Advertisement

Phytoestrogen supplementation and body composition in postmenopausal women: A systematic review and meta-analysis of randomized controlled trials

      Highlights

      • An increasing number of women use phytoestrogens as a complementary treatment for menopausal symptoms.
      • An increase in body weight in postmenopausal women is associated with greater risk of metabolic disorders and may cause a worsening of menopausal symptoms.
      • Based on current evidence from clinical trials, phytoestrogen supplementation may have potential adverse effect on body weight.
      • Phytoestrogen intake in menopausal women shall be followed with hypocaloric diet/enhanced physical activity during supplementation period.

      Abstract

      Phytoestrogen-based medications are commonly used by menopausal women, and especially by obese postmenopausal women, to relieve menopausal symptoms. Substitution of animal with soy protein is often used in weight loss regimens, yet the effect of phytoestrogens, the main constituent of soy foods, on body composition is not completely understood. We conducted a systematic review and meta-analysis to investigate the associations between phytoestrogen supplementation and body weight and the main parameters of body composition in postmenopausal women. A literature search was done using 5 electronic databases from inception to April 2018. Randomized controlled trials (RCTs) with postmenopausal women comparing phytoestrogen supplementation followed by usual diet and placebo were included in the present meta-analysis. From 5932 references, we identified 23 RCTs that met our inclusion criteria, with a total of 1880 postmenopausal women. No association was observed between phytoestrogen supplementation and body weight, body mass index, waist and hip circumference, total fat mass or percentage of body fat. However, the use of phytoestrogens supplementation was associated with a slight decrease in waist-hip ratio; the pooled mean difference was −0.01 cm (95%CI: −0.01 to −0.006). In subgroup analysis, we found a modest decrease in body weight with phytoestrogens supplementation compared with placebo in healthy postmenopausal women [pooled mean difference of changes −0.28 kg (95%CI: −0.52 to −0.04)] and in RCTs with a median number of participants of 66 or less [pooled mean difference of changes −0.49 kg (95%CI: −0.87 to −0.11)]. In contrast, phytoestrogen supplementation was associated with increased body weight in postmenopausal women with preexisting metabolic disorders (prediabetes, type 2 diabetes, prehypertension and hyperlipidemia) [pooled mean difference of changes: 0.78 kg (95%CI: 0.53–1.03)]. In addition, there were some indications that some types of phytoestrogens, such as daidzein, but not soy products or isoflavone mix, could lead to modest adverse changes in body composition in menopausal women. Therefore, future studies should investigate the potential adverse effects of phytoestrogen supplementation on body composition among postmenopausal women.

      Abbreviations:

      BMI (body mass index), FM (fat mass), HC (hip circumference), MHT (menopausal hormone therapy), PBF (percentage of body fat), RCT (randomized controlled trial), T2D (type 2 diabetes), WC (waist circumference), WHR (waist to hip ratio)

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Maturitas
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Davis S.R.
        • Lambrinoudaki I.
        • Lumsden M.
        • Mishra G.D.
        • Pal L.
        • Rees M.
        • Santoro N.
        • Simoncini T.
        Menopause.
        Nat. Rev. Dis. Primers. 2015; 1: 15004
        • Dibonaventura M.D.
        • Chandran A.
        • Hsu M.A.
        • Bushmakin A.
        Burden of vasomotor symptoms in France, Germany, Italy, Spain, and the United Kingdom.
        Int. J. Womens Health. 2013; 5: 261-269
        • Reed S.D.
        • Lampe J.W.
        • Qu C.
        • Gundersen G.
        • Fuller S.
        • Copeland W.K.
        • Newton K.M.
        Self-reported menopausal symptoms in a racially diverse population and soy food consumption.
        Maturitas. 2013; 75: 152-158
        • Misso M.L.
        • Jang C.
        • Adams J.
        • Tran J.
        • Murata Y.
        • Bell R.
        • Boon W.C.
        • Simpson E.R.
        • Davis S.R.
        Differential expression of factors involved in fat metabolism with age and the menopause transition.
        Maturitas. 2005; 51: 299-306
        • Thurston R.C.
        • Chang Y.
        • Mancuso P.
        • Matthews K.A.
        Adipokines, adiposity, and vasomotor symptoms during the menopause transition: findings from the study of women’s health across the nation.
        Fertil. Steril. 2013; 100: 793-800
        • Fernández-Alonso AM C.J.
        • Chedraui P.
        • Mendoza M.
        • Cuadros A.M.
        • Pérez-López F.R.
        Obesity is related to increased menopausal symptoms among Spanish women.
        Menopause Int. 2010; 16: 105-110
        • Thurston R.C.
        • Sowers M.R.
        • Sutton-Tyrrell K.
        • Everson-Rose S.A.
        • Lewis T.T.
        • Edmundowicz D.
        • Matthews K.A.
        Abdominal adiposity and hot flashes among midlife women.
        Menopause. 2008; 15: 429-434
        • Thurston R.C.
        • Sowers M.R.
        • Sternfeld B.
        • Gold E.B.
        • Bromberger J.
        • Chang Y.
        • Joffe H.
        • Crandall C.J.
        • Waetjen L.E.
        • Matthews K.A.
        Gains in body fat and vasomotor symptom reporting over the menopausal transition: the study of women’s health across the nation.
        Am. J. Epidemiol. 2009; 170: 766-774
        • Mintziori G.
        • Lambrinoudaki I.
        • Goulis D.G.
        • Ceausu I.
        • Depypere H.
        • Erel C.T.
        • Perez-Lopez F.R.
        • Schenck-Gustafsson K.
        • Simoncini T.
        • Tremollieres F.
        • Rees M.
        EMAS position statement: non-hormonal management of menopausal vasomotor symptoms.
        Maturitas. 2015; 81: 410-413
        • Franco O.H.
        • Chowdhury R.
        • Troup J.
        • Voortman T.
        • Kunutsor S.
        • Kavousi M.
        • Oliver-Williams C.
        • Muka T.
        Use of plant-based therapies and menopausal symptoms: a systematic review and meta-analysis.
        JAMA. 2016; 315: 2554-2563
        • Cano A.
        • Garcia-Perez M.A.
        • Tarin J.J.
        Isoflavones and cardiovascular disease.
        Maturitas. 2010; 67: 219-226
        • Guthrie J.R.
        • Ball M.
        • Murkies A.
        • Dennerstein L.
        Dietary phytoestrogen intake in mid-life Australian-born women: relationship to health variables.
        Climacteric. 2000; 3: 254-261
        • Yamori Y.
        Worldwide epidemic of obesity: hope for Japanese diets.
        Clin. Exp. Pharmacol. Physiol. 2004; 2: S2-S4
        • Goodman-Gruen D.
        • Kritz-Silverstein D.
        Usual dietary isoflavone intake and body composition in postmenopausal women.
        Menopause. 2003; 10: 427-432
        • Ho S.C.
        • Chen Y.M.
        • Ho S.S.
        • Woo J.L.
        Soy isoflavone supplementation and fasting serum glucose and lipid profile among postmenopausal Chinese women: a double-blind, randomized, placebo-controlled trial.
        Menopause. 2007; 14: 905-912
        • Kim J.
        • Lee H.
        • Lee O.
        • Lee K.H.
        • Lee Y.B.
        • Young K.D.
        • Jeong Y.H.
        • Choue R.
        Isoflavone supplementation influenced levels of triglyceride and luteunizing hormone in Korean postmenopausal women.
        Arch. Pharmacol. Res. 2013; 36: 306-313
        • Sites C.K.
        • Cooper B.C.
        • Toth M.J.
        • Gastaldelli A.
        • Arabshahi A.
        • Barnes S.
        Effect of a daily supplement of soy protein on body composition and insulin secretion in postmenopausal women.
        Fertil. Steril. 2007; 88: 1609-1617
        • Arjmandi B.H.
        • Lucas E.A.
        • Khalil D.A.
        • Devareddy L.
        • Smith B.J.
        • McDonald J.
        • Arquitt A.B.
        • Payton M.E.
        • Mason C.
        One year soy protein supplementation has positive effects on bone formation markers but not bone density in postmenopausal women.
        Nutr. J. 2005; 4: 8
        • Liu Z.M.
        • Ho S.C.
        • Chen Y.M.
        • Woo J.
        A six-month randomized controlled trial of whole soy and isoflavones daidzein on body composition in equol-producing postmenopausal women with prehypertension.
        J. Obes. 2013; 2013
        • Maesta N.
        • Nahas E.A.P.
        • Nahas-Neto J.
        • Orsatti F.L.
        • Fernandes C.E.
        • Traiman P.
        • Burini R.C.
        Effects of soy protein and resistance exercise on body composition and blood lipids in postmenopausal women.
        Maturitas. 2007; 56: 350-358
        • Zhang Y.B.
        • Chen W.H.
        • Guo J.J.
        • Fu Z.H.
        • Yi C.
        • Zhang M.
        • Na X.L.
        Soy isoflavone supplementation could reduce body weight and improve glucose metabolism in non-Asian postmenopausal women–a meta-analysis.
        Nutrition. 2013; 29: 8-14
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • Group P.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS Med. 2009; 6: e1000097
      1. Higgins J.P.T. Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011 (Available from www.handbook.cochrane.org)
        • Higgins J.P.
        • Thompson S.G.
        • Deeks J.J.
        • Altman D.G.
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • Thompson S.G.
        • Sharp S.J.
        Explaining heterogeneity in meta-analysis: a comparison of methods.
        Stat. Med. 1999; 18: 2693-2708
        • Aubertin-Leheudre M.
        • Lord C.
        • Khalil A.
        • Dionne I.J.
        Effect of 6 months of exercise and isoflavone supplementation on clinical cardiovascular risk factors in obese postmenopausal women: a randomized, double-blind study.
        Menopause. 2007; 14: 624-629
        • Bakhtiari A.
        • Yassin Z.
        • Hanachi P.
        • Rahmat A.
        • Ahmad Z.
        • Sajadi P.
        • Shojaei S.
        Effects of soy on body composition: a 12-week randomized controlled trial among Iranian elderly women with metabolic syndrome.
        Iran. J. Public Health. 2012; 41: 9-18
        • Choquette S.
        • Riesco E.
        • Cormier E.
        • Dion T.
        • Aubertin-Leheudre M.
        • Dionne I.J.
        Effects of soya isoflavones and exercise on body composition and clinical risk factors of cardiovascular diseases in overweight postmenopausal women: a 6-month double-blind controlled trial.
        Br. J. Nutr. 2011; 105: 1199-1209
        • Colacurci N.
        • Chiàntera A.
        • Fornaro F.
        • De Novellis V.
        • Manzella D.
        • Arciello A.
        • Chiàntera V.
        • Improta L.
        • Paolisso G.
        Effects of soy isoflavones on endothelial function in healthy postmenopausal women.
        Menopause. 2005; 12: 299-307
        • Garrido A.
        • De la Maza M.P.
        • Hirsch S.
        • Valladares L.
        Soy isoflavones affect platelet thromboxane A2 receptor density but not plasma lipids in menopausal women.
        Maturitas. 2006; 54: 270-276
        • Liu Z.M.
        • Chen Y.M.
        • Ho S.C.
        • Ho Y.P.
        • Woo J.
        Effects of soy protein and isoflavones on glycemic control and insulin sensitivity: a 6-mo double-blind, randomized, placebo-controlled trial in postmenopausal Chinese women with prediabetes or untreated early diabetes.
        Am. J. Clin. Nutr. 2010; 91: 1394-1401
        • Wu J.
        • Oka J.
        • Tabata I.
        • Higuchi M.
        • Toda T.
        • Fuku N.
        • Ezaki J.
        • Sugiyama F.
        • Uchiyama S.
        • Yamada K.
        • Ishimi Y.
        Effects of isoflavone and exercise on BMD and fat mass in postmenopausal Japanese women: a 1-year randomized placebo-controlled trial.
        J. Bone Miner. Res. 2006; 21: 780-789
        • Chiechi L.M.
        • Secreto G.
        • Vimercati A.
        • Greco P.
        • Venturelli E.
        • Pansini F.
        • Fanelli M.
        • Loizzi P.
        • Selvaggi L.
        The effects of a soy rich diet on serum lipids: the Menfis randomized trial.
        Maturitas. 2002; 41: 97-104
        • Villa P.
        • Costantini B.
        • Suriano R.
        • Perri C.
        • Macrì F.
        • Ricciardi L.
        • Panunzi S.
        • Lanzone A.
        The differential effect of the phytoestrogen genistein on cardiovascular risk factors in postmenopausal women: relationship with the metabolic status.
        J. Clin. Endocrinol. Metab. 2009; 94: 552-558
        • Martin M.R.
        • Weickert O.
        • Otto Bärbel
        • Hall Wendy L.
        • Vafeiadou Katherina
        • Hallund Jesper
        • Ferrari Marika
        • Talbot Duncan
        • Branca Francesco
        • Bügel Susanne
        • Williams Christine M.
        • Zunft Hans-Joachim
        • Koebnick Corinna
        Soy isoflavones increase preprandial peptide YY (PYY), but have no effect on ghrelin and body weight in healthy postmenopausal women.
        J. Negat. Results Biomed. 2006; : 5-11
        • Orsatti F.L.
        • Nahas E.A.
        • Nahas-Neto J.
        • Maesta N.
        • Orsatti C.L.
        • Fernandes C.E.
        Effects of resistance training and soy isoflavone on body composition in postmenopausal women.
        Obstet. Gynecol. Int. 2010; 2010156037
        • Aubertin-Leheudre M.
        • Lord C.
        • Khalil A.
        • Dionne I.J.
        Isoflavones and clinical cardiovascular risk factors in obese postmenopausal women: a randomized double-blind placebo-controlled trial.
        J. Womens Health (Larchmt.). 2008; 17: 1363-1369
        • Khaodhiar L.
        • Ricciotti H.A.
        • Li L.
        • Pan W.
        • Schickel M.
        • Zhou J.
        • Blackburn G.L.
        Daidzein-rich isoflavone aglycones are potentially effective in reducing hot flashes in menopausal women.
        Menopause. 2008; 15: 125-132
        • Delmanto A.
        • Nahas-Neto J.
        • Traiman P.
        • Uemura G.
        • Pessoa E.C.
        • Nahas E.A.
        Effects of soy isoflavones on mammographic density and breast parenchyma in postmenopausal women: a randomized, double-blind, placebo-controlled clinical trial.
        Menopause. 2013; 20: 1049-1054
        • Hidalgo L.A.
        • Chedraui P.A.
        • Morocho N.
        • Ross S.
        • San Miguel G.
        The effect of red clover isoflavones on menopausal symptoms, lipids and vaginal cytology in menopausal women: a randomized, double-blind, placebo-controlled study.
        Gynecol. Endocrinol. 2005; 21: 257-264
        • Engelbert A.K.
        • Soukup S.T.
        • Roth A.
        • Hoffmann N.
        • Graf D.
        • Watzl B.
        • Kulling S.E.
        • Bub A.
        Isoflavone supplementation in postmenopausal women does not affect leukocyte LDL receptor and scavenger receptor CD36 expression: a double-blind, randomized, placebo-controlled trial.
        Mol. Nutr. Food Res. 2016; 60: 2008-2019
        • Colli M.C.
        • Bracht A.
        • Soares A.A.
        • de Oliveira A.L.
        • Boer C.G.
        • de Souza C.G.
        • Peralta R.M.
        Evaluation of the efficacy of flaxseed meal and flaxseed extract in reducing menopausal symptoms.
        J. Med. Food. 2012; 15: 840-845
        • Weickert M.O.
        • Reimann M.
        • Otto B.
        • Hall W.L.
        • Vafeiadou K.
        • Hallund J.
        • Ferrari M.
        • Talbot D.
        • Branca F.
        • Bugel S.
        • Williams C.M.
        • Zunft H.J.
        • Koebnick C.
        Soy isoflavones increase preprandial peptide YY (PYY), but have no effect on ghrelin and body weight in healthy postmenopausal women.
        J. Negat. Results Biomed. 2006; 5: 11
        • Naaz A.
        • Yellayi S.
        • Zakroczymski M.A.
        • Bunick D.
        • Doerge D.R.
        • Lubahn D.B.
        • Helferich W.G.
        • Cooke P.S.
        The soy isoflavone genistein decreases adipose deposition in mice.
        Endocrinology. 2003; 144: 3315-3320
        • Matvienko O.A.
        • Alekel D.L.
        • Genschel U.
        • Ritland L.
        • Van Loan M.D.
        • Koehler K.J.
        Appetitive hormones, but not isoflavone tablets, influence overall and central adiposity in healthy postmenopausal women.
        Menopause. 2010; 17: 594-601
        • Kim H.K.
        • Nelson-Dooley C.
        • Della-Fera M.A.
        • Yang J.Y.
        • Zhang W.
        • Duan J.
        • Hartzell D.L.
        • Hamrick M.W.
        • Baile C.A.
        Genistein decreases food intake, body weight, and fat pad weight and causes adipose tissue apoptosis in ovariectomized female mice.
        J. Nutr. 2006; 136: 409-414
        • Cederroth C.R.
        • Nef S.
        Soy, phytoestrogens and metabolism: a review.
        Mol. Cell. Endocrinol. 2009; 304: 30-42
        • Wu J.
        • Wang X.
        • Chiba H.
        • Higuchi M.
        • Nakatani T.
        • Ezaki O.
        • Cui H.
        • Yamada K.
        • Ishimi Y.
        Combined intervention of soy isoflavone and moderate exercise prevents body fat elevation and bone loss in ovariectomized mice.
        Metabolism. 2004; 53: 942-948
        • Szkudelska K.
        • Nogowski L.
        • Szkudelski T.
        Genistein affects lipogenesis and lipolysis in isolated rat adipocytes.
        J. Steroid Biochem. Mol. Biol. 2000; 75: 265-271
        • Lovejoy J.C.
        • Champagne C.M.
        • de Jonge L.
        • Xie H.
        • Smith S.R.
        Increased visceral fat and decreased energy expenditure during the menopausal transition.
        Int. J. Obes. (Lond.). 2008; 32: 949-958