Soy in the metabolic syndrome 25/10/2017

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Soy in the metabolic syndrome: obesity and diabetes

Marco Mensink, Assistant Professor Nutrition, Energy Metabolism & Health, Wageningen University, NL

Alpro Foundation Symposium, Brussels, Oct. 24 2017

Metabolic Syndrome (MetS)

Clustering risk factors DM and CVD● Dyslipidaemia, Hyperglycaemia, Hypertension● Abdominal obesity

Ectopic lipid deposition Insulin resistance Low-grade inflammation

Dysregulated Energy Metabolism

Soy in the metabolic syndrome 25/10/2017

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Metabolic Syndrome (MetS)

Insulin resistanceglycemic control

LIPOTOXICITY

InflammationAdipokine secretion

ExcessLipid deposition

nutrient / energy balance

Blood lipids Body weight &composition

METABOLIC SYNDROME

PhD project - Monique van NielenDIETARY PROTEINS and aspects of the METABOLIC SYNDROME

Step 1: observational study protein and DM Step 2: strictly controlled dietary intervention

Soy and aspects MetS

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DIETARY PROTEIN INTAKE AND THE INCIDENCE OF TYPE 2 DIABETES

THE EPIC-INTERACT CASE-COHORT STUDY

Van Nielen et al, Diabetes Care 2014

InterAct (Part of EPIC)European Prospective Investigation into Cancer ( )

Study population InterAct: 8 European countries

~27 000 participants

>12 000 T2D cases

EPIC 450.00 participants

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Diet (FFQ)Lifestyle

1991 ’92 ’93 ’94 ’95 1996 ’97 ’98 ’99 ’00 ’01 ’02 ’03 ’04 ’05 ’06 2007

Type 2 diabetes

Start

Prospective case-cohort design

Hazard Ratio - Total protein intake

(I2=24%)

FranceItalySpainUKNetherlandsGermanySwedenDenmarkOverall (I2=0%)

Model1 (age = timescale) energy, centre, sexModel2 model1 + smoking, education, PA, alcohol

Model3 model2 + fibre, SFA, MUFA, PUFA, cholesterol, soft drinks, tea ,coffee (no carbohydrates: substitution model)

Model4 model3 + BMI, waist

Women Men

Soy in the metabolic syndrome 25/10/2017

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Associations by sources of protein

No specific source associated with T2D● Animal: meat (red/processed/poultry/etc.), fish, eggs, dairy,

milk, cheese, other

● Plant: cereals, bread, potato, pasta & rice, vegetables (leafy/fruiting/etc.), cabbage, nuts, other

● Soy: too low intakes in Europe

Protein Women Men Overall

HR (95%CI) HR (95%CI) HR (95%CI)

Total protein 1.10 (1.06-1.14) 1.02 (0.98-1.06) 1.06 (1.02-1.09)

Animal protein 1.09 (1.05-1.14) 1.02 (0.97-1.06) 1.05 (1.02-1.08)

Plant protein 0.98 (0.87-1.09) 1.09 (0.99-1.21) 1.04 (0.93-1.16)

Intermediate conclusion I

Diets high in total protein are associated with a modest increased T2D risk ● Confirmed in women, not in men● Largely explained by animal protein

● Cannot be explained by a single food source

● BMI and Waist strongly influence associations

(Van Nielen et al, Diabetes Care 2014)

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Characteristics by protein intakea

WOMEN MEN

Q1 Q3 Q5 Q1 Q3 Q5

Protein intake (g/day) 74 91 110 69 89 114

BMI (kg/m2) 24 26 27 26 27 28

Physical Activity (%) 20 17 14 24 23 27

Smokers (%) 24 22 20 29 31 36

High Education(%) 24 18 14 29 25 19

Dietary intake

Carbohydrates (E%) 48 45 41 46 43 39

Fibre (g) 23 24 24 20 22 24

SFA (E%) 14 13 13 14 13 12

MUFA (E%) 13 13 14 12 13 15

Magnesium (mg) 330 315 354 384 380 429

Cholesterol (mg) 288 342 405 274 335 423Coffee, tea and soft drinks were lower with increasing intakeBeta carotene and calcium were higher with increasing intake

SOY PROTEIN INTAKE AND THE METABOLIC SYNDROMEA strictly-controlled dietary intervention

van Nielen et al, Journal of Nutrition 2014

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Soy protein intake & the MetS

Soy-protein diet(amino acids, peptides,

isoflavones)

Insulin resistanceglycemic control

LIPOTOXICITY

InflammationAdipokine secretion

ExcessLipid deposition

nutrient / energy balance

Blood lipids Body weight &composition

METABOLIC SYNDROME

Cross-over study

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Strictly controlled dietary intervention

Hot lunch at the university90% of foods provided (10% ‘free’)No supplements

Take-home packages Weight monitored twice a week

Macronutrient composition diets

Diet Protein Carbs Fat Soy protein

(En%) (En%) (En%) (gram)

Mixed protein (HPmixed) 21 52 26 0

Soy protein (HPsoy) 21 51 26 30

According to the ‘Dutch guidelines for a healthy diet’

Main differences in protein source between diets: Meat vs. Soy meat analoguesMeat snack vs. Soy nuts 

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Composition of the diets and duplicates

Characteristics (n=15)

Mean (SD)Age (y) 61.2 (5.4)

Weight (kg) 69.4 (12.4)

Waist circumference (cm) 90.0 (9.6)

BMI (kg/m2) 25.4 (4.1)

Fasting glucose (mmol/l) 5.7 (0.7)

2hour glucose (mmol/l) 5.1 (1.5)

Total cholesterol (mmol/l) 5.9 (0.7)

HDL (mmol/l) 1.8 (0.4)

LDL (mmol/l) 3.5 (0.7)

Systolic blood pressure (mmHg) 122.0 (16.5)

Diastolic blood pressure (mmHg) 70.8 (9.7)

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Measurements

Measurement MethodMetabolic control Insulin, glucose, lipids, CRP Plasma, FSIGT

Vascular function Augmentation Index, BP BP and PWA

Body composition Weight, body fat percentage DXA

Hepatic fat Lipid content in the liver 1H-MRS

glucose, insulin, inflammation, IHL

Variable Mixed Soy P-valueMean (SD) Mean (SD) ANCOVA

Glucose (mmol/l) 5.4 (0.4) 5.4 (0.5) 0.90

Insulin (mU/l) 3.0 (1.4) 3.4 (1.7) 0.12

HOMA-IR 0.4 (0.2) 0.5 (0.2) 0.12

C-reactive protein (mg/l) 2.1 (1.7) 1.4 (1.3) 0.11

IHL (%) 2.3 (3.3) 2.9 (4.3) 0.20

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Intravenous glucose tolerance test (IVGTT)

P= 0.048 P= 0.038

• Improved insulin sensitivity (Si and DI)• No difference in glucose effectiveness (Sg)

and acute insulin response (AIR)

Total and LDL cholesterol

P= 0.001 P= 0.004

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Compared to a mixed-protein diet, the soy-protein diet had a stronger effect on: Insulin sensitivity Total and LDL cholesterol.. but not on intra hepatic lipids

Both high-protein diets reduced: Total, LDL, HDL cholesterol, triglycerides Glucose, insulin, C-reactive protein Body weight, total body and abdominal fat.. and tended to reduce Hepatic fat

Intermediate conclusions II

Soy protein

The inclusion of whole soy foods (corresponding to 30 g/day protein) in a lipid-lowering diet significantly improved a relevant set of biomarkers (lipid, adiposity) associated with cardiovascular risk.

24(Ruscica et al, Eur J Nutr 2016)

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Summary and Conclusion

total and animal protein consumption, not plant protein, are associated with an increased diabetes risk partly replacing meat by soy in a moderate high-protein

diet has clear advantages regarding insulin sensitivity and total and LDL cholesterol.

-> Therefore, exchanging meat products for soy products, could be important in fighting the metabolic syndrome and reducing the risk for type 2 diabetes mellitus and cardiovascular disease

Thanks !

Monique van NielenAnnemarie RietmanEdith FeskensEls SiebelinkAlpro Foundation

marco.mensink@wur.nl

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