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Lignan Intake in the Netherlands and Its Relation with Mortality

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Lignan Intake in the Netherlands and Its Relation with Mortality Uitnodiging Lignan intake in the Netherlands and its relation with mortality Hierbij nodig ik u van harte uit Lignan intake in the Netherlands voor het bijwonen van de openbare verdediging and its relation with mortality van mijn proefschrift op woensdag 30 mei 2007 om 16.00u in de Aula van Wageningen Universiteit, Generaal Foulkesweg 1a te Wageningen Aansluitend is er een receptie Ivon Milder in restaurant Drinks and Bites Markt 9 te Wageningen Ivon Milder Koningsstraat 65-13 1211 NK Hilversum 035-7726760 [email protected] Paranimfen: Anneleen Kuijsten [email protected] Ivon Milder Linda Mulder [email protected] VKProefschrift Ivondef.indd 1 6-4-2007, 13:50 IM-proefschrift.qxd 4/7/2007 11:41 PM Page 1 Lignan intake in the Netherlands and its relation with mortality IM-proefschrift.qxd 4/17/2007 10:58 AM Page 2 Promotor Prof. dr. ir. D. Kromhout Hoogleraar Volksgezondheidsonderzoek Afdeling Humane Voeding, Wageningen Universiteit Co-promotoren Dr. ir. P.C.H. Hollman Senior wetenschappelijk onderzoeker Cluster Bioactieve Stoffen, RIKILT – Instituut voor Voedselveiligheid Dr. ir. E.J.M. Feskens Universitair hoofddocent Afdeling Humane Voeding, Wageningen Universiteit Promotiecommissie Prof. dr. ir. H. Gruppen, Wageningen Universiteit Prof dr. ir. C.P.G.M. de Groot, Wageningen Universiteit Dr. L.M. Valsta, National Public Health Institute (KTL), Helsinki, Finland Dr. H.B. Bueno-de-Mesquita, Rijksinstituut voor Volksgezondheid en Milieu (RIVM), Bilthoven Dit onderzoek is uitgevoerd binnen de onderzoeksschool VLAG (Voeding, Levensmiddelentechnologie, Agrobiotechnologie en Gezondheid) IM-proefschrift.qxd 4/7/2007 11:41 PM Page 3 Lignan intake in the Netherlands and its relation with mortality Ivon Elisabeth Josephina Milder Proefschrift ter verkrijging van de graad van doctor op gezag van de rector magnificus van Wageningen Universiteit, Prof. dr. M.J. Kropff, in het openbaar te verdedigen op woensdag 30 mei 2007 des namiddags te vier uur in de Aula. IM-proefschrift.qxd 4/7/2007 11:41 PM Page 4 Ivon EJ Milder Lignan intake in the Netherlands and its relation with mortality Thesis Wageningen University, the Netherlands-with summary in Dutch ISBN 978-90-8504-652-3 IM-proefschrift.qxd 4/7/2007 11:41 PM Page 5 IEJ MILDER [2007] Lignan intake in the Netherlands and its relation with mortality Abstract Plant lignans are diphenolic compounds that are present in many plant foods. The plant lignans lariciresinol (LARI), pinoresinol (PINO), secoisolari- ciresinol (SECO), and matairesinol (MAT) are efficiently converted into enterolignans by the intestinal microflora. Enterolignans possess several bio- logical activities, e.g. antioxidant and estrogen-like activities by which they may reduce the risk of chronic diseases. Studies on the health effects of lig- nans were hampered by the lack of comprehensive data on the lignan con- tents of foods and diets. Therefore, we developed a liquid chromatography-tandem mass spec- trometry method to measure these four lignans in foods and beverages; and we constructed a lignan database with lignan contents of 83 solid foods and 26 beverages commonly consumed in the Netherlands. Almost all plant foods contained lignans. The most abundant lignan sources were flaxseed (≈300 mg/100 g; mainly SECO); and sesame seeds (≈40 mg/100 g; mainly PINO). The lignan contents of grain products, vegetables, fruits, and legumes varied mostly between 50 and 200 μg/100 g. Higher values were found for Brassica vegetables, garlic, French beans, apricots, strawberries, and peaches. Lignan contents in beverages ranged from 0 for cola to 91 μg/100 ml for red wine. The median total lignan intake among a representative sample of Dutch adults was 979 μg/d (range 43-77584 μg/d). LARI plus PINO contributed 75% to the lignan intake, whereas SECO plus MAT only 25%. Remarkably, the major food sources of lignans were beverages (37%), followed by vegetables (24%), nuts and seeds (14%), bread (9%) and fruits (7%). Besides the consumption of lignan-rich foods, the major determinants of plasma enterolignan concentrations in an endoscopy-based population of 637 adults were defecation frequency, smoking, and body weight. The correlation between total lignan intake and plasma enterolignans was modest (rs = 0.18). In a prospective cohort study, in which 570 men aged 64-84 y were fol- lowed for 15 y, total lignan intake was not related with mortality. However, intake of MAT was inversely associated with coronary heart disease, cardio- vascular diseases, cancer, and all-cause mortality. Multivariate adjusted rate IM-proefschrift.qxd 4/7/2007 11:41 PM Page 6 ABSTRACT ratios (95% CI) per 1-SD increase in intake were 0.72 (0.53-0.98) for CHD, 0.83 (0.69-1.00) for CVD, 0.81 (0.65-1.00) for cancer, and 0.86 (0.76-0.97) for all- cause mortality. Before conclusions can be drawn, these results need to be confirmed in other prospective studies. Keywords: lignans, phytoestrogens, liquid chromatography, mass spectrometry, food composition, intake, cancer, cardiovascular diseases, mortality IM-proefschrift.qxd 4/7/2007 11:41 PM Page 7 Contents 1 – General introduction ............................................................................9 2 – An analytical method for the quantification of four plant lignans in foods and beverages ........................................................27 J Agric Food Chem (2004) 52: 4643-4651 3 – A database with lignan contents of Dutch plant foods ..............49 Br J Nutr (2005) 93: 393-402 4 – Lignan intake and major food sources of lignans in the Netherlands .........................................................................................71 J Nutr (2005) 135: 1202-1207 5 – Relation between enterolignans in plasma and intake of plant lignans ........................................................................................85 J Nutr (2007) 137: in press 6 – Relation between lignan intake and disease-specific and all-cause mortality ............................................................................101 Am J Clin Nutr (2006) 84: 400-405 7 – General discussion ...........................................................................117 Summary............................................................................................145 Samenvatting.....................................................................................148 Dankwoord .......................................................................................152 About the author..............................................................................155 IM-proefschrift.qxd 4/7/2007 11:42 PM Page 8 IM-proefschrift.qxd 4/7/2007 11:42 PM Page 9 General introduction 1 IM-proefschrift.qxd 4/7/2007 11:42 PM Page 10 CHAPTER 1 Background A high consumption of plant foods, such as whole grain products, fruits and vegetables has been associated with a lower risk of chronic diseases.1-4 These protective effects have traditionally been attributed to the high content of dietary fiber, vitamins and minerals in these products.3,5,6 However, plant foods also contain numerous other bioactive compounds such as terpenes, plant sterols and polyphenols that may contribute to their protective effects.7 For about 20 years RIKILT-Institute of Food Safety, the National Institute of Public Health and the Environment (RIVM), and the Division of Human Nutrition of Wageningen University, in the Netherlands, have joined forces to study bioactive compounds in plant foods. This research focused on flavonoids. Flavonoids are polyphenolic compounds, which have been stud- ied because of their antioxidant activity, by which they may prevent both car- diovascular diseases and cancer. Specific research projects have focused a.o. on flavonols and flavones8,9 and catechins.10 In 2001 the ‘Lignan project’ was started, to study the dietary intake of lignans, their bioavailability, their molecular mechanisms of biological action, and the relation of dietary and plasma lignans with chronic diseases. The part of the project described in this thesis focuses on the dietary lignans. The studies that focused on the bioavailability and plasma lignans have been reported in the thesis of Anneleen Kuijsten.11 Plant lignans form a diverse group of diphenolic compounds, and have been identified in many plant foods.12 Especially flaxseed (linseed) is a rich lignan source. After ingestion, some plant lignans can be converted to the enterolignans, enterodiol (END) and enterolactone (ENL) by the intestinal microflora, and absorbed into the body.13 It has long been assumed that only secoisolariciresinol (SECO) and matairesinol (MAT) are precursors of enterolignans, but recently it has been shown that also lariciresinol (LARI) and pinoresinol (PINO) can be efficiently converted.14 Enterolignans are thought to be the biologically active metabolites of plant lignans. Besides their antioxidant activity, lignans have also gained attention because of their estrogen-like structure, which provides another mechanism by which lignan intake could modify the risk of both cardiovascular diseases and cancer. Epidemiological studies provide some evidence for the protec- tive effects of lignan intake; however, the results are inconsistent.15 This can be attributed to the lack of suitable methods for quantification of lignans in a wide range of foods, and consequent lack of comprehensive data on the lignan content of foods and diets. 10 IM-proefschrift.qxd 4/7/2007 11:42 PM Page 11 GENERAL INTRODUCTION Therefore, in the project described in this thesis, we have developed
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