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Background: The value of soy, as an effective component of a cholesterol lowering diet, is currently questioned due to smaller lipid reductions than previously reported for the currently approved US FDA health claim for soy. Nevertheless, intrinsic and extrinsic factors may exist that influence the effectiveness of soy, but little research has been done in this area. Such factors include the soy isoflavone content, dietary components that alter colonic fermentation and the colon’s ability to biotransform isoflavones (i.e. equol status). Objective: To determine if specific factors, such as dose of soy isoflavones and those that alter colonic fermentation, influence the hypocholesterolemic effect of soy. Furthermore, whether cholesterol reductions differ depending on the interindividual variation in isoflavone biotransformation (i.e. equol status), when soy is consumed under different dietary conditions (i.e. with specific factors). Methods: 85 men and postmenopausal women (42M, 43F) with hyperlipidemia participated in one of three substudies where soy foods, containing 30-52g/d of soy protein, were provided over a one-month period under the following conditions: 1) high-normal (73mg/d) or low (10mg/d) soy isoflavones (N=41); 2) with or without a prebiotic (10g/d polyfructans) to increase colonic fermentation (N=22); or 3) with a reduced carbohydrate diet (26% of calories) to decrease colonic fermentation (N=22). Results: Unmodified soy foods significantly reduced LDL-C by 5.1%±2.0% (P=0.016). LDL-C reductions were not altered with increased soy isoflavone content nor were the effects dampened with reduced carbohydrate. However, coingestion of soy with a prebiotic improved the cholesterol lowering effect of soy. Equol producers (N=30) showed a relative increase of 5.3±2.5% in HDL-C (P=0.035) after soy compared to nonproducers (N=55), but no significant differences were observed for LDL-C or other lipids. Equol excretion was increased with increased soy isoflavone content, but not with the addition of a prebiotic. Conclusion: The effectiveness of soy, as a cholesterol lowering food, may be improved with the addition of prebiotics, but not with decreased carbohydrate or increased isoflavones. Equol status appears to alter the HDL-C, but not the LDL-C response. These data support the continued use of soy foods as part of the dietary approach to coronary heart disease risk reduction.

Introduction: Stunting in childhood predisposes to obesity, increasing the risk for chronic diseases of lifestyle in adulthood (i.e. the double burden of disease). Objectives: To gain insight into the eating patterns and anthropometric nutritional status of children (<7 years) and adults (25 to 64 years) in the rural- and urban Free State. Methods: Dietary intake was measured in 60 rural- and 116 urban children; and 553 rural- and 419 urban adults using 24- hour recall and food frequency questionnaires. Anthropometric data was measured using WHO guidelines. Results: Mean energy intake was 4254 kJ for rural children younger than two years (56,9% carbohydrates; 17,2% protein; 25,7% fat) and 3292kJ for urban children younger than two years (64,2% carbohydrates; 19,5% protein; 20,1% fat). The percentage of energy from carbohydrates and protein were within prudent dietary guidelines (carbohydrates (CHO): 45-65%; protein: 5-20%), while the percentage energy from fat was lower than the recommended 30-40%. Mean energy intake for rural children older than two years was 5581kJ (57,5% carbohydrates; 16,9% protein; 28,7% fat) and 4220kJ for urban children (65,5% carbohydrates; 17,9% protein; 20,3% fat). As in the younger children, the percentage of energy from carbohydrates and protein were within prudent dietary guidelines (CHO: 45-65%; protein: 10-30%; fat: 25-35%) except for fat intake which was lower than recommended among urban participants. The average energy intake for all men was 8040 kJ (61% carbohydrates; 17,8% protein; and 24,3% fat) and for all women in the current study was 7243 kJ (61,7% carbohydrates; 17,3% protein and 24,5% fat). Macronutirent distributions were thus within prudent guidelines (CHO: 45-65%; protein: 10-35%; fat: 20-35%). The energy intake was below the estimated energy requirements (EER) range of 10143 kJ for sedentary men and 7947 kJ for sedentary women. More than half (65,6%) of rural females and two-thirds (66,2%) of urban females were overweight or obese (bodymass- index (BMI) >25kg/m2). Fewer men were overweight or obese (23,3% rural men and 16% urban men). A significantly larger percentage of urban than rural men (urban: 61,0%; rural: 43,6%) had a normal BMI (18,5 to 24,9 kg/m2) (p=0.007). A third (33,1%) of rural men and 23% of urban men were underweight (BMI <18,5kg/m2). Mean BMI for men was within the normal range at 20 kg/m2. For women mean BMI fell in the overweight range at 28 kg/m2. Significantly more urban than rural men had a normal waist circumference (<94 cm) (p=0.002) and similarly, significantly more urban (32%) than rural women (24,4%) had a normal waist circumference (<80 cm) (p=0.03). Significantly more rural than urban men had a waist circumference >94 cm (p=0.01), placing them at risk for developing chronic diseases of lifestyle (CDLs). About one-fifth (17,8%) of rural and 19,4% of urban women were at risk (>80 cm). Significantly more rural women (57,9%) were at high risk of developing CDLs (>88cm) than urban women (48,6%) (p=0.02). Median waist circumference for rural women was 92 cm (high risk) and for urban women 87cm (at risk). The median waist circumference for rural men was 78,5 cm (normal) and for urban men 76 cm (normal). Rural children were more often underweight (weight-for-age <-2 standard deviations (SD))(rural: 31,7%; urban: 17,3%) than urban children. In contrast to what was expected, urban children were more often stunted (height-forage <-2SD) than rural children (rural: 38,4%; urban: 44,0%). Prevalence of wasting (weight-for-height <-2SD) was similar in rural and urban children (rural: 11,9%; urban: 10,1%). A double burden of undernutrition in children and overweight in caretakers was confirmed in this sample, with 63,2% of stunted- and 66,7% of underweight rural children and 71,9% of stunted- and 66,7% of underweight children in urban areas living with an overweight/obese caregiver. Conclusion: A double burden of disease and nutrition transition were confirmed in both rural- and urban communities.