|Year : 2013 | Volume
| Issue : 4 | Page : 352-357
Amelioration of selected cardiac risk factors through supplementation of diet with flaxseed and soya bean
Charu Katare1, Sonali Saxena2
1 Department of Food and Nutrition, Government Kamla Raja Girls (PG) Autonomous College, Gwalior, Madhya Pradesh, India
2 School of Studies in Biochemistry, Jiwaji University, Gwalior, Madhya Pradesh, India
|Date of Submission||21-Mar-2013|
|Date of Acceptance||31-May-2013|
|Date of Web Publication||15-Oct-2013|
Department of Food and Nutrition, Government Kamla Raja Girls (PG) Autonomous College, Gwalior - 474 011, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aims: Flax seeds and soya bean are a rich source of unsaturated fatty acids, antioxidants and fibers known to have anti-atherogenic activities. The study attempted to evaluate the effect of flaxseed and soya bean supplementation on serum lipids of dyslipidemic subjects. Methods: The subjects were divided into three groups: Experimental group-I (E-I), experimental group-II (E-II) and a control group (C). Group E-I was given 30 g of roasted flaxseed chutney powder and group E-II was given 30 g of soya nuts for 12 weeks. Both groups and the control group were prescribed with similar dietary guidelines. Anthropometric parameters, blood pressure and blood lipid profile were estimated before and after completion of the study. Results: Twelve week therapeutic intervention indicated significant drop (P < 0.05) in blood pressure, whereas a highly significant reduction (P < 0.01) was noted in Total cholesterol and triglycerides. A significant improvement in high density lipoprotein cholesterol was recorded in the groups receiving flaxseed (P < 0.01) and soya bean (P < 0.05). Body mass index, cardiac risk ratio, atherogenic coefficient and atherogenicity index of plasma were also found to improve significantly. Conclusion: These findings suggest that therapeutic intervention with flaxseed and soya may be a preliminary, but efficacious means of improving cholesterol and triglyceride levels in those diagnosed with dyslipidemia and may also be advocated in place of drug therapy when cholesterol levels soar just above the normal range.
Keywords: Antiatherogenic, dyslipidemia, flaxseed, soya bean, supplementation
|How to cite this article:|
Katare C, Saxena S. Amelioration of selected cardiac risk factors through supplementation of diet with flaxseed and soya bean. Int J Nutr Pharmacol Neurol Dis 2013;3:352-7
|How to cite this URL:|
Katare C, Saxena S. Amelioration of selected cardiac risk factors through supplementation of diet with flaxseed and soya bean. Int J Nutr Pharmacol Neurol Dis [serial online] 2013 [cited 2020 Jan 24];3:352-7. Available from: http://www.ijnpnd.com/text.asp?2013/3/4/352/119844
| Background|| |
Coronary heart disease (CHD) is a leading cause of morbidity and mortality in developed countries and is emerging as an epidemic in developing countries.  A majority of young people are unconcerned about their risk for development of this disease. Population based studies in the youth show that the precursors of heart disease start in adolescence. The marked increase in cardiovascular diseases (CVDs) in economically developing countries has resulted from the economic growth and associated socio-demographic changes that have occurred over recent decades. During this period, the burden of illness from infectious disease has fallen and parallel changes. Parallel changes in life-style and diet have led to an increase in life expectancy and a greatly increased burden of CVD and other chronic diseases. Dyslipidemia, a major systemic disorder, is one of the most important risk factors for CVD, which are a major cause of morbidity and a leading contributor to mortality world-wide.  Dyslipidemia is one of the modifiable risk factors of CHD, characterized by high triglycerides (TG), decreased high density lipoprotein cholesterol (HDL-C) and increased lipoprotein (LPa). LPa provides a carrier system for low density lipoprotein cholesterol (LDL-C) facilitating cholesterol accumulation in cells. Oxidized LDL-C and LPa accumulate in an excessive amount in macrophages forming fatty streaks, which then leads to the formation of atherosclerotic plaque.  Several studies have been conducted on the effect of diet on lipid profile and inflammatory markers, especially on the effect of soy intake; however, most of these studies have been performed on healthy people or hypercholesterolemic or diabetic patients. 
Soy is a plant-derived estrogen, known for anti- inflammatory and anti-hyperlipidemic properties which can potentially protect against CVD.  Flaxseed is a complex food containing high amounts of polyunsaturated fatty acid (PUFA), mainly alpha-linolenic acid (ALA), which is an (n-3) fatty acid as well as soluble ﬁber, lignan precursors, and other substances that may have health benefits.  Several studies have documented that consumption of PUFA tend to improve blood lipid profile. Hence, the present study aims to investigate the effect of supplementation of diet with flaxseed and soya bean on dyslipidemic subjects.
| Methods|| |
In the present study, 75 dyslipidemic subjects, in the age group of 40-60 years were selected from various areas of greater Gwalior by stratified random sampling (purposive) method [Table 1]. Dyslipidemic subjects with elevated levels (based on Adult Treatment Panel III criteria)  of TG (>150 mg/dl) or cholesterol (>200 mg/dl) or low density lipoproteins (>130 mg/dl), who were regular visitors of hospitals and clinics were selected. The subjects were divided into three groups each comprising of 25 subjects.
|Table 1: Distribution of the subject according to age, sex and study groups|
Click here to view
One group served as the control (C) and remaining two groups as experimental group-I (E-I) and experimental group-II (E-II). The study design and experimental protocols were approved by the Institutional Human Ethics Committee.
The methodology consisted of administration of a pre-tested questionnaire to the subjects to collect general information viz., nutritional status data (height, weight, body mass index [BMI], blood pressure, health complaints, socio-economic status, dietary pattern, medical history and life-style.
At the beginning of the study baseline values for blood pressure, body weight and BMI were recorded. Blood samples were collected from the selected subjects after 12 h from the last meal consumed. Plasma TG was estimated by glycerol-3-phosphate oxidation-peroxidase method,  total cholesterol was estimated by cholesterol-oxidase and p-aminophenazone method  and HDL-C level was estimated by phosphotungstate method.  The LDL and VLDL level was calculated by Friedewald's equation. 
The following atherogenic indices ,,, were calculated: Cardiac risk ratio (CRR) = TC/HDL-C, atherogenicity coefficient (AC) = (TC − HDL-C)/HDL-C and athrogenic index of plasma [AIP = Log (TG/HDL)].
Several food products were formulated by using flaxseed and soya bean and subjected to sensory evaluation prior to administration. Sensory evaluation was performed by 9 point hedonic scale.  The most acceptable preparations were "roasted flaxseed chutney powder (RFCP)" and "soya nuts (SN)."Ingredients and nutritive value  of RFCP are given in [Table 2] and [Table 3].
RFCP (30 g) and SN (30 g) were administered to group E-I and group E-II respectively for 12 weeks. The control group was not provided with any supplementation. All subjects were asked to follow similar dietary guidelines. After completion of 12 weeks, estimation of blood lipid profile, measurement of blood pressure and determination of body weight and BMI was done.
| Results|| |
Effect of RFCP and SN administration on body weight and BMI
Control group exhibited mean drop of 0.55% in body weight. Mean Reduction of 2.89% and 1.75% of body weight was noticed in group E-I and group E-II respectively. A significant difference (P < 0.01) in the baseline and final values of body weight and BMI of the subjects receiving RFCP (group E-I) was observed. Group E-II was found to have a significant decrease (P < 0.05) in body weight and reduction in BMI was also highly significant (P < 0.01) [Table 4].
|Table 4: Effect of 12 week administration of RFCP and SN on anthropometric parameters|
Click here to view
Effect of RFCP and SN administration on blood pressure
A mean drop of 0.35% was recorded in systolic blood pressure in the control group whereas group E-I and E-II showed a mean fall of 0.88% (P < 0.05) and 1.35% (P < 0.05) respectively. The diastolic blood pressure of the control group showed a mean decline of 0.88% and the group E-I and group E-II showed mean fall of 1.91% (P < 0.05) and 1.54% (P < 0.05) in diastolic blood pressure respectively [Table 5].
|Table 5: Effect of 12 week administration of RFCP and SN on blood pressure|
Click here to view
Effect of RFCP and SN administration on blood lipid profile
Control group exhibited mean lowering of 1.81% in total serum cholesterol level followed by 16.19% (P < 0.01) and 3.79% (P < 0.01) drop in group E-I and E-II. A highly significant reduction (P < 0.01) in TG was noted in groups E-I and E-II with a mean lowering of 13.99% and 11.73% respectively where as a decline of 1.84% was seen in the control group. Elevation of 4.94% (P < 0.01) and 3.21% (P < 0.05) in HDL level was seen in groups E-I and E-II with a considerable change shown by the control group. LDL-C values were also significantly lowered (P < 0.01) in group E-I and group E-II with a mean change of 19.93% and 3.92%. Both experimental groups showed a significant lowering (P < 0.05) of VLDL-C with a mean change of 17.94% and 10.37%, whereas mean drop of 5.35% was seen in the control group [Table 6].
|Table 6: Effect of 12 week administration of RFCP and SN on blood lipid profile|
Click here to view
Effect of RFCP and SN administration on cardiac risk
A remarkable improvement in atherogenicity indices was noticed. CRR, AC and AIP were found to be significantly reduced (P < 0.01) in group E-I and group E-II [Table 7].
|Table 7: Effect of 12 week administration of RFCP and SN on cardiac risk|
Click here to view
| Discussion|| |
Twelve week supplementation of RFCP and SN to dyslipidemic subjects indicated that both interventions were well-tolerated by subjects and the dropout rate was minimum. In the present study supplementation of Soy and flaxseed to dyslipidemic subjects resulted in a significant decrease in body weight, BMI, systolic and diastolic blood pressure. A study reveals that daily consumption of flaxseed during a 4-month period may lead to a modest amount of weight loss of up to 0.9 kg.  Results of yet another study reported a reduction in abdominal fat among women supplemented with 20 grams of isolated soy protein.  Feeding soy protein is also associated with lowering of body weight and fat in rats and mice.  A pre-clinical study has shown that soy protein suppresses appetite partly by stimulating the release of cholecystokinin, which regulates satiety and gastric emptying.  Soy iso-flavones have been observed to lower blood pressure in hypertensive subjects.  The above studies were found to be in agreement with the conclusions of our study on SN and RFCP supplementation. Viscous flaxseed dietary fibers may be a useful tool for lowering blood cholesterol and may also play a potential role in the energy balance. 
Supplementation of RFCP and SN to the diet of dyslipidemic subjects brought significant fall in blood pressure, which may be attributed to the presence of PUFA, mainly ALA, soluble ﬁber, lignan precursors and estrogen in flaxseeds and soya bean. Findings of several studies corroborate with the results of our study. A decrease in diastolic blood pressure was noted in men taking flaxseed lignin when evaluated against the men taking placebo and increased triacylglycerol in men taking placebo compared with men taking flax lignin was observed in a randomized double-blind placebo controlled study.  Results of yet another study revealed that Omega-3 PUFA deficiency, particularly during the prenatal period, can cause hypertension in later life.  A study attempted to clarify the antihypertensive effect showed that ALA reduced the systolic blood pressure of spontaneously hypertensive rats and its mechanism may be related to increases of prostaglandin I (2) and nitric oxide through bradykinin stimulation. 
Administration of SN and RFCP exhibited anti-hyperlipidemic effect conclusive of the highly significant reductions in Total Cholesterol, TG, LDL and VLDL with elevated HDL levels, which also signify cardio protective activity. However, magnitude of the change in lipid profile was greater with RFCP. Results of a study, similar to our findings report that flaxseed consumption by postmenopausal women was found to be effective in reducing total cholesterol, non-HDL-C and apo B levels that are well-known risk factors of CHD.  Consumption of Flax drink and Flax bread resulted in decreased total plasma and LDL-C and increased fat excretion, but the food matrix and/or processing may influence these results.  In a study highly significant improvement was seen in serum lipid profile and Apolipoprotein A1 and B levels in women taking soy proteins, whereas women taking soy isoflavones demonstrated significant improvement in serum TG. 
Major constituents of soy protein and flaxseed, which may be responsible for their lipid lowering effects are claimed to be phytoestrogens, namely isoflavones and lignans.  Soy protein isolate is a rich source of isoflavones, genistein and daidzein, , which exert hypocholesterolemic effects in animals and humans. ,, The predominant fatty acid in soybean is linoleic acid, although a lesser amount of n-3 fatty acid, ALA, is also found. Linoleic acid has been reported to lower cholesterol. The ratio of linoleic to ALA in soybeans is about 7.5:1.  Whole flaxseed contains approximately 41% fat and 21% protein of the seed weight.  Unlike soybean, flaxseed is particularly rich in ALA (approximately 57% of the total fatty acids in flaxseed), which has lipid lowering properties.  Thus, the reduction of blood cholesterol by either dietary soy protein or flaxseed in these studies may be due in part to linoleic acid and ALA present in whole bean or seed.
Atherogenic index (AI) indicates the deposition of foam cells or plaque or fatty infiltration or lipids in heart, coronaries, aorta, liver and kidney. The higher the AI, the higher is the risk of above organs for oxidative damage.  In our study noteworthy improvement in atherogenic indices were observed. In support to our results, another study demonstrated a significant decrease in the degree of lipid peroxidation in the liver when compared with rats fed the same amount of pork lard during 4 weeks of experimental feeding with flaxseed oil enriched diet (16%). Moreover, the addition of soybean oil or flaxseed oil to the diet (16%) significantly decreased triglyceride and total cholesterol blood levels and also reduced AI of plasma. 
Dyslipidemia is a state that accelerates the beginning and development of atherosclerosis. Dyslipidemia can often be prevented or treated with life-style management and proper nutrition. Findings of our study indicated beneficial effects of flaxseed and soya bean supplementation on atherogenic lipid profile. And therefore, it can be said that nutritional supplementation can prove very effective and convenient aid in mitigative effect on dyslipidemia.
| References|| |
|1.||Yusuf K, Vitamin E. In cardiovascular disease; has the diet been cast? Asia Pac J Clin Nutr 2002;11:5443. |
|2.||Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global burden of disease study. Lancet 1997;349:1269-76. |
|3.||Mishra A, Luthra K. Lipoprotein (a): Biology and role in atherosclerotic vascular diseases. Med Update 2001;11:516-8. |
|4.||McVeigh BL, Dillingham BL, Lampe JW, Duncan AM. Effect of soy protein varying in isoflavone content on serum lipids in healthy young men. Am J Clin Nutr 2006;83:244-51. |
|5.||Hall WL, Vafeiadou K, Hallund J, Bugel S, Reimann M, Koebnick C, et al. Soy-isoflavone-enriched foods and markers of lipid and glucose metabolism in postmenopausal women: Interactions with genotype and equol production. Am J Clin Nutr 2006;83:592-600. |
|6.||Hall III C, Tulbek MC, Xu Y, Steve LT. Flaxseed. Advances in Food and Nutrition Research. Fargo: Academic Press; 2006. p. 1-97. |
|7.||National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106:3143-421. |
|8.||Fossati P, Prencipe L. Serum triglycerides determined colorimetrically with an enzyme that produces hydrogen peroxide. Clin Chem 1982;28:2077-80. |
|9.||Stockbridge H, Hardy RI, Glueck CJ. Public cholesterol screening: Motivation for participation, follow-up outcome, self-knowledge, and coronary heart disease risk factor intervention. J Lab Clin Med 1989;114:142-51. |
|10.||Lopes-Virella MF, Stone P, Ellis S, Colwell JA. Cholesterol determination in high-density lipoproteins separated by three different methods. Clin Chem 1977;23:882-4. |
|11.||Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499-502. |
|12.||Koyamori F, Igarashi K. Effects of dietary nasunin on the serum cholesterol level in rats. Biosci Biotechnol Biochem 1994;58:570-1. |
|13.||Martirosyan DM, Miroshnichenko LA, Kulakova SN, Pogojeva AV, Zoloedov VI. Amaranth oil application for coronary heart disease and hypertension. Lipids Health Dis 2007;6:1. |
|14.||Brehm A, Pfeiler G, Pacini G, Vierhapper H, Roden M. Relationship between serum lipoprotein ratios and insulin resistance in obesity. Clin Chem 2004;50:2316-22. |
|15.||Frohlich J, Dobiásová M. Fractional esterification rate of cholesterol and ratio of triglycerides to HDL-cholesterol are powerful predictors of positive findings on coronary angiography. Clin Chem 2003;49:1873-80. |
|16.||Srilaklshmi B. Food Science, New Delhi: New Age International (P) Limited Publisher; 1997. p. 377-97. |
|17.||Gopalan C, Rama Sastri BV, Balasubramanian SC. Nutritive Value of Indian Foods. Hyderabad: National Institute of Nutrition, Indian Council of Medical Research; 2004. |
|18.||Nowak DA, Snyder DC, Brown AJ, Demark-Wahnefried W. The Effect of Flaxseed Supplementation on Hormonal Levels Associated with Polycystic Ovarian Syndrome: A case study. Curr Top Nutraceutical Res 2007;5:177-81. |
|19.||Christie DR, Grant J, Darnell BE, Chapman VR, Gastaldelli A, Sites CK. Metabolic effects of soy supplementation in postmenopausal caucasian and African American women: A randomized, placebo-controlled trial. Am J Obstet Gynecol 2010;203:153e1-9. |
|20.||Nagasawa A, Fukui K, Funahashi T, Maeda N, Shimomura I, Kihara S, et al. Effects of soy protein diet on the expression of adipose genes and plasma adiponectin. Horm Metab Res 2002;34:635-9. |
|21.||Nishi T, Hara H, Asano K, Tomita F. The soybean beta-conglycinin beta 51-63 fragment suppresses appetite by stimulating cholecystokinin release in rats. J Nutr 2003;133:2537-42. |
|22.||Liu XX, Li SH, Chen JZ, Sun K, Wang XJ, Wang XG, et al. Effect of soy isoflavones on blood pressure: A meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis 2012;22:463-70. |
|23.||Kristensen M, Jensen MG, Aarestrup J, Petersen KE, Søndergaard L, Mikkelsen MS, et al. Flaxseed dietary fibers lower cholesterol and increase fecal fat excretion, but magnitude of effect depends on food type. Nutr Metab 2012;9:8. |
|24.||Cornish SM, Chilibeck PD, Paus-Jennsen L, Biem HJ, Khozani T, Senanayake V, et al. A randomized controlled trial of the effects of flaxseed lignan complex on metabolic syndrome composite score and bone mineral in older adults. Appl Physiol Nutr Metab 2009;34:89-98. |
|25.||Begg DP, Sinclair AJ, Stahl LA, Premaratna SD, Hafandi A, Jois M, et al. Hypertension induced by omega-3 polyunsaturated fatty acid deficiency is alleviated by alpha-linolenic acid regardless of dietary source. Hypertens Res 2010;33:808-13. |
|26.||Sekine S, Sasanuki S, Aoyama T, Takeuchi H. Lowering systolic blood pressure and increases in vasodilator levels in SHR with oral alpha-linolenic acid administration. J Oleo Sci 2007;56:341-5. |
|27.||Lucas EA, Wild RD, Hammond LJ, Khalil DA, Juma S, Daggy BP, et al. Flaxseed improves lipid profile without altering biomarkers of bone metabolism in postmenopausal women. J Clin Endocrinol Metab 2002;87:1527-32. |
|28.||Jassi HK, Jain A, Arora S, Chitra R. Effect of soy proteins Vs soy isoflavones on lipid profile in postmenopausal women. Indian J Clin Biochem 2010;25:201-7. |
|29.||Bhathena SJ, Ali AA, Haudenschild C, Latham P, Ranich T, Mohamed AI, et al. Dietary flaxseed meal is more protective than soy protein concentrate against hypertriglyceridemia and steatosis of the liver in an animal model of obesity. J Am Coll Nutr 2003;22:157-64. |
|30.||Coward K, Barnes NC, Setchel KD, Barnes S. Genistein and daidzein, and their a-glycoside conjugates: Antitumor isoflavones in soybean foods from American and Asian diets. J Agric Food Chem 1993;41:1961-7. |
|31.||Wang HJ, Murphy PA: Isoflavone content in commercial soybean foods. J Agric Food Chem 1994;42:1666-73. |
|32.||Crouse 3 rd JR, Morgan T, Terry JG, Ellis J, Vitolins M, Burke GL. A randomized trial comparing the effect of casein with that of soy protein containing varying amounts of isoflavones on plasma concentrations of lipids and lipoproteins. Arch Intern Med 1993;159:2070-6. |
|33.||Anthony MS, Clarkson TB, Hughes CL Jr, Morgan TM, Burke GL. Soybean isoflavones improve cardiovascular risk factors without affecting the reproductive system of peripubertal rhesus monkeys. J Nutr 1996;126:43-50. |
|34.||Teixeira SR, Potter SM, Weigel R, Hannum S, Erdman JW Jr, Hasler CM. Effects of feeding 4 levels of soy protein for 3 and 6 wk on blood lipids and apolipoproteins in moderately hypercholesterolemic men. Am J Clin Nutr 2000;71:1077-84. |
|35.||U.S. Department of Agriculture, Nutrient Data Research Branch, Nutrition Monitoring Division: "Provisional Table on the Content of Omega-3-Fatty Acids and Other Components in Selected Foods". Hyattsville: MD: Human Nutrition Information Service; 1988. |
|36.||Oomah BD, Mazza G. Flaxseed proteins: A review. Food Chem 1993;48:109-14. |
|37.||Bhatty RS. Nutrient composition of whole flaxseed and flaxseed meal. In: Cunnane SC, Thompson LU, editors. "Flaxseed in Human Nutrition." Champaign, IL: AOCS Press, 1995. p. 22-42. |
|38.||Basu M, Prasad R, Jayamurthy P, Pal K, Arumughan C, Sawhney RC. Anti-atherogenic effects of seabuckthorn (Hippophaea rhamnoides) seed oil. Phytomedicine 2007;14:770-7. |
|39.||Jurgoñski A, Ju?kiewicz J, Zduñczyk P. Usefulness of flaxseed oil in the limitation of diet induced metabolic disturbances. Rocz Panstw Zakl Hig. 2011;62:215-8. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]
|This article has been cited by|
||Effect of Flaxseed Supplementation on Lipid Profile: An Updated Systematic Review and Dose-Response Meta-Analysis of Sixty-Two Randomized Controlled Trials
| ||Amir Hadi,Moein Askarpour,Shekoufeh Salamat,Ehsan Ghaedi,Micheal E. Symonds,Maryam Miraghajani |
| ||Pharmacological Research. 2019; : 104622 |
|[Pubmed] | [DOI]|
||The effect of flaxseed supplementation on body weight and body composition: a systematic review and meta-analysis of 45 randomized placebo-controlled trials
| ||M. Mohammadi-Sartang,Z. Mazloom,H. Raeisi-Dehkordi,R. Barati-Boldaji,N. Bellissimo,J. O. Totosy de Zepetnek |
| ||Obesity Reviews. 2017; |
|[Pubmed] | [DOI]|
||Grape seed and linseed, alone and in combination, enhance unsaturated fatty acids in the milk of Sarda dairy sheep
| ||F. Correddu,G. Gaspa,G. Pulina,A. Nudda |
| ||Journal of Dairy Science. 2016; 99(3): 1725 |
|[Pubmed] | [DOI]|
||Effects of flaxseed supplements on blood pressure: A systematic review and meta-analysis of controlled clinical trial
| ||Sorin Ursoniu,Amirhossein Sahebkar,Florina Andrica,Corina Serban,Maciej Banach |
| ||Clinical Nutrition. 2015; |
|[Pubmed] | [DOI]|