From: Subject: Soy Protein, Isoflavones, and Cardiovascular Health: An American Heart Association Science Advisory for Professionals From the Nutrition Committee -- Sacks et al. 113 (7): 1034 -- Circulation Date: Mon, 15 May 2006 17:42:29 +0200 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_003D_01C67846.F0008E90" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.2869 This is a multi-part message in MIME format. ------=_NextPart_000_003D_01C67846.F0008E90 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: http://circ.ahajournals.org/cgi/content/full/113/7/1034 Soy Protein, Isoflavones, and Cardiovascular Health: = An American Heart Association Science Advisory for Professionals From = the Nutrition Committee -- Sacks et al. 113 (7): 1034 -- = Circulation
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Published online before print January 17, 2006,=20 doi:10.1161/CIRCULATIONAHA.106.171052
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(Circulation. 2006;113:1034-1044.)
=A9 2006 = American Heart=20 Association, Inc.

AHA Science Advisory

Soy Protein, Isoflavones, and Cardiovascular Health

An American Heart Association Science Advisory for Professionals = From the=20 Nutrition Committee

Frank M. Sacks, MD; = Alice=20 Lichtenstein, DSc; Linda Van Horn, PhD, RD; = William=20 Harris, PhD; Penny Kris-Etherton, PhD; Mary = Winston,=20 EdD, for the American Heart Association Nutrition = Committee=20


3D""   =20 Abstract
Top
Abstract
Introduction
The Soy Protein Hypothesis...
Effect of Soy Protein...
Effects on Blood Pressure
Effects on Health Conditions...
Conclusions
References
 
S= oy=20 protein and isoflavones (phytoestrogens) have gained considerable=20 attention for their potential role in improving risk factors=20 for cardiovascular disease. This scientific advisory assesses = the more recent work published on soy protein and its = component=20 isoflavones. In the majority of 22 randomized trials, = isolated=20 soy protein with isoflavones, as compared with milk or other=20 proteins, decreased LDL cholesterol concentrations; the = average=20 effect was &3%. This reduction is very small relative to=20 the large amount of soy protein tested in these studies, = averaging=20 50 g, about half the usual total daily protein intake. No = significant=20 effects on HDL cholesterol, triglycerides, lipoprotein(a), or = blood pressure were evident. Among 19 studies of soy = isoflavones,=20 the average effect on LDL cholesterol and other lipid risk = factors=20 was nil. Soy protein and isoflavones have not been shown to=20 lessen vasomotor symptoms of menopause, and results are mixed = with regard to soy=92s ability to slow postmenopausal bone = loss.=20 The efficacy and safety of soy isoflavones for preventing or = treating=20 cancer of the breast, endometrium, and prostate are not = established;=20 evidence from clinical trials is meager and cautionary with = regard to=20 a possible adverse effect. For this reason, use of isoflavone = supplements in food or pills is not recommended. Thus, = earlier=20 research indicating that soy protein has clinically important = favorable effects as compared with other proteins has not = been=20 confirmed. In contrast, many soy products should be = beneficial to=20 cardiovascular and overall health because of their high = content of=20 polyunsaturated fats, fiber, vitamins, and minerals and low = content=20 of saturated fat.


Key Words: AHA Scientific Statements =95 = cardiovascular=20 diseases =95 soybean proteins =95 isoflavones =95 cholesterol


3D""   =20 Introduction
Top
Abstract
Introduction
The Soy Protein Hypothesis...
Effect of Soy Protein...
Effects on Blood Pressure
Effects on Health Conditions...
Conclusions
References
 
S= oy=20 protein has gained considerable attention for its potential = role in=20 improving risk factors for cardiovascular disease (CVD). In = October=20 1999, the US Food and Drug Administration (FDA) approved = labeling for=20 foods containing soy protein as protective against coronary = heart=20 disease.1=20 The FDA based this decision on clinical studies showing that = at least=20 25 g of soy protein per day lowered total and LDL = cholesterol. The=20 FDA requires for the claim that a serving contain at least = 6.25 g of=20 soy protein, 25% of the necessary daily amount (25 g), with = the=20 expectation that foods containing soy protein would be eaten = at least=20 4 times per day. The FDA also stated that "the evidence did = not=20 support a significant role for soy isoflavones in=20 cholesterol-lowering effects of soy protein."1=20

In 2000, the American Heart Association (AHA) Nutrition = Committee=20 released a scientific advisory on soy protein and CVD.2=20 At that time, the conclusion was that "it is prudent to = recommend=20 including soy protein foods in a diet low in saturated fat = and=20 cholesterol." Since then, many well-controlled studies on soy = protein=20 and soy-derived isoflavones substantially added to the = knowledge=20 base. For this reason, the AHA Nutrition Committee decided to = reevaluate the evidence on soy protein and CVD and update its = scientific advisory. Thus, this scientific advisory assesses=20 the more recent work published on soy protein and its = component=20 isoflavones. The focus is on blood LDL cholesterol because it = is by far the most studied risk factor for CVD, is the = primary=20 criterion on which the National Cholesterol Education Program = estimates risk and recommends therapy,3=20 and forms the basis for the FDA-approved health claim. In = this=20 advisory, we also consider the effects of soy protein and = isoflavones=20 on several other CVD risk factors: HDL cholesterol, = triglycerides,=20 lipoprotein(a), and blood pressure. The medical literature = was=20 searched comprehensively for original research publications = on the=20 effects of soy protein or isoflavones on CVD risk factors, = and all=20 controlled trials that separately listed soy protein and = isoflavone=20 content were used. In addition, this advisory reviews the = evidence on=20 soy products in other health conditions, including menopausal = symptoms, osteoporosis, and cancer.

Soy protein, like any other dietary protein, contains calories = and=20 could be used in the diet to replace animal protein or other=20 vegetable proteins. Soy protein also could replace other = sources=20 of calories such as carbohydrate or fat, raising the total = amount=20 of protein eaten and reducing carbohydrate or fat intake. = Most=20 studies exchanged soy protein for other dietary proteins, and = this evidence is evaluated in the present advisory. Much less = is known about the potential impact on risk factors for CVD = of=20 increasing total protein intake by adding soy or other plant = protein=20 in place of carbohydrate or fat; this important dietary = change is=20 currently being studied.


3D""    The=20 Soy Protein Hypothesis on LDL Cholesterol An Overview=20
Top
Abstract
Introduction
The Soy Protein = Hypothesis...
Effect of Soy Protein...
Effects on Blood Pressure
Effects on Health Conditions...
Conclusions
References
 
A= nimal=20 proteins raise blood cholesterol concentrations in several = animal=20 species fed cholesterol-free semisynthetic diets.4,5=20 Casein, the most prevalent protein in milk, has been used = most=20 often, although other animal proteins such as pork and beef=20 protein do the same. This is a useful established nutritional = model for studying diet-induced hypercholesterolemia and=20 atherosclerosis and an alternative to feeding animals large = amounts=20 of cholesterol. In contrast, when soy protein is substituted = for the=20 animal protein, hypercholesterolemia does not occur. Thus, = either=20 some animal proteins have a direct hypercholesterolemic = action,=20 or soy protein has a cholesterol-lowering action. This latter = possibility led to intensive work in the late 1970s and 1980s = to test=20 the hypothesis that soy protein can be a nutritional approach = to=20 reducing blood cholesterol. This concept gained support from=20 epidemiological observations on diet and CVD in Japan and = other=20 Asian countries where large amounts of soy products were = eaten=20 and blood cholesterol concentration and CVD incidence were low.6=20 However, many differences in diet and lifestyle between Asian = and Western countries could explain the differences in the = prevalence=20 of CVD.

Early indications that soy protein had much less effect in = humans=20 than in animals came from direct application of the animal = model=20 to humans. Diets similar to those eaten by humans, based on=20 either soy protein or casein, were fed to rabbits, and, as = expected,=20 casein produced hypercholesterolemia.7=20 However, when the same diets were fed to healthy people, the = protein=20 source did not affect blood cholesterol.7,8=20 Others studied the effect of casein in strict vegetarians who = ate no=20 dairy or animal proteins to provide a human counterpart to = the mainly=20 vegetarian animal (eg, rabbit) models. Compared with soy = protein, no=20 effect of casein on blood cholesterol was found.9=20

In the late 1970s and early 1980s, the soy protein hypothesis = was=20 greatly strengthened as a result of studies by Sirtori et = al10=20 and Descovich et al,11=20 who found that diets high in soy protein, replacing nearly = all the=20 animal protein, substantially reduced blood LDL cholesterol = by 20% to=20 30% in severe hypercholesterolemia. Because the soy protein = diets=20 were also reduced in saturated fat and cholesterol and = increased in=20 polyunsaturated fat and because the patients also often lost = weight=20 on the dietary protocols, the results were often confounded. = The=20 authors reported that textured soy protein (50% soy flour, = 50% soy=20 protein concentrate) but not soy protein isolate (90% soy = protein)=20 was effective. This raised the possibilities that, rather = than the=20 soy protein itself, the nonprotein components of the soy = protein=20 preparation or the effect of soy displacing = cholesterol-raising fats=20 in the diet could have had a blood cholesterol=96lowering = action.=20 Results of other early studies of soy protein in = hypercholesterolemic=20 subjects showed either cholesterol reduction12=20 or no effect.13,14=20

A meta-analysis published in 1995 attempted to reconcile the = many=20 divergent findings among studies of soy protein.15=20 In 29 controlled studies, a trend emerged that soy protein=20 selectively reduced blood cholesterol in direct proportion to = the=20 degree of hypercholesterolemia. For example, in those with=20 severely elevated blood cholesterol (>335 mg/dL), soy = protein=20 reduced blood cholesterol by 20%. Only a 7% reduction = occurred in=20 those with cholesterol levels between 259 and 333 mg/dL; if = the=20 initial blood cholesterol was <255 mg/dL, there was no=20 significant effect. Thus, the response to soy protein was = determined=20 more by the initial blood cholesterol level and, = surprisingly,=20 not by the amount of soy protein eaten, which ranged widely = from=20 18 to 124 g/d. When the control group was not included in the = statistical analysis, there was a significant correlation = between=20 the dose of soy protein and the degree of cholesterol = reduction.=20 However, an analysis without a control group introduces the=20 effects of confounding and drift in serum cholesterol that = often=20 occur in experimental situations. This meta-analysis also was = limited by the quality of the studies; studies were less well = controlled in people with hypercholesterolemia than in those=20 with average cholesterol levels. It is difficult to determine = how much effect this had on the overall results of the = meta-analysis.=20 Thus, the available literature provided some support, albeit=20 with limitations, for the concept that soy protein is an = effective=20 treatment for severe hypercholesterolemia, that it produces = a=20 mild benefit in people with moderate elevations of cholesterol, = but=20 that it has no effect in those with mildly elevated or average=20 cholesterol levels. The soy protein hypothesis culminated in=20 FDA approval of a health claim for soy protein in foods. =

Soy Isoflavones
Subsequent to the meta-analysis = by=20 Anderson et al,15=20 many well-controlled studies explored the soy protein = hypothesis with=20 greater specificity. In addition, recognition that soy = protein=20 products contain bioactive molecules called phytoestrogens or = isoflavones added a fascinating new aspect to the soy protein = hypothesis.16,17,18=20 Isoflavones remain in soy protein preparations that are not = extracted=20 with alcohol. During the preparation of soy protein isolate, = the=20 soy is washed with alcohol, removing a substantial amount of=20 the isoflavones. The soy isoflavones have strong biological=20 properties in animals, causing arterial vasodilation, = lowering=20 serum cholesterol,18=20 and inhibiting atherosclerosis in postmenopausal monkeys.19=20 This led to the intriguing idea that the presence and amount = of=20 isoflavones explain the variable results of soy studies; only = those=20 that used high-isoflavone preparations produced favorable = results.18,20=20 Isoflavone content was not known in many of the earlier = studies.=20 Several subsequent studies tested the effects of soy protein = and=20 isoflavones separately.

The 3 major isoflavones found in soybeans are genistin, daidzin, = and glycitin. Their abundance in soy protein preparations = varies=20 widely and depends on the processing techniques used during=20 production.21,22=20 These compounds have both estrogenic and antiestrogenic = activity23,24=20 and effects that are unrelated to estrogen activity.25=20 Dehulling, flaking, and defatting soybeans produces a = relatively=20 pure preparation of protein that is low in isoflavones,26,27=20 whereas methods used to produce textured soy protein result = in=20 a preparation that retains the isoflavones.21=20 Isoflavone concentrations range from &2 mg/g protein in = textured=20 soy protein, soy flour, and soy granules to 0.6 to 1.0 mg/g=20 protein in isolated soy protein. Intakes of 45 g soy flour = have=20 resulted in a 20- to 40-fold increase and a 50- to 100-fold=20 increase in blood and urinary isoflavones, respectively,28=20 and there is a dose-dependent relationship at more moderate=20 intakes.29=20


3D""    Effect=20 of Soy Protein on LDL Cholesterol and Other Lipoproteins=20
Top
Abstract
Introduction
The Soy Protein Hypothesis...
Effect of Soy = Protein...
Effects on Blood Pressure
Effects on Health Conditions...
Conclusions
References
 
<= STRONG>Soy=20 Protein With Isoflavones
First, we summarize studies that = tested soy=20 protein that contained a substantial amount of isoflavones. = Because=20 it was recognized that isoflavones could be the bioactive = component=20 attributed to soy protein, studies published in the late = 1990s and=20 beyond generally stated the amount and type of isoflavones in = the=20 soy protein. In 22 randomized trials, isolated soy protein = with=20 isoflavones was compared with casein or milk protein,20,30=9646=20 wheat protein,47=20 or mixed animal proteins.48=9650=20 The range of soy protein was 25 to 135 g/d; the range for=20 isoflavones was 40 to 318 mg. LDL or non-HDL cholesterol=20 concentrations decreased in most studies, statistically = significantly=20 in 8, with an overall effect of &3% (weighted average). A = recent meta-analysis that included 10 studies published from = 1995=20 to 2002 found a similar percentage reduction in LDL = cholesterol=20 with no dose effect.51=20 Over all studies in Tab= le 1,=20 there is no apparent dose effect; the 8 studies with 50 g of = soy=20 protein showed a drop in LDL cholesterol concentration = similar to=20 those using a smaller amount of soy, &3% overall (Tab= le=20 1). This cutpoint for daily soy protein intake, 50 g, = defines a=20 large amount, half or more of the daily average total protein = intake in the United States. No significant effects were = evident=20 for HDL cholesterol or triglycerides in most of the studies; = the=20 weighted average effects were very small: 1.5% for HDL = cholesterol=20 and =965% for triglycerides.


View = this=20 table:
[in= =20 this window]
[in a new window]
  		TABLE 1. Soy Protein and = Blood Lipid=20 Risk Factors: Effects of Soy Protein With Isoflavones=20

Soy Protein Without Isoflavones
In 7 trials, soy = protein,=20 washed with alcohol to remove isoflavones, was compared with = casein=20 or milk protein20,33,39,43,52=20 or various animal proteins (Tab= le=20 2).49,50=20 Two studies showed small significant decreases in LDL = cholesterol.49,50=20 These studies were very carefully controlled feeding studies, = with=20 all meals formulated according to strict nutritional = specifications,=20 and complete meals were provided to the participants.49,50=20 Specifically designed to sort out the effects of the protein = from the=20 effects of the isoflavones, the studies showed an effect of = protein=20 but not isoflavones on LDL cholesterol. The declines in LDL=20 cholesterol were small, 2% to 7%, relative to the large = amounts of=20 soy protein eaten daily, 50 to 55 g. However, other = well-controlled=20 studies did not find significant effects of soy protein on = LDL=20 cholesterol,20,33,39,43,52=20 and the average change across all 7 studies was only a 1% to = 2%=20 decrease. Changes in HDL cholesterol and triglycerides were = generally=20 small and were nonsignificant in 6 of the 7 trials. No dose = effect=20 was evident.


View = this=20 table:
[in= =20 this window]
[in a new window]
  		TABLE 2. Effects of Soy = Protein With=20 Low or No Isoflavones=20

Effect of Isoflavones
Some studies compared soy = protein=20 that did or did not contain isoflavones (Tab= le=20 3),20,30,33,39,43,49,50,52=9657=20 whereas other studies tested isoflavones in pill form as = compared=20 with placebo.58=9663 A=20 wide range of isoflavone amounts was studied. One study = compared the=20 effect of isoflavones provided with either soy or animal = proteins.49=20 Among these 19 studies,20,30,33,39,43,49,50,52=9663=20 only 3 showed significant reductions in LDL cholesterol = concentration,52,55,56=20 and the effect among all studies (weighted average) was nil,=20 0%. Changes in HDL cholesterol and triglycerides were not = significant=20 and showed no trend toward an effect of isoflavones. Despite=20 large increases in blood isoflavone concentrations, there is = no=20 indication of a dose effect on blood lipids. A recent meta-analysis = concluded that isoflavones do not affect blood lipid = concentrations.51=20


View = this=20 table:
[in= =20 this window]
[in a new window]
  		TABLE 3. Effects of = Isoflavones=20

Influence of Initial Blood LDL = Cholesterol=20 Level
In the Anderson et al15=20 meta-analysis, a strong gradient of LDL cholesterol reduction = was=20 found among studies according to initial cholesterol level.=20 Lichtenstein et al49=20 and Crouse et al20=20 found slightly more LDL cholesterol reduction in people with = LDL=20 cholesterol >160 to 164 mg/dL than in those with lower = levels,=20 although Dent et al33=20 did not find an effect in women with hypercholesterolemia as = compared=20 with women with average cholesterol levels. However, a larger = percentage reduction in LDL cholesterol in = hypercholesterolemia is=20 not evident among the 22 recent trials (Tab= le=20 1). Among studies of isoflavones, no relation is evident = between=20 initial cholesterol and cholesterol lowering (Tab= le=20 3).

Influence of Serum = Cholesterol=96Lowering=20 Diet
In their meta-analysis, Anderson et al15=20 reported that soy protein tended to have less effect on LDL=20 cholesterol in trials in which the participants were eating a = low-fat=20 and low-cholesterol diet as compared with a more usual = higher-fat and=20 higher-cholesterol diet. In 11 of the studies listed in Tab= les 1=20 through 3, soy protein or isoflavones were tested in = combination=20 with a serum cholesterol=96lowering diet.20,30,31,34,42,45,47,48,50,58,60=20 The average reduction in LDL in these studies was 2%, similar = to that in the full group. Thus, the effect on LDL of soy = protein=20 or isoflavones does not appear to be modulated by the = saturated=20 fat and cholesterol content of the diet.

Effects on=20 Lipoprotein(a)
Lipoprotein(a), an LDL-like=20 lipoprotein that is an independent predictor of CVD,64=20 was increased by soy protein in 2 studies35,65=20 and unchanged in 9 others.20,31,32,36,40,44=9646,50=20 Meinertz et al39=20 found that alcohol-extracted soy protein, lacking isoflavones, = did=20 not raise lipoprotein(a) as found in their earlier study of = intact=20 soy protein,65=20 which suggests an adverse effect of isoflavones. However, = isoflavones=20 had no effect on lipoprotein(a) in 6 other studies,20,50,55,60,61,63=20 nor did soy protein that contained isoflavones.20,31,32,36,40,44=9646,50=20


3D""   =20 Effects on Blood Pressure
Top
Abstract
Introduction
The Soy Protein Hypothesis...
Effect of Soy Protein...
Effects on Blood = Pressure
Effects on Health Conditions...
Conclusions
References
 
S= everal=20 studies tested the effect of soy protein with isoflavones, as = compared with casein or milk protein, on blood pressure.32,35,40,42,47,50=20 Blood pressure decreased significantly in 1 study35=20 but not in the other 5 studies.32,40,42,47,50=20 The weighted average change is =961 mm Hg systolic blood = pressure.=20 Several studies that evaluated the effect of soy isoflavones = also did=20 not find a significant effect on blood pressure.50,58,60,62,66=20


3D""   =20 Effects on Health Conditions Related to Estrogens=20
Top
Abstract
Introduction
The Soy Protein Hypothesis...
Effect of Soy Protein...
Effects on Blood Pressure
Effects on Health = Conditions...
Conclusions
References
 
<= STRONG>Menopausal=20 Vasomotor Symptoms
Because of their weak estrogenic = activity, soy=20 isoflavones have been hypothesized to improve several=20 estrogen-dependent conditions, including perimenopausal = vasomotor=20 symptoms (hot flashes) and postmenopausal bone loss. A recent = review=20 examined 11 clinical trials of soy protein or isoflavones67=20 for treating hot flashes. Only 3 of 8 studies with treatment = lasting=20 >6 weeks found modest improvement in hot flashes, and most = benefits disappeared after 6 weeks. Five additional studies68=9672=20 not included in that review showed no benefit for hot flashes = of soy=20 isoflavones. Longer studies showed no benefit of isoflavones = at 24=20 weeks73=20 or 2 years.71=20 Substantial reduction in hot flashes, often 40% to 60%, = occurred in=20 the placebo or control group in these studies, similar to the = reduction in the soy group. In contrast, estrogen replacement = markedly reduces hot flashes, more so than placebo. Thus, it = seems=20 unlikely that soy isoflavones have enough estrogenic activity = to have=20 an important impact on vasomotor symptoms of estrogen = deficiency in=20 perimenopausal women.

Osteoporosis
Another estrogenic effect of soy = isoflavones=20 could be to reduce bone loss after menopause; this hypothesis = gains=20 strength from population studies and certain animal models of = osteoporosis.74=20 However, clinical trials so far have had insufficient = duration=20 and size to be conclusive, and results have varied.44,74=20 The studies used either direct measurements of bone mineral=20 content and density in the spine and hip or biochemical = indices of=20 bone resorption or formation to test the effect of soy=20 isoflavones ranging in amount from 54 to 300 mg, but most = studies=20 used 80 to 110 mg. Soy isoflavones lessened bone loss over 6 = to 24=20 months in some studies,75=9678=20 whereas other trials did not show a benefit over the same = duration.44,57,79=20 There is also inconsistency in the studies showing favorable = effects,=20 with one study showing benefit in the spine but not hip75=20 and another showing the opposite,77=20 or improvement in bone mineral content but not bone mineral=20 density.76,77=20 Diminution of bone loss, indicated by a reduction in = biochemical=20 markers of bone resorption, was found in some studies78,80,81=20 but not in others.38,44,53,55,82,83=20 The amounts of isoflavones were similar in studies that found = favorable or no effects. The longest study in any primate = species=20 was in postmenopausal monkeys (cynomolgus macaques); after 3=20 years, soy isoflavones did not slow bone loss, whereas = estrogen=20 replacement increased bone mineral content and density, as=20 expected.84=20 These varied results of clinical trials suggest the need for=20 investigations of isoflavones and bone health that have = substantial=20 sample size and long duration to provide a definitive = result.=20

Cancer
The weak estrogenic action of soy = isoflavones and=20 other phytoestrogens suggested the possibility that they = could lessen=20 the deleterious effects of more potent endogenous estrogens = on breast=20 and endometrial cancer. This hypothesis came from the low = incidence=20 of breast and endometrial cancers in Asian countries where = soy=20 products are prevalent in the diet and from certain animal = models=20 of breast and endometrial cancer showing benefit of soy=20 isoflavones.85=9687=20 In reality, a host of complexities have emerged that make it=20 impossible to state a clinical recommendation for the use of=20 soy isoflavones. In epidemiological studies, associations = varied=20 between intake of soy foods and isoflavones and incidence of=20 breast cancer85,88=9690;=20 some showed protective associations, and others showed no=20 association.85,88=9690=20 Clinical studies suggested that soy phytoestrogens stimulate=20 epithelial cell proliferation in breasts of premenopausal = women, a=20 potential precursor of cancer.91,92=20 Animal and cell culture experiments also found a = cancer-stimulating=20 effect.93=9695=20 Phytoestrogens reduce the activity of enzymes that inactivate = endogenous estrogens, potentially leading to increased active = estrogen concentrations.96=20 Nonlinear dose effects, unique effects of specific types of=20 isoflavones, changes in isoflavone composition and structure=20 during the processing of soy foods, and interperson variation = in isoflavone metabolism all could affect cancer initiation = and=20 progression22,86,87=20 and are virtually unexplored in the clinical arena. It has = been=20 hypothesized from animal experiments that soy isoflavones = could be=20 protective throughout adult life only if eaten in childhood = or=20 puberty.97=20 Case-control studies in Shanghai98=20 and in Asian Americans99=20 found that high soy intake in adolescence was associated with = low=20 risk for breast cancer in adulthood. Finally, several recent = expert=20 reviews and editorials concluded that the research overall = remains=20 insufficient to know whether certain phytoestrogens are = protective or=20 harmful for breast cancer and at what dose and time period, = if=20 any, in a woman=92s life they are active.87,100,101=20

Concepts with regard to soy isoflavones and breast cancer are=20 applicable to uterine endometrial cancer, an = estrogen-dependent=20 cancer, although data are much less extensive. Soy food or = isoflavone=20 intake was associated with low risk for endometrial cancer in = case-control studies in Shanghai,102=20 Hawaii,103=20 and California.104=20 This suggests that soy phytoestrogens have antiestrogenic = effects=20 on the uterus. However, a single pilot trial of soy = isoflavones=20 given together with estrogen to perimenopausal or = postmenopausal=20 women found no lessening of estrogen-mediated stimulation of=20 the endometrium.105=20 Several clinical trials found that isoflavones did not affect = the=20 uterine endometrium of perimenopausal or postmenopausal = women.105=96110=20 However, these trials may have had insufficient duration (3 = to 6=20 months) or sample size to identify an effect. Recently, a = relatively=20 large placebo-controlled trial in postmenopausal women found = that=20 isoflavone tablets caused endometrial hyperplasia, a = precursor to=20 cancer, after 5 years in 6 of 154 women compared with none on = placebo=20 (P<0.05).111=20 Another 5 women in the phytoestrogen group had proliferative=20 endometrium compared with none in the placebo group after 5=20 years. These effects were not found at 23D1/2=20 years. = Thus, some=20 cautionary evidence indicates that soy phytoestrogens have = enough=20 estrogenic activity to stimulate the endometrium of = postmenopausal=20 women, although the evidence overall is inadequate to draw=20 conclusions on whether soy protein or isoflavones taken by=20 perimenopausal or postmenopausal women eventually would cause = endometrial cancer.

Soy isoflavones have estrogenic, antiandrogenic, and other = activities=20 that could prevent prostate cancer or slow its progression.86,87,112,113=20 Prostate cancer incidence is relatively low in Asian = countries=20 where soy products are commonly eaten, and certain = epidemiological=20 studies have shown an inverse association between soy foods,=20 serum phytoestrogen levels, and prostate cancer.113,114=20 However, as pointed out by Messina,113=20 the epidemiological findings are inconsistent, and there are=20 important limitations in study design. Soy isoflavones = prevent the=20 development and growth of prostate cancer in animal models. = In=20 prostate cancer cells, genistein reduced the synthesis of=20 prostate-specific antigen, a marker of prostate cancer = development=20 and progression that is in extensive clinical use.86=20 However, soy isoflavones did not reduce either = prostate-specific=20 antigen or serum testosterone levels in men with early-stage = prostate=20 cancer112,115,116=20 or in healthy middle-aged men.117=20 Thus, the effectiveness of soy isoflavones in preventing or = treating=20 human prostate cancer is unknown.


3D""   =20 Conclusions
Top
Abstract
Introduction
The Soy Protein Hypothesis...
Effect of Soy Protein...
Effects on Blood Pressure
Effects on Health Conditions...
Conclusions
References
 
E= arlier=20 research indicating that soy protein, as compared with other=20 proteins, has clinically important favorable effects on LDL=20 cholesterol and other CVD risk factors has not been confirmed = by many=20 studies reported during the past 10 years. A very large = amount of soy=20 protein, more than half the daily protein intake, may lower = LDL=20 cholesterol by a few percentage points when it replaces dairy = protein=20 or a mixture of animal proteins. The evidence favors soy = protein=20 rather than soy isoflavones as the responsible nutrient. = However, at=20 this time, the possibility cannot be ruled out that another = component=20 in soybeans could be the active factor. No benefit is evident = on HDL=20 cholesterol, triglycerides, lipoprotein(a), or blood = pressure. Thus,=20 the direct cardiovascular health benefit of soy protein or=20 isoflavone supplements is minimal at best. Soy protein or = isoflavones=20 have not been shown to improve vasomotor symptoms of = menopause,=20 and results are mixed with regard to the slowing of=20 postmenopausal bone loss. The efficacy and safety of soy = isoflavones=20 for preventing or treating cancer of the breast, endometrium, = and=20 prostate are not established; evidence from clinical trials = is=20 meager and cautionary with regard to a possible adverse = effect.=20 For this reason, use of isoflavone supplements in food or = pills=20 is not recommended. In contrast, soy products such as tofu, = soy=20 butter, soy nuts, or some soy burgers should be beneficial to = cardiovascular and overall health because of their high content = of=20 polyunsaturated fats, fiber, vitamins, and minerals and low = content=20 of saturated fat118=20 (Tab= le=20 4). Using these and other soy foods to replace foods high = in=20 animal protein that contain saturated fat and cholesterol may = confer=20 benefits to cardiovascular health.119=20 Soy protein also may be used to increase total dietary = protein intake=20 and to reduce carbohydrate or fat intake. However, much less = is known=20 about the potential impact of high-protein diets on risk = factors for=20 CVD. In the meantime, these remain dynamic areas for = research. The=20 AHA will continue to monitor the results and modify its = advisory=20 statement as needed.


View = this=20 table:
[in= =20 this window]
[in a new window]
  		TABLE 4. Nutrient Content of = Popular=20 Soy-Containing Foods=20


3D""   =20 Acknowledgments =
 
Writing Group=20 Disclosures


View = this=20 table:
[in= =20 this window]
[in a new window]
 

Reviewers=92 Disclosures


View = this=20 table:
[in= =20 this window]
[in a new window]
 


3D""   =20 Footnotes
 
The American Heart Association makes every = effort to=20 avoid any actual or potential conflicts of interest that may = arise=20 as a result of an outside relationship or a personal,=20 professional, or business interest of a member of the writing = panel.=20 Specifically, all members of the writing group are required = to=20 complete and submit a Disclosure Questionnaire showing all = such=20 relationships that might be perceived as real or potential = conflicts=20 of interest.

This statement was approved by the = American Heart=20 Association Science Advisory and Coordinating Committee on = August 10,=20 2005. A single reprint is available by calling 800-242-8721 = (US=20 only) or writing the American Heart Association, Public=20 Information, 7272 Greenville Ave, Dallas, TX 75231-4596. Ask = for=20 reprint No. 71-0279. To purchase additional reprints: up to = 999=20 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1000 = or=20 more copies, call 410-528-4121, fax 410-528-4264, or e-mail=20 kramsay@lww.com. To make photocopies for personal or = educational use,=20 call the Copyright Clearance Center, 978-750-8400. =

Expert peer review of AHA Scientific = Statements=20 is conducted at the AHA National Center. For more on AHA = statements=20 and guidelines development, visit=20 http://www.americanheart.org/presenter.jhtml?identifier=3D3023366. =


3D""   =20 References
Top
Abstract
Introduction
The Soy Protein Hypothesis...
Effect of Soy Protein...
Effects on Blood Pressure
Effects on Health Conditions...
Conclusions
References
&nb= sp;

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Opera = requires=0A= the Sun Java Runtime Environment .=0A= =0A= by Andrew Gregory=0A= http://www.scss.com.au/family/andrew/webdesign/xmlhttprequest/=0A= =0A= This work is licensed under the Creative Commons Attribution License. To = view a=0A= copy of this license, visit = http://creativecommons.org/licenses/by-sa/2.5/ or=0A= send a letter to Creative Commons, 559 Nathan Abbott Way, Stanford, = California=0A= 94305, USA.=0A= =0A= Attribution: Leave my name and web address in this script intact.=0A= =0A= Not Supported in Opera=0A= ----------------------=0A= * user/password authentication=0A= * responseXML data member=0A= =0A= Not Fully Supported in Opera=0A= ----------------------------=0A= * async requests=0A= * abort()=0A= * getAllResponseHeaders(), getAllResponseHeader(header)=0A= =0A= */=0A= // IE support=0A= if (window.ActiveXObject && !window.XMLHttpRequest) {=0A= window.XMLHttpRequest =3D function() {=0A= var msxmls =3D new Array(=0A= 'Msxml2.XMLHTTP.5.0',=0A= 'Msxml2.XMLHTTP.4.0',=0A= 'Msxml2.XMLHTTP.3.0',=0A= 'Msxml2.XMLHTTP',=0A= 'Microsoft.XMLHTTP');=0A= for (var i =3D 0; i < msxmls.length; i++) {=0A= try {=0A= return new ActiveXObject(msxmls[i]);=0A= } catch (e) {=0A= }=0A= }=0A= return null;=0A= };=0A= }=0A= // Gecko support=0A= /* ;-) */=0A= // Opera support=0A= if (window.opera && !window.XMLHttpRequest) {=0A= window.XMLHttpRequest =3D function() {=0A= this.readyState =3D 0; // = 0=3Duninitialized,1=3Dloading,2=3Dloaded,3=3Dinteractive,4=3Dcomplete=0A= this.status =3D 0; // HTTP status codes=0A= this.statusText =3D '';=0A= this._headers =3D [];=0A= this._aborted =3D false;=0A= this._async =3D true;=0A= this._defaultCharset =3D 'ISO-8859-1';=0A= this._getCharset =3D function() {=0A= var charset =3D _defaultCharset;=0A= var contentType =3D = this.getResponseHeader('Content-type').toUpperCase();=0A= val =3D contentType.indexOf('CHARSET=3D');=0A= if (val !=3D -1) {=0A= charset =3D contentType.substring(val);=0A= }=0A= val =3D charset.indexOf(';');=0A= if (val !=3D -1) {=0A= charset =3D charset.substring(0, val);=0A= }=0A= val =3D charset.indexOf(',');=0A= if (val !=3D -1) {=0A= charset =3D charset.substring(0, val);=0A= }=0A= return charset;=0A= };=0A= this.abort =3D function() {=0A= this._aborted =3D true;=0A= };=0A= this.getAllResponseHeaders =3D function() {=0A= return this.getAllResponseHeader('*');=0A= };=0A= this.getAllResponseHeader =3D function(header) {=0A= var ret =3D '';=0A= for (var i =3D 0; i < this._headers.length; i++) {=0A= if (header =3D=3D '*' || this._headers[i].h =3D=3D header) {=0A= ret +=3D this._headers[i].h + ': ' + this._headers[i].v + '\n';=0A= }=0A= }=0A= return ret;=0A= };=0A= this.getResponseHeader =3D function(header) {=0A= var ret =3D getAllResponseHeader(header);=0A= var i =3D ret.indexOf('\n');=0A= if (i !=3D -1) {=0A= ret =3D ret.substring(0, i);=0A= }=0A= return ret;=0A= };=0A= this.setRequestHeader =3D function(header, value) {=0A= this._headers[this._headers.length] =3D {h:header, v:value};=0A= };=0A= this.open =3D function(method, url, async, user, password) {=0A= this.method =3D method;=0A= this.url =3D url;=0A= this._async =3D true;=0A= this._aborted =3D false;=0A= this._headers =3D [];=0A= if (arguments.length >=3D 3) {=0A= this._async =3D async;=0A= }=0A= if (arguments.length > 3) {=0A= opera.postError('XMLHttpRequest.open() - user/password not = supported');=0A= }=0A= this.readyState =3D 1;=0A= if (this.onreadystatechange) {=0A= this.onreadystatechange();=0A= }=0A= };=0A= this.send =3D function(data) {=0A= if (!navigator.javaEnabled()) {=0A= alert("XMLHttpRequest.send() - Java must be installed and = enabled.");=0A= return;=0A= }=0A= if (this._async) {=0A= setTimeout(this._sendasync, 0, this, data);=0A= // this is not really asynchronous and won't execute until the = current=0A= // execution context ends=0A= } else {=0A= this._sendsync(data);=0A= }=0A= }=0A= this._sendasync =3D function(req, data) {=0A= if (!req._aborted) {=0A= req._sendsync(data);=0A= }=0A= };=0A= this._sendsync =3D function(data) {=0A= this.readyState =3D 2;=0A= if (this.onreadystatechange) {=0A= this.onreadystatechange();=0A= }=0A= // open connection=0A= var url =3D new java.net.URL(new = java.net.URL(window.location.href), this.url);=0A= var conn =3D url.openConnection();=0A= for (var i =3D 0; i < this._headers.length; i++) {=0A= conn.setRequestProperty(this._headers[i].h, this._headers[i].v);=0A= }=0A= this._headers =3D [];=0A= if (this.method =3D=3D 'POST') {=0A= // POST data=0A= conn.setDoOutput(true);=0A= var wr =3D new = java.io.OutputStreamWriter(conn.getOutputStream(), this._getCharset());=0A= wr.write(data);=0A= wr.flush();=0A= wr.close();=0A= }=0A= // read response headers=0A= // NOTE: the getHeaderField() methods always return nulls for me :(=0A= var gotContentEncoding =3D false;=0A= var gotContentLength =3D false;=0A= var gotContentType =3D false;=0A= var gotDate =3D false;=0A= var gotExpiration =3D false;=0A= var gotLastModified =3D false;=0A= for (var i =3D 0; ; i++) {=0A= var hdrName =3D conn.getHeaderFieldKey(i);=0A= var hdrValue =3D conn.getHeaderField(i);=0A= if (hdrName =3D=3D null && hdrValue =3D=3D null) {=0A= break;=0A= }=0A= if (hdrName !=3D null) {=0A= this._headers[this._headers.length] =3D {h:hdrName, = v:hdrValue};=0A= switch (hdrName.toLowerCase()) {=0A= case 'content-encoding': gotContentEncoding =3D true; break;=0A= case 'content-length' : gotContentLength =3D true; break;=0A= case 'content-type' : gotContentType =3D true; break;=0A= case 'date' : gotDate =3D true; break;=0A= case 'expires' : gotExpiration =3D true; break;=0A= case 'last-modified' : gotLastModified =3D true; break;=0A= }=0A= }=0A= }=0A= // try to fill in any missing header information=0A= var val;=0A= val =3D conn.getContentEncoding();=0A= if (val !=3D null && !gotContentEncoding) = this._headers[this._headers.length] =3D {h:'Content-encoding', v:val};=0A= val =3D conn.getContentLength();=0A= if (val !=3D -1 && !gotContentLength) = this._headers[this._headers.length] =3D {h:'Content-length', v:val};=0A= val =3D conn.getContentType();=0A= if (val !=3D null && !gotContentType) = this._headers[this._headers.length] =3D {h:'Content-type', v:val};=0A= val =3D conn.getDate();=0A= if (val !=3D 0 && !gotDate) this._headers[this._headers.length] = =3D {h:'Date', v:(new Date(val)).toUTCString()};=0A= val =3D conn.getExpiration();=0A= if (val !=3D 0 && !gotExpiration) = this._headers[this._headers.length] =3D {h:'Expires', v:(new = Date(val)).toUTCString()};=0A= val =3D conn.getLastModified();=0A= if (val !=3D 0 && !gotLastModified) = this._headers[this._headers.length] =3D {h:'Last-modified', v:(new = Date(val)).toUTCString()};=0A= // read response data=0A= var reqdata =3D '';=0A= var stream =3D conn.getInputStream();=0A= if (stream) {=0A= var reader =3D new java.io.BufferedReader(new = java.io.InputStreamReader(stream, this._getCharset()));=0A= var line;=0A= while ((line =3D reader.readLine()) !=3D null) {=0A= if (this.readyState =3D=3D 2) {=0A= this.readyState =3D 3;=0A= if (this.onreadystatechange) {=0A= this.onreadystatechange();=0A= }=0A= }=0A= reqdata +=3D line + '\n';=0A= }=0A= reader.close();=0A= this.status =3D 200;=0A= this.statusText =3D 'OK';=0A= this.responseText =3D reqdata;=0A= this.readyState =3D 4;=0A= if (this.onreadystatechange) {=0A= this.onreadystatechange();=0A= }=0A= if (this.onload) {=0A= this.onload();=0A= }=0A= } else {=0A= // error=0A= this.status =3D 404;=0A= this.statusText =3D 'Not Found';=0A= this.responseText =3D '';=0A= this.readyState =3D 4;=0A= if (this.onreadystatechange) {=0A= this.onreadystatechange();=0A= }=0A= if (this.onerror) {=0A= this.onerror();=0A= }=0A= }=0A= };=0A= };=0A= }=0A= // ActiveXObject emulation=0A= if (!window.ActiveXObject && window.XMLHttpRequest) {=0A= window.ActiveXObject =3D function(type) {=0A= switch (type.toLowerCase()) {=0A= case 'microsoft.xmlhttp':=0A= case 'msxml2.xmlhttp':=0A= case 'msxml2.xmlhttp.3.0':=0A= case 'msxml2.xmlhttp.4.0':=0A= case 'msxml2.xmlhttp.5.0':=0A= return new XMLHttpRequest();=0A= }=0A= return null;=0A= };=0A= }=0A= ------=_NextPart_000_003D_01C67846.F0008E90 Content-Type: application/octet-stream Content-Transfer-Encoding: quoted-printable Content-Location: http://circ.ahajournals.org/javascript/ajax/utility.js /************************************************************************= *****=0A= * javascript/ajax/utility.js=0A= *=0A= * Utility functions for working with XMLHttpRequest data.=0A= *=0A= * Copyright 2006 Board of Trustees of the Leland Stanford Junior = University.=0A= = *************************************************************************= ***/=0A= =0A= /*=0A= * Copy XML nodes into an HTMLElement. This effectively=0A= * clones XML markup which uses XHTML naming conventions=0A= * into an HTML DOM.=0A= */=0A= function copy_xml_to_html(src, dst) {=0A= if (src.nodeType =3D=3D 1) { /* Node.ELEMENT_NODE */=0A= var e =3D document.createElement(src.nodeName);=0A= for (var i =3D 0; i < src.childNodes.length; i++) {=0A= copy_xml_to_html(src.childNodes[i], e);=0A= }=0A= for (var i =3D 0; i < src.attributes.length; i++) {=0A= var n =3D src.attributes[i].name;=0A= var v =3D unescape_xml_string(src.attributes[i].value); =0A= e.setAttribute(n, v);=0A= if (n =3D=3D "class") {=0A= e.className =3D v;=0A= }=0A= else if (n =3D=3D "style") {=0A= set_css_style(v, e, "");=0A= }=0A= }=0A= dst.appendChild(e);=0A= }=0A= else if (src.nodeType =3D=3D 3) { /* Node.TEXT_NODE */=0A= dst.appendChild(document.createTextNode(src.nodeValue));=0A= }=0A= }=0A= =0A= /* =0A= * It is unclear that this is the right thing to be calling=0A= * from copy_xml_to_html, but it appears that Safari decides=0A= * to convert & to the NCR #, and then encodes that=0A= * NCR to &%26%2338;. So, I'm going to treat the DOM Attr=0A= * value as a plain string, and run our XML string input=0A= * through the decoding routine below.=0A= */=0A= function unescape_xml_string(s) {=0A= return s.replace(/'/g, "'")=0A= .replace(/'/g, "'")=0A= .replace(/"/g, "\"")=0A= .replace(/"/g, "\"")=0A= .replace(/>/g, ">")=0A= .replace(/>/g, ">")=0A= .replace(/</g, "<")=0A= .replace(/</g, "<")=0A= .replace(/&/g, "&")=0A= .replace(/&/g, "&");=0A= }=0A= =0A= /*=0A= * Parse set of CSS rules and apply them to an element.=0A= * This is quite horrifying, but I'm unable to determine=0A= * how else to handle this with IE 6. FireFox and other=0A= * sane browsers let you simply set the style attribute=0A= * or use e.style.setProperty(rule, value, priority),=0A= * IE 6 appears to have neither of these capabilities..=0A= */=0A= function set_css_style(css, e, priority) {=0A= var rules =3D css.split(";");=0A= for (var i =3D 0; i < rules.length; i++) {=0A= var nvpair =3D rules[i].split(":");=0A= if (nvpair.length =3D=3D 2) {=0A= try {=0A= var name =3D nvpair[0]; /* style attribute */=0A= var value =3D nvpair[1]; /* attribute value */=0A= =0A= /*=0A= * For each possible style attribute, set the=0A= * appropriate style property in the element.=0A= */=0A= if (name =3D=3D "background") {=0A= e.style.background =3D value;=0A= }=0A= else if (name =3D=3D "background-attachment") {=0A= e.style.backgroundAttachment =3D value;=0A= }=0A= else if (name =3D=3D "background-color") {=0A= e.style.backgroundColor =3D value;=0A= }=0A= else if (name =3D=3D "background-image") {=0A= e.style.backgroundImage =3D value;=0A= }=0A= else if (name =3D=3D "background-position") {=0A= e.style.backgroundPosition =3D value;=0A= }=0A= else if (name =3D=3D "background-position-x") {=0A= e.style.backgroundPositionX =3D value;=0A= }=0A= else if (name =3D=3D "background-position-y") {=0A= e.style.backgroundPositionY =3D value;=0A= }=0A= else if (name =3D=3D "background-repeat") {=0A= e.style.backgroundRepeat =3D value;=0A= }=0A= else if (name =3D=3D "behavior") {=0A= e.style.behavior =3D value;=0A= }=0A= else if (name =3D=3D "border") {=0A= e.style.border =3D value;=0A= }=0A= else if (name =3D=3D "border-bottom") {=0A= e.style.borderBottom =3D value;=0A= }=0A= else if (name =3D=3D "border-bottom-color") {=0A= e.style.borderBottomColor =3D value;=0A= }=0A= else if (name =3D=3D "border-bottom-style") {=0A= e.style.borderBottomStyle =3D value;=0A= }=0A= else if (name =3D=3D "border-bottom-width") {=0A= e.style.borderBottomWidth =3D value;=0A= }=0A= else if (name =3D=3D "border-collapse") {=0A= e.style.borderCollapse =3D value;=0A= }=0A= else if (name =3D=3D "border-color") {=0A= e.style.borderColor =3D value;=0A= }=0A= else if (name =3D=3D "border-left") {=0A= e.style.borderLeft =3D value;=0A= }=0A= else if (name =3D=3D "border-left-color") {=0A= e.style.borderLeftColor =3D value;=0A= }=0A= else if (name =3D=3D "border-left-style") {=0A= e.style.borderLeftStyle =3D value;=0A= }=0A= else if (name =3D=3D "border-left-width") {=0A= e.style.borderLeftWidth =3D value;=0A= }=0A= else if (name =3D=3D "border-right") {=0A= e.style.borderRight =3D value;=0A= }=0A= else if (name =3D=3D "border-right-color") {=0A= e.style.borderRightColor =3D value;=0A= }=0A= else if (name =3D=3D "border-right-style") {=0A= e.style.borderRightStyle =3D value;=0A= }=0A= else if (name =3D=3D "border-right-width") {=0A= e.style.borderRightWidth =3D value;=0A= }=0A= else if (name =3D=3D "border-style") {=0A= e.style.borderStyle =3D value;=0A= }=0A= else if (name =3D=3D "border-top") {=0A= e.style.borderTop =3D value;=0A= }=0A= else if (name =3D=3D "border-top-color") {=0A= e.style.borderTopColor =3D value;=0A= }=0A= else if (name =3D=3D "border-top-style") {=0A= e.style.borderTopStyle =3D value;=0A= }=0A= else if (name =3D=3D "border-top-width") {=0A= e.style.borderTopWidth =3D value;=0A= }=0A= else if (name =3D=3D "border-width") {=0A= e.style.borderWidth =3D value;=0A= }=0A= else if (name =3D=3D "bottom") {=0A= e.style.bottom =3D value;=0A= }=0A= else if (name =3D=3D "clear") {=0A= e.style.clear =3D value;=0A= }=0A= else if (name =3D=3D "clip") {=0A= e.style.clip =3D value;=0A= }=0A= else if (name =3D=3D "color") {=0A= e.style.color =3D value;=0A= }=0A= else if (name =3D=3D "cssText") {=0A= e.style.Sets =3D value;=0A= }=0A= else if (name =3D=3D "cursor") {=0A= e.style.cursor =3D value;=0A= }=0A= else if (name =3D=3D "direction") {=0A= e.style.direction =3D value;=0A= }=0A= else if (name =3D=3D "display") {=0A= e.style.display =3D value;=0A= }=0A= else if (name =3D=3D "font") {=0A= e.style.font =3D value;=0A= }=0A= else if (name =3D=3D "font-family") {=0A= e.style.fontFamily =3D value;=0A= }=0A= else if (name =3D=3D "font-size") {=0A= e.style.fontSize =3D value;=0A= }=0A= else if (name =3D=3D "font-style") {=0A= e.style.fontStyle =3D value;=0A= }=0A= else if (name =3D=3D "font-variant") {=0A= e.style.fontVariant =3D value;=0A= }=0A= else if (name =3D=3D "font-weight") {=0A= e.style.fontWeight =3D value;=0A= }=0A= else if (name =3D=3D "height") {=0A= e.style.height =3D value;=0A= }=0A= else if (name =3D=3D "ime-mode") {=0A= e.style.imeMode =3D value;=0A= }=0A= else if (name =3D=3D "layout-flow") {=0A= e.style.layoutFlow =3D value;=0A= }=0A= else if (name =3D=3D "layout-grid") {=0A= e.style.layoutGrid =3D value;=0A= }=0A= else if (name =3D=3D "layout-grid-char") {=0A= e.style.layoutGridChar =3D value;=0A= }=0A= else if (name =3D=3D "layout-grid-line") {=0A= e.style.layoutGridLine =3D value;=0A= }=0A= else if (name =3D=3D "layout-grid-mode") {=0A= e.style.layoutGridMode =3D value;=0A= }=0A= else if (name =3D=3D "layout-grid-type") {=0A= e.style.layoutGridType =3D value;=0A= }=0A= else if (name =3D=3D "left") {=0A= e.style.left =3D value;=0A= }=0A= else if (name =3D=3D "letter-spacing") {=0A= e.style.letterSpacing =3D value;=0A= }=0A= else if (name =3D=3D "line-break") {=0A= e.style.lineBreak =3D value;=0A= }=0A= else if (name =3D=3D "line-height") {=0A= e.style.lineHeight =3D value;=0A= }=0A= else if (name =3D=3D "list-style") {=0A= e.style.listStyle =3D value;=0A= }=0A= else if (name =3D=3D "list-style-image") {=0A= e.style.listStyleImage =3D value;=0A= }=0A= else if (name =3D=3D "list-style-position") {=0A= e.style.listStylePosition =3D value;=0A= }=0A= else if (name =3D=3D "list-style-type") {=0A= e.style.listStyleType =3D value;=0A= }=0A= else if (name =3D=3D "margin") {=0A= e.style.margin =3D value;=0A= }=0A= else if (name =3D=3D "margin-bottom") {=0A= e.style.marginBottom =3D value;=0A= }=0A= else if (name =3D=3D "margin-left") {=0A= e.style.marginLeft =3D value;=0A= }=0A= else 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quoted-printable Content-Location: http://circ.ahajournals.org/javascript/entrez/callback.js /************************************************************************= *****=0A= * javascript/entrez/callback.js=0A= *=0A= * Entrez Linking callback to populate content box.=0A= *=0A= * Copyright 2006 Board of Trustees of the Leland Stanford Junior = University.=0A= = *************************************************************************= ***/=0A= =0A= /*=0A= * Execute callback to fill content box with Entrez Linking information.=0A= */=0A= function entrez_callback(pmid, callback_url) {=0A= /*=0A= * MSIE 5.5 and below have issues with the JavaScript=0A= * used for Entrez Linking. 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