SOY PROTEIN IN VEGETARIAN DIET

INVERSELY RELATED TO PREVALENCE

OF HYPERLIPIDEMIA
Vy Doan
Dietetic Intern 2015-2016
November 18 t h , 2015

Purpose
Compare prevalence of dyslipidemia
(hyperlipidemia and any altered lipid
conditions included) in vegetarian diet
versus regular diet at Patton State
Hospital

Market Projection

Soy
Considered a complete protein, contains all of the
essential amino acids
Modified into textured vegetable protein (TVP) found
in many meat and dairy substitutes.
Soy protein isolates (SPI) cheapest and highest
protein quality
Offers essential omega-3 fatty acid linolenic acid
Rich source of isoflavones (phytoestrogens)subclass of flavonoids that bind to estrogen
receptors (ERs)

Soy Controversy
Increased pre-packaged frozen meat-substitute
options with increased awareness of vegetarian diet
benefits
Soy protein raises questions and doubts on benefits
of a vegetarian diet
Mostly centered on Cancer
But what about in terms of CVD and lipids?

Benefits
Soy protein: 20-50 g
Isoflavone: 50-100 mg/d
Manages hot flashes, endothelial function, bone
mineral density and blood pressure (Webb, 2010).
FDA Guidelines for Cholesterol Reduction:
100 mg/d isoflavones
25 g soy protein
*no clinical evidence to suggest exceeding these
levels are harmful

Literature Review
17 RCTs : Exposure to Isoflavone-Containing Soy products affecting
endothelial function (EF)
Endothelial dysfunction independent coronary heart disease risk
factor and strong predictor of long-term cardiovascular morbidity
and mortality.
Results: Soy isoflavones = EF
Japan, 12 year prospective epidemiology study
Postmenopausal women
Average Isoflavone intake of 41 mg/d
>60% reduction in risk of cerebral and myocardial infarctions

including 25 g of soy protein per day in

a diet low in saturated fat and cholesterol
may reduce the risk of heart disease by
lowering blood cholesterol levels.
(FDA, 2015).

The Catch
Responsible for only cholesterol reduction in 3-5%
Benefits only healthy, young (median age 53 y.o.) at
low risk for CVD
Insignificant role in reversal treatment for those
already at moderate or high risk for CVD
Study (Hodis, et. al 2011):
25 g soy protein to 350 postmenopausal women for
2.7 years
No significant in reducing atherosclerosis

Hypothesis
Lipid
s

Regular
Diet

Vegetarian
Diet

Lipid
s

Demographic
Patton State Hospital
Feeds 1,540 patients, 3 times a day, including snacks, 7 days a
week
10 different diets
Regular and vegetarian diet = same heart healthy guidelines
2300-2500 kcals
Less than 25% calories from fat
<7% calories from saturated fat
<300 mg cholesterol
4-5 g Sodium

Vegetarian Meat Substitutes

Cedar Lake
Morning Star
Boca Burgers

Methods

Data (current diet) collected as of October 12, 2015

Included yo-yo vegetarians
No noted difference between inconsistent vs. consistent adherence to
vegetarian diet
Adherence determined from November 8 th, 2015
Rounded up to nearest month
Exclusions
Diets: Sodium control, puree, kosher
patients currently not here
Admits with no available medical condition or BMI
Medical Hx tab in compnutrition to determine open condition for dyslipidemia

Methods

Design: Cross-sectional

Veget.
Male
Female

Gender

Regular
Male
Female

Gender

Total
Male
Female

Gender

Age
29
17

BMI
44
40

Age
28
18

BMI
46
51

Age
57
35

27.8
32.1

29.0
33.4
BMI

45
46

32.8
33.4

Statistical Tests
Individual T-test
Determine P-value (<0.05=significant)
Done on individual variables between regular vs.
vegetarians
Chi-Square test & Contingency Table
Test relationship between regular vs. vegetarians for
prevalence of dyslipidemia

Odds ratio
To determine future risk between the variables and
outcome of developing dyslipidemia

Variables

Age SD
Gender SD

48.07 14.04

BMI SD
Adherence SD
Dyslipidemia
Present SD

Regular Diet
(n=46)

0.61 0.49
30.70 5.17

Vegetarian
PDiet (n=46) Value
13.8
42.57
2
0.06
0.63 0.49
29.40 6.39

0.83
0.29

4.78 4.50

3.44 3.71

0.06

0.37 0.49

0.26 0.44

0.15

**Variable Comparison with mean + SD and calculated Pvalue to show varying differences. No P-value statistically
significant

Results

22
%
diff
ere
nce
!

Prevalence of Dyslipidemia in Vegetarians

Female

Male
0%

5%

10%

15%

20%

25%

30%

35%

40%

Prevalence of Dyslipidemia in Regular

Female

Male

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Prevalance of Dyslipidemia: Vegetarian vs. Regular (out of n=92)

Veget

Regular

0%

2%

4%

6%

8% 10% 12% 14% 16% 18% 20%

Contingency Tables
Dyslipidemia?

Diet
Yes
No
Vegetari
an
12
Regular
17
Totals
29

X^2

1.258

P-value

0.262

34
29
63

Totals

46
46
92

Odds
Ratio
Relative
Risk

0.602
0.705

Calculated from Observed Contingency Table from 2007 The Pennsylvania State University. All rights
reserved.

Male vs. Female (Vegetarians)

Dyslipidemia?

Gender
Male
Female
Totals

X^2
P-value

Yes

No
10
2
12

6.133
0.013

Totals

36
46
44
46
80
92

Odds ratio
Relative
Risk

6.111
5

Calculated from Observed Contingency Table from 2007 The Pennsylvania State University. All rights
reserved.

Results Discussed
Hypothesis Rejected
Although there was an 11% difference, P-value 0.262 = not
statistically significant
No significant difference between adherence or BMI
No significant difference between age and BMI or prevalence
New Finding
Male vs. Female Vegetarians
P-value: 0.013 is statistically significant
*Less open medical conditions in vegetarian group versus regular
group

Limitations
No other risk factors recorded/collected
Canteen intake
Physical activity
Drug interaction
No surveys or questionnaires
No measure of LDL, HDL, TG, and Chol levels
Limited to generalized condition: dyslipidemia

Conclusions
Prevalence of dyslipidemia higher in regular group vs.
vegetarian group by 11%
Although not statistically significant P-value 0.262
No significant change in BMI
No correlation between length of adherence and
improved lipid or wt. management
Minimal open conditions in vegetarian group vs. regular
group
Vegetarian group more likely to improve overall health

Further Considerations
Adding WHOLE soy protein or plant based
protein into the diets for institutionalized
patients
Optimize health
Improve lipid profile
Manage Cardiovascular Risk

References

1.Beavers, D., Beavers, K., Miller, M., Stamey, J., & Messina, M. (2010). Exposure to isoflavone-containing soy products and endothelial function: A
Bayesian meta-analysis of randomized controlled trials. Nutrition, Metabolism and Cardiovascular Diseases, 182-191.
2.Cardiovascular diseases (CVDs). (n.d.). Retrieved October 18, 2015.
3.Cedar Lake Foods (2013). < http://www.cedarlakefoods.com/>. Retrieved October 18, 2015.
4.CFR - Code of Federal Regulations Title 21. (2015, April 1). Retrieved October 18, 2015.
5.Dichi, I. (2015). Effects of Soy, Soy-Based Products, and Soy Components on Metabolic
6.Syndrome Parameters. In Nutritional intervention in metabolic syndrome. Boca Raton, FL: Taylor and Francis Group.
7.Hodis, H., Mack, W., Kono, N., Azen, S., Shoupe, D., Hwang-Levine, J., . . . Selzer, R. (2011).
8.Isoflavone Soy Protein Supplementation and Atherosclerosis Progression in Healthy Postmenopausal Women: A Randomized Controlled Trial. Stroke,
3168-3175.
9.Messina, M. (2014). Soy foods, isoflavones, and the health of postmenopausal women. American Journal of Clinical Nutrition.
10.
Messina M, Messina V. The role of soy in vegetarian diets.Nutrients. 2010;2(8):855-888.
11.
Nielen, M., Feskens, E., Rietman, A., Siebelink, E., & Mensink, M. (2014). Partly Replacing Meat Protein with Soy Protein Alters Insulin Resistance and
Blood Lipids in Postmenopausal Women with Abdominal Obesity. Journal of Nutrition, 1423-1429.
12.
Soy Protein Ingredients Market by Type, Application (Bakery & Confectionery, Meat Alternatives, Functional Foods, Dairy Replacements & Infant Foods),
& by Region - Global Trends & Forecast to 2020
13.
Webb, D. (2010, November 1). Shedding Light on Soy. Today's Dietitian, 28-28.
14.
Wofford, M., Rebholz, C., Reynolds, K., Chen, J., Chen, C., Myers, L., . . . He, J. (2011). Effect of soy and milk protein supplementation on serum lipid
levels: A randomized controlled trial. European Journal of Clinical Nutrition Eur J Clin Nutr, 419-425.

Thank you!
Any Questions?