p < 0.01), whereas no difference was found between the oral fennel and placebo in terms of superficial, parabasal and intermediate cells as well as Maturation value. Administration of 80 mg red clover oil had a significant effect on superficial ( p < 0.005), intermediate ( p < 0.005) and parabasal and vaginal dryness ( p < 0.005) compared to the placebo. Flaxseed had also a trivial effect on maturation value. Genistein had a more prominent effect on the genital score. The severity of dyspareunia decreased by 27%.

CONCLUSION

Phytoestrogens have various effects based on administration route and type on the vaginal atrophy.

Development of Health Products from Natural Sources

BioActive Compounds (BACs) recovered from food or food by-product matrices are useful in maintaining well being, enhancing human health, and modulating immune function to prevent or to treat chronic diseases. They are also generally seen by final consumers as safe, non-toxic and environment-friendly. Despite the complex process of production, chemical characterization, and assessment of health effects, BACs must also be manufactured in stable and bioactive ingredients to be used in pharmaceutical, food and nutraceutical industry. Generally, vegetable derivatives occur as sticky raw materials with pervasive smell and displeasing flavor. Also, they show critical water solubility and dramatic stability behavior over time, involving practical difficulties for industrial use. Therefore, the development of novel functional health products from natural sources requires the design of a suitable formulation to delivery BACs at the site of action, preserve stability during processing and storage, slow down the degradation processes, mask lousy tasting or smell, and increase the bioavailability, while maintaining the BACs functionality. The present review focuses on human health benefits, BACs composition, and innovative technologies or formulation approaches of natural ingredients from some selected foods and by-products from industrial food transformations.

A Possible Mechanism: Genistein Improves Metabolism and Induces White Fat Browning Through Modulating Hypothalamic Expression of Ucn3, Depp, and Stc1

Bioactive food components have gained growing attention in recent years. Multiple studies demonstrated that genistein had beneficial effects on metabolism. However, the exact mechanism by which genistein improves metabolism remains unclear, especially the central regulation. This study was designed to evaluate whether addition of genistein to the high-fat diet could counter metabolic disorders and whether these alterations were associated with gene expression in hypothalamus. C57BL/6 mice were fed either a high-fat diet (HF), high-fat diet with genistein (0.25 g/kg diet) (HFG) or a normal control diet (CON) for 8 weeks. Body weight was assessed during the study. After 8-week intervention, content of inguinal subcutaneous adipose tissue (SAT), perirenal visceral adipose tissue (VAT) and brown adipose tissue (BAT) were weighed. Glucose tolerance test, the serum levels of insulin and lipid were assessed. The mRNA of browning marker was detected in the white fat. The hypothalamus was collected for whole transcriptome sequencing and reverse transcription quantitative PCR validation. The results demonstrated that mice fed HFG diet had lower body weight and SAT mass, decrease levels of low-density lipoprotein cholesterol and free fatty acids, higher browning marker of Ucp1 and Cidea in WAT and an improvement in glucose tolerance and insulin sensitivity compared with those in HF group. Transcriptome sequencing showed that there were three differentially expressed genes in hypothalamus among the three groups, including Ucn3, Depp, and Stc1, which were significantly correlated with the browning markers in WAT and insulin sensitivity. Thus, regulating gene expressions in hypothalamus is a potential mechanism for genistein improving metabolism and inducing WAT browning, which may provide a novel target for the precaution and treatment of T2DM.

Soy Isoflavones and their Effects on Xenobiotic Metabolism

BACKGROUND

Soy isoflavones, such as genistein and daidzein, are bioflavonoids found in soy products that are able to interact with various hormones such as estrogen. Epidemiological studies reveal a proper level of isoflavones in diet can prevent many diseases like cancers or diabetes. Therefore, it is important to study the biotransformation and xenobiotic metabolism of soy isoflavones.

METHODS

A systematic review of published studies was carried out to investigate the characterization of isoflavones and their metabolites, sample pretreatment and quantitative analysis of isoflavones, and the influence of soy isoflavones on drug and xenobiotic metabolism.

RESULTS

Aglycones with weak estrogen-like activities are the biologically active forms of the soy isoflavones in mammals. The most recent advances including extraction, purification and detection of isoflavones in soybean and soy products are discussed. The effects of soy isoflavones on drug and xenobiotic metabolism involve in regulation of phase I cytochrome P450 (CYPs) enzyme and phase I detoxifying enzymes expression and activity. At the molecular level, soy isoflavones have proved capable of estrogenic/antiestrogenic with tissue-selective, anti-cancer, antiobesity, anti-oxidation, and tyrosine kinase inhibition activities.

CONCLUSION

This review summarized different aspects of soy isoflavones and their molecular mechanisms of pharmacological action on xenobiotic, which demonstrated that soy isoflavones can decrease the incidence of many diseases and benefit for human health. However, since the lack of clinical research for evaluation of the proper dosage of intake of soy isoflavones in diet or adjunctive therapy, there is a need for further studies on the selection of doses, biomedical applications and adverse effects of isoflavones for human health.

Prevention Strategies in Endometrial Carcinoma

PURPOSE OF THE REVIEW

To assess the most recent high-quality evidence for endometrial cancer prevention strategies.

RECENT FINDINGS

Obesity is an established risk factor for endometrial cancer. Weight cycling and weight gain in middle age are risk factors for endometrial cancer. Bariatric surgery reduces the risk of endometrial cancer by up to 81% in obese women who attain and maintain a normal weight. Combined oral contraceptives provide durable protection against endometrial cancer for 30 years or more. Ever use of the levonorgestrel intrauterine system (LNG-IUS) and inert intrauterine devices reduce endometrial cancer risk. The first oestrogen-based non-progestin HRT for non-hysterectomised women that contains estradiol and bazedoxifene has an effective protective effect on endometrium. Bisphosphonates reduce endometrial cancer risk. Weight loss and LNG-IUS would seem to be an effective strategy for preventing the development of obesity-driven endometrial cancer in the highest risk women. Future research may identify other safe and effective chemoprevention interventions, such as aspirin, bisphosphonates or metformin.

The Role of Polyphenols in Human Health and Food Systems: A Mini-Review

This narrative mini- review summarizes current knowledge of the role of polyphenols in health outcomes-and non-communicable diseases specifically-and discusses the implications of this evidence for public health, and for future directions for public health practice, policy, and research. The publications cited originate mainly from animal models and feeding experiments, as well as human cohort and case-control studies. Hypothesized protective effects of polyphenols in acute and chronic diseases, including obesity, neurodegenerative diseases, type 2 diabetes, and cardiovascular diseases, are evaluated. Potential harmful effects of some polyphenols are also considered, counterbalanced with the limited evidence of harm in the research literature. Recent international governmental regulations are discussed, as the safety and health claims of only a few specific polyphenolic compounds have been officially sanctioned. The implications of food processing on the bioavailability of polyphenols are also assessed, in addition to the health claims and marketing of polyphenols as a functional food. Finally, this mini-review asserts the need for increased regulation and guidelines for polyphenol consumption and supplementation in order to ensure consumers remain safe and informed about polyphenols.

Soy, Soy Foods and Their Role in Vegetarian Diets

Soy is a basic food ingredient of traditional Asian cuisine used for thousands of years. In Western countries, soybeans have been introduced about a hundred years ago and recently they are mainly used for surrogate foods production. Soy and soy foods are common nutritional solutions for vegetarians, due to their high protein content and versatility in the production of meat analogues and milk substitutes. However, there are some doubts about the potential effects on health, such as the effectiveness on cardiovascular risk reduction or, conversely, on the possible disruption of thyroid function and sexual hormones. The soy components that have stimulated the most research interest are isoflavones, which are polyphenols with estrogenic properties highly contained in soybeans. In this review, we discuss the characteristics of soy and soy foods, focusing on their nutrient content, including phytoestrogens and other bioactive substances that are noteworthy for vegetarians, the largest soy consumers in the Western countries. The safety of use will also be discussed, given the growing trend in adoption of vegetarian styles and the new soy-based foods availability.

Comprehensive evaluation of the role of soy and isoflavone supplementation in humans and animals over the past two decades

Soy and soy-based foods are considered healthy, particularly in many Asia-Pacific countries, where soy products have long been consumed. Soy and soy-related products have been found to help prevent the occurrence of cardiovascular diseases and certain types of cancer, such as breast and prostate cancer. These products can also have antioxidative effects that alleviate hot flashes during menopause and bone loss. These biological and therapeutic functions are primarily due to the isoflavones derived from soy, whose structure is similar to the structure of 17-β-oestradiol. Despite the many health benefits for humans and animals, the application of isoflavones remains controversial because of their anti-oestrogenic properties. We focused on general information regarding isoflavones, as well as their structure, function, and application. We summarized evidence showing that dietary or supplemental isoflavones exert protective effects on the health of humans and animals. Based on the literature, we conclude that soy foods and isoflavones may be effective and safe; however, more high-quality trials are needed to fully substantiate their potential use.

Legume bioactive compounds: influence of rhizobial inoculation

Legumes consumption has been recognized as beneficial for human health, due to their content in proteins, fiber, minerals and vitamins, and their cultivation as beneficial for sustainable agriculture due to their ability to fix atmospheric nitrogen in symbiosis with soil bacteria known as rhizobia. The inoculation with these baceria induces metabolic changes in the plant, from which the more studied to date are the increases in the nitrogen and protein contents, and has been exploited in agriculture to improve the crop yield of several legumes. Nevertheless, legumes also contain several bioactive compounds such as polysaccharides, bioactive peptides, isoflavones and other phenolic compounds, carotenoids, tocopherols and fatty acids, which makes them functional foods included into the nutraceutical products. Therefore, the study of the effect of the rhizobial inoculation in the legume bioactive compounds content is gaining interest in the last decade. Several works reported that the inoculation of different genera and species of rhizobia in several grain legumes, such as soybean, cowpea, chickpea, faba bean or peanut, produced increases in the antioxidant potential and in the content of some bioactive compounds, such as phenolics, flavonoids, organic acids, proteins and fatty acids. Therefore, the rhizobial inoculation is a good tool to enhance the yield and quality of legumes and further studies on this field will allow us to have plant probiotic bacteria that promote the plant growth of legumes improving their functionality.