Effect of soy consumption on liver enzymes, lipid profile, anthropometry indices, and oxidative stress in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis of clinical trials

Document Type : Review Article

Authors

1 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

2 Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

3 Interdepartmental Hepatology Center MASVE, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy

Abstract

The present systematic review and meta-analysis was conducted to investigate the effects of soy intake on liver enzymes, lipid profile, anthropometry indices, and oxidative stress in non-alcoholic fatty liver disease (NAFLD). A systematic search was undertaken in PubMed, Embase, Scopus, Web of Science, and Cochrane Library covering up to 10 January 2020. A fixed-effect or random-effects models were applied to pool mean difference (MD) and its 95 % confidence intervals (CI). Four clinical trials comprising 234 participants were included in the meta-analysis. Compared to the controls, alanine aminotransferase (ALT) levels (MD=-7.53, 95% CI=[-11.98, -3.08], P=0.001, I2=0.0 %), body weight (MD=-0.77, 95 % CI=[-1.38, -0.16], P=0.01, I2=36.9%), and the concentration of serum Malondialdehyde (MDA) (MD=-0.75, 95% CI=[-1.29, -0.21], P=0.007, I2=63.6%) were significantly changed following soy intake. Lipid profile was not significantly affected by soy intake. Moreover, no evidence of a significant publication bias was found. The present study suggests lowering effects for soy intake on ALT levels, body weight, and MDA in nonalcoholic liver patients. Therefore, further large-scale and well-designed clinical trials are needed to find conclusive findings.

Keywords


1. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer MJH. Global epidemiology of nonalcoholic fatty liver disease—meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016;64:73-84.
2. Liver EASL, Diabetes EASD, EASO. EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. Diabetologia 2016;59:1121-1140.
3. Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005;41:1313-1321.
4. Sanyal AJ, Brunt EM, Kleiner DE, Kowdley KV, Chalasani N, Lavine JE, et al. Endpoints and clinical trial design for nonalcoholic steatohepatitis. Hepatology 2011;54:344-353.
5. Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2018;67:328-357.
6. Targher G, Byrne CD, Lonardo A, Zoppini G, Barbui CJJoh. Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: a meta-analysis. J Hepatol 2016;65:589-600.
7. (WHO) WHO. Cardiovascular Disease 2019 [Available from: https://www.who.int/health-topics/cardiovascular-diseases/#tab=tab_1.
8. Torres N, Torre-Villalvazo I, Tovar AR. Regulation of lipid metabolism by soy protein and its implication in diseases mediated by lipid disorders. J Nutr Biochem 2006;17:365-373.
9. Busnelli M, Manzini S, Sirtori C, Chiesa G, Parolini CJN. Effects of Vegetable Proteins on Hypercholesterolemia and Gut Microbiota Modulation. Nutrients 2018;10:1249.
10. Rizzo G, Baroni L. Soy, soy foods and their role in vegetarian diets. Nutrients 2018;10:43-93.
11. Ramdath D, Padhi E, Sarfaraz S, Renwick S, Duncan AJN. Beyond the cholesterol-lowering effect of soy protein: a review of the effects of dietary soy and its constituents on risk factors for cardiovascular disease. Nutrients 2017;9:324.
12. Bellini M, Biagi S, Stasi C, Costa F, Mumolo MG, Ricchiuti A, et al. Gastrointestinal manifestations in myotonic muscular dystrophy. World J Gastroenterol 2006;12:1821-1828.
13. Giera M, Lingeman H, Niessen WM. Recent Advancements in the LC- and GC-Based Analysis of Malondialdehyde (MDA): A Brief Overview. Chromatographia 2012;75:433-440.
14. Kim MH, Kang KS. Isoflavones as a smart curer for non-alcoholic fatty liver disease and pathological adiposity via ChREBP and Wnt signaling. Prev Med 2012;54:57-63.
15. Gudbrandsen OA, Wergedahl H, Berge RK. A casein diet added isoflavone-enriched soy protein favorably affects biomarkers of steatohepatitis in obese Zucker rats. Nutrition 2009;25:574-580.
16. Kani AH, Alavian SM, Esmaillzadeh A, Adibi P, Azadbakht L. Effects of a novel therapeutic diet on liver enzymes and coagulating factors in patients with non-alcoholic fatty liver disease: A parallel randomized trial. Nutrition 2014;30:814-821.
17. Eslami O, Shidfar F, Maleki Z, Jazayeri S, Hosseini AF, Agah S, et al. Effect of Soy Milk on Metabolic Status of Patients with Nonalcoholic Fatty Liver Disease: A Randomized Clinical Trial. J Am Coll Nutr 2019;38:51-58.
18. Amanat S, Eftekhari MH, Fararouei M, Bagheri Lankarani K, Massoumi SJ. Genistein supplementation improves insulin resistance and inflammatory state in non-alcoholic fatty liver patients: A randomized, controlled trial. Clin Nutr (Edinburgh, Scotland). 2018;37:1210-1215.
19. Deibert P, Lazaro A, Schaffner D, Berg A, Koenig D, Kreisel W, et al. Comprehensive lifestyle intervention vs soy protein-based meal regimen in non-alcoholic steatohepatitis. World J Gasteoenterol 2019;25:1116-1131.
20. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. 2009;151:264-269.
21. Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc 2015;13:141-146.
22. Higgins JP, Green S, Higgins G. Cochrane handbook for systematic reviews of interventions, version 5.1. 0. 2011.
23. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557-560.
24. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005;5:13-25.
25. Maleki Z, Jazayeri S, Eslami O, Shidfar F, Hosseini AF, Agah S, et al. Effect of soy milk consumption on glycemic status, blood pressure, fibrinogen and malondialdehyde in patients with non-alcoholic fatty liver disease: a randomized controlled trial. Complement Ther Med 2019;44:44-50.
26. Wang S, Wang Y, Pan MH, Ho CT. Anti-obesity molecular mechanism of soy isoflavones: weaving the way to new therapeutic routes. Food Funct 2017;8:3831-3846.
27. Crespillo A, Alonso M, Vida M, Pavón F, Serrano A, Rivera P, et al. Reduction of body weight, liver steatosis and expression of stearoyl-CoA desaturase 1 by the isoflavone daidzein in diet-induced obesity. Br J Pharmacol 2011;164:1899-1915.
28. Zang Y, Igarashi K, Yu C. Anti-obese and anti-diabetic effects of a mixture of daidzin and glycitin on C57BL/6J mice fed with a high-fat diet. Biosci Biotechnol Biochem 2015;79:117-123.
29. Ali AA, Velasquez MT, Hansen CT, Mohamed AI, Bhathena SJ. Effects of soybean isoflavones, probiotics, and their interactions on lipid metabolism and endocrine system in an animal model of obesity and diabetes. J Nutr Biochem 2004;15:583-590.
30. Fabbrini E, Luecking CT, Love-Gregory L, Okunade AL, Yoshino M, Fraterrigo G, et al. Physiological mechanisms of weight gain−induced steatosis in people with obesity.  J Gastro 2016;150:79-81.
31. Liu H, Zhong H, Leng L, Jiang Z. Effects of soy isoflavone on hepatic steatosis in high fat-induced rats. J Clinl Biochem Nutr 2017;61:85-90.
32. Ibrahim WH, Habib HM, Chow CK, Bruckner GG. Isoflavone-rich soy isolate reduces lipid peroxidation in mouse liver. Int J Vitam Nutr Res 2008;78:217-222.