ArticleLiterature Review

Egg Consumption and Heart Health: A Review

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Abstract

Cardiovascular disease is the leading cause of death in the United States. Until recently, reducing dietary cholesterol has been a part of the American Heart Association (AHA) and American College of Cardiology (ACC) guidelines on lifestyle management, despite inconclusive evidence to support the recommendation. Considering eggs are a rich source of dietary cholesterol (typically containing 141–234 mg per egg), individuals with increased risk for CVD are advised not to consume eggs. Furthermore, based on the 2012 AHA/ACC guidelines, individuals with lower risk for CVD have previously been advised to avoid consuming eggs due to the high content of dietary cholesterol. Rather than strictly limiting cholesterol intake, the AHA and ACC guidelines now recommend dietary patterns that emphasize fruits, vegetables, whole grains, low-fat dairy products, poultry, fish, and nuts as an approach to favorably alter blood lipid levels. Of note, the 2015–2020 Dietary Guidelines for Americans have removed the recommendation of limiting cholesterol intake to no more than 300 mg per day; however, the guidelines advise that individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern. The purpose of this review is to summarize the documented health risks of egg consumption in individuals with low and high risk for CVD and determine whether current recommendations are warranted based on the available literature. We also aim to provide guidance for future studies that will help further elucidate the health modulating effect of eggs.

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... 9 Egg contains high quality protein and several bioactive compounds but is also a major source of dietary cholesterol and hence still has a controversial role on heart health and mortality. 39,50 Lifestyle factors related to egg intake may also affect its associations with health. 50 More research on effects of egg intake in diverse populations is thus needed. ...
... 39,50 Lifestyle factors related to egg intake may also affect its associations with health. 50 More research on effects of egg intake in diverse populations is thus needed. 50 The strengths of our study are the prospective population-based setting, no losses during the follow-up, and extensive measurement of diet and possible confounding factors. ...
... 50 More research on effects of egg intake in diverse populations is thus needed. 50 The strengths of our study are the prospective population-based setting, no losses during the follow-up, and extensive measurement of diet and possible confounding factors. Our study also has limitations. ...
Article
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Background: Animal and plant protein intakes have indicated opposite associations with cardiovascular mortality risk. Whether dietary proteins are associated with risk of heart failure (HF) is unclear. Thus, we examined the associations of proteins from different food sources with risk of HF. Methods and results: The study included 2441 men aged 42 to 60 years at the baseline examinations in 1984 to 1989 in the Kuopio Ischaemic Heart Disease Risk Factor Study. Protein intakes at baseline were assessed with 4-day dietary records. Data on incident HF cases were obtained from national registers. HF risk according to protein intake was estimated by Cox proportional hazard ratios. During the mean follow-up of 22.2 years, 334 incident HF cases occurred. Higher intake of total protein indicated a trend toward increased risk of HF (multivariable-adjusted hazard ratio in the highest versus lowest quartile=1.33; 95% confidence interval: 0.95-1.85; P-trend=0.05). The associations between specific types and sources of protein with incident HF were consistent with this overall finding although not all associations reached statistical significance. For example, the hazard ratio in the highest versus lowest quartile was 1.43 (95% confidence interval: 1.00-2.03; P-trend=0.07) for total animal protein and 1.17 (95% confidence interval: 0.72-1.91; P-trend=0.35) for total plant protein. Conclusions: In middle-aged men, higher protein intake was marginally associated with increased risk of HF. Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03221127.
... Eggs are an affordable and low-calorie source of many nutrients, including unsaturated fatty acids, choline, essential amino acids, iron, folate, and other B vitamins (1). Eggs are also among the foods with the highest cholesterol content, with ∼200 mg cholesterol/egg (1). ...
... Eggs are an affordable and low-calorie source of many nutrients, including unsaturated fatty acids, choline, essential amino acids, iron, folate, and other B vitamins (1). Eggs are also among the foods with the highest cholesterol content, with ∼200 mg cholesterol/egg (1). Given the potential impact of dietary cholesterol on serum cholesterol concentrations (2), it has long been recommended to consume no more than 300 mg/d of dietary cholesterol (3). ...
Article
Background: Whether egg consumption is associated with the risk of type 2 diabetes (T2D) remains unsettled. Objectives: We evaluated the association between egg consumption and T2D risk in 3 large US prospective cohorts, and performed a systematic review and meta-analysis of prospective cohort studies. Methods: We followed 82,750 women from the Nurses' Health Study (NHS; 1980-2012), 89,636 women from the NHS II (1991-2017), and 41,412 men from the Health Professionals Follow-up Study (HPFS; 1986-2016) who were free of T2D, cardiovascular disease, and cancer at baseline. Egg consumption was assessed every 2-4 y using a validated FFQ. We used Cox proportional hazard models to estimate HRs and 95% CIs. Results: During a total of 5,529,959 person-years of follow-up, we documented 20,514 incident cases of T2D in the NHS, NHS II, and HPFS. In the pooled multivariable model adjusted for updated BMI, lifestyle, and dietary confounders, a 1-egg/d increase was associated with a 14% (95% CI: 7%, 20%) higher T2D risk. In random-effects meta-analysis of 16 prospective cohort studies (589,559 participants; 41,248 incident T2D cases), for each 1 egg/d, the pooled RR of T2D was 1.07 (95% CI: 0.99, 1.15; I2 = 69.8%). There were, however, significant differences by geographic region (P for interaction = 0.01). Each 1 egg/d was associated with higher T2D risk among US studies (RR: 1.18; 95% CI: 1.10, 1.27; I2 = 51.3%), but not among European (RR: 0.99; 95% CI: 0.85, 1.15; I2 = 73.5%) or Asian (RR: 0.82; 95% CI: 0.62, 1.09; I2 = 59.1%) studies. Conclusions: Results from the updated meta-analysis show no overall association between moderate egg consumption and risk of T2D. Whether the heterogeneity of the associations among US, European, and Asian cohorts reflects differences in egg consumption habits warrants further investigation.This systematic review was registered at www.crd.york.ac.uk/prospero as CRD42019127860.
... 84 Considering eggs are a rich source of dietary cholesterol, individuals with increased risk for CVD are traditionally advised not to consume eggs. 86 This view that has been challenged because clinical trials associating egg consumption and CVD risk are not available in individuals at risk for heart disease. 86 However, egg consumption has been shown to have minimal effects on cholesterol levels on the majority of subjects tested. ...
... 86 This view that has been challenged because clinical trials associating egg consumption and CVD risk are not available in individuals at risk for heart disease. 86 However, egg consumption has been shown to have minimal effects on cholesterol levels on the majority of subjects tested. 87 ...
Article
Cardiovascular disease (CVD) is the leading cause of death in many developed countries and remains one of the major diseases strongly affected by the diet. Nutrition can affect CVD directly by contributing to the accumulation of vascular plaques and also indirectly by regulating the rate of aging. This review summarizes research on nutrition and CVD incidence based on a multipillar system that includes basic research focused on aging, epidemiological studies, clinical studies, and studies of centenarians. The relevant research linking nutrition and CVD with focus on macronutrients and aging will be highlighted. We will review some of the most relevant studies on nutrition and CVD treatment, also focusing on interventions known to delay aging. We will discuss both everyday dietary compositions, as well as intermittent and periodic fasting interventions with the potential to prevent and treat CVD.
... Eggs can on the one hand be a good source of nutrients, but are also controversially discussed due to their high cholesterol content. The particular focus here is cardiovascular diseases [1,2], which are among the most common causes of death in Germany. In 2016 they were the cause of a total of 37.0% of all deaths [3]. ...
... In the evidence-based guideline of the German Nutrition Society (Deutsche Gesellschaft für Ernährung, DGE): fat intake and prevention of selected nutrition-related diseases [5] the intake of dietary cholesterol was linked to an increase in the ratio of total cholesterol to high density lipoprotein (HDL) cholesterol with probable evidence and to a small increase in the ratio of total and LDL cholesterol with convincing evidence, although this latter is probably more pronounced in what are known as responders than non-responders. 1 Studies on specific foods, such as eggs, were not considered in the guidelines on fat intake since their effects are based on the overall food matrix and it is therefore not possible to derive definitive statements on the effects of fat or cholesterol in the diet. The association between egg intake and the risk of cardiovascular diseases has been investigated in recent years in several prospective observational studies. ...
Article
Although eggs are a valuable source of nutrients, the role of egg intake has been controversially discussed due to eggs´ high content of cholesterol. Currently there is no consensus in the recommendations of (inter)national nutrition and cardiological scientific bodies on egg and cholesterol intake. Meta-analyses, systematic reviews and recent cohort studies predominantly show no association between egg intake and the risk of cardiovascular diseases in the general population. As regards people with type 2 diabetes mellitus, study results mainly indicate an increased risk for cardiovascular diseases in relation to egg intake. Controlled intervention studies are required to confirm these associations. The current knowledge on the effects of egg intake on cardiometabolic risk factors and the risk of type 2 diabetes mellitus are presented and reviewed in a second article.
... INTERHEART, a case-control study conducted in 52 countries, identifield the factors and health behaviors that create the risk of acute myocardial infarction, which accounts for more than 90% of the population. These factors include hypertension, dyslipidemia, diabetes, obesity, smoking, alcohol, diet, and sedentary lifestyle (Timmis et al., 2020) Eggs are the main source of dietary cholesterol (200-300 mg/100 g, approximately 180 mg per medium egg), and their consumption in moderation has been recommended to reduce dietary cholesterol intake (Clayton et al., 2017). ...
... Americans accentuate taking cholesterol more than 300 mg per day. Guidelines recommend individuals to reduce dietary cholesterol (Clayton et al., 2017). Eggs are rich in nutrients and the source of essential oils and amino acids and nutrients with the highest cholesterol content. ...
Article
This study was planned and conducted to investigate the effects of egg consumption on metabolic syndrome components and potential mechanisms of action on humans. Egg, an important source of animal protein, is defined as a functional food containing various bioactive compounds that can affect the proinflammatory and anti-inflammatory pathways. As a matter of fact, the egg can show immunomodulatory, anti-inflammatory, antioxidant, anticancer, or antihypertensive effects with its bioactive components. It is claimed that egg consumption may protect individuals against metabolic syndrome by increasing HDL-C levels and reducing inflammation. The increase in egg consumption creates the perception that it may lead to cardiovascular diseases due to its cholesterol content. However, there is insufficient evidence as to whether dietary cholesterol-lowers LDL-C. The possible potential mechanisms of egg impact on human health, MEDLINE, Embase, the Cochrane Central, www.ClinicalTrials.gov, PubMed, Science Direct, Google Scholar, and selected websites including) and databases were examined in this regard. With a view to delving into the rather mysterious relationship between egg cholesterol and blood cholesterol, it is necessary to understand the absorption of cholesterol from the egg and to know the functioning of the intestinal microbiota. Studies conducted to date have generally yielded inconsistent results regarding egg consumption and risks of CVD, diabetes, and metabolic syndrome.
... LDL-C) often combined data from low-cholesterol diets, such as decreasing saturated fat-containing meats along with eggs (11) . Given that eggs are low in saturated fat (1·56 g per large chicken egg) and contain components that may decrease risk of certain cardiometabolic diseases, combining data on eggs with saturated fat-rich foods may not reflect the actual effect of eggs alone on health outcomes (12) . Indeed, in contrast to the intervention studies that measured biomarkers, prospective cohort studies that assessed cardiometabolic disease outcomes reported associations of eggs with either decreased or null risks in the general population (13) . ...
... Indeed, in contrast to the intervention studies that measured biomarkers, prospective cohort studies that assessed cardiometabolic disease outcomes reported associations of eggs with either decreased or null risks in the general population (13) . Data from sub-groups of prospective studies, however, have been inconsistent, particularly in diabetics (12,13) . Although numerous reviews on eggs and health have been published, most are narrative and, until recently, only a few systematic reviews and meta-analyses on the effect of eggs on cardiometabolic-related health outcomes have become available (14,15) . ...
Article
Objective This umbrella review provides an overview of the consistency and gaps in the evidence base on eggs and cardiometabolic health. Design PubMed, Web of Science, Cochrane Library, the Nutrition Evidence Systematic Review and Agency for Healthcare Research and Quality databases were screened for evidence-based reviews in English that assessed human studies on egg consumption and cardiometabolic outcomes. Results Seven systematic reviews and fifteen meta-analyses were identified, with eighteen of these published since 2015. Overall, the systematic reviews were of low quality, while meta-analyses were of moderate- to high-quality. No association of increased egg intake and risks of heart disease or stroke in the general population were found in the meta-analyses. Increased risk of heart failure was noted in two meta-analyses that analysed the same three cohort studies. Five recent meta-analyses reported no increased risk of type 2 diabetes mellitus (T2DM) in the general population, although increased risk in US-based populations only has been reported. Older (<2013) meta-analyses reported increased risks of cardiovascular disease (CVD) or heart disease in T2DM populations, and no recent evidence-based reviews were identified. Finally, only one meta-analysis reported intervention studies specifically on eggs and biomarkers (i.e. lipids), and the results contradicted those from observation studies. Conclusions Recent evidence-based reviews conclude that increased egg consumption is not associated with CVD risk in the general population. More research is needed on the positive associations between egg consumption and heart failure and T2DM risk, as well as CVD risk in diabetics, before firm conclusions can be made.
... On one hand, eggs are an inexpensive source of highquality protein, all B vitamins, folate, fat-soluble vitamins, as well as, several essential minerals that play a fundamental role in basic nutrition. On the other hand, eggs are a main source of cholesterol and relevant of saturated fat that are potentially associated with an increased risk of cardiovascular diseases (CVD) and type 2 diabetes [1]. ...
... Dietary guidelines on egg and cholesterol consumption vary among specialist societies, countries, and also differ along the time. The 2010 American Heart Association Dietary Guidelines recommendation to limit consumption of 1 3 dietary cholesterol to 300 mg per day is not included in the 2015 edition; however, the guidelines state that "individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern" [1]. Similarly, the British Heart Foundation recently removed their advice to limit egg consumption to three per week and there is currently no restriction on egg consumption [2]. ...
Article
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Purpose: Dietary guidelines for egg consumption for general population differ among public health agencies. Our aim was to investigate the association between egg intake and both all-cause and specific-cause of mortality in a Mediterranean population. Methods: The European Prospective Investigation into Cancer and Nutrition (EPIC)-Spain cohort included 40,621 men and women aged 29-69 years old in the nineties from 5 Spanish regions. After a mean of 18 years of follow-up, 3,561 deaths were recorded, of which 1,694 were from cancer, 761 from CVD, and 870 from other causes. Data on egg consumption was collected using a validated diet history at recruitment. Cox proportional hazards models, adjusted for confounders, were used in the analyses. Results: The mean (standard deviation) egg consumption was 22.0 g/day (15.8) and 30.9 g/day (23.1) in women and men, respectively. No association was observed between egg consumption and all-cause mortality for the highest vs the lowest quartile (HR 1.01; 95% CI 0.91-1.11; P trend = 0.96). Likewise, no association was observed with cancer and cardiovascular diseases mortality. However, an inverse association was found between egg consumption and deaths for other causes (HR 0.76; 95% CI 0.63-0.93; P trend = 0.003), particularly for deaths from the nervous system (HR 0.59; 95% CI 0.35-1.00; P trend = 0.036). No interaction was detected with the adherence to Mediterranean diet. Conclusions: This study shows no association between moderate egg consumption, up to 1 egg per day, and main causes of mortality in a large free-living Mediterranean population.
... The two main sports disciplines involve different types of muscle metabolism. Sprint and other sports that require explosive power require anaerobic muscle metabolism, while endurance exercise depends on aerobic metabolism [2]. ...
Conference Paper
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The purpose of this study was to determine the effect of combining honey and eggs as an additional supplement into improving the endurance of badminton athletes. This study is a pre-experimental study which is used to find a cause-and-effect relationship and not uses control group so using research design of one-group pre-posttest design, with the number of samples counted 15 people. Based on the results of data analysis, it was found that supplementary addition of honey and eggs before the test was done to give a significant effect compared to the initial test conducted on the same sample without intervention. Provision of honey and eggs was made one hour before the exercise activity resulted in maximal endurance performance of the data showed that the mean value of endurance after being given honey and egg combination supplement on badminton athlete was 41.627 ml/kg/min, higher than the value The average initial resistance at the badminton athlete before the intervention is 37.407 ml/kg/min, so it can be concluded that there is significant influence from supplementary supplement combination of honey and egg to increase endurance athlete.
... The two main sports disciplines involve different types of muscle metabolism. Sprint and other sports that require explosive power require anaerobic muscle metabolism, while endurance exercise depends on aerobic metabolism [2]. Endurance exercise is an exercise that requires a lot of stamina, so today many athletes are taking supplements that can increase endurance when consumed before exercising to support their performance in the field, such as athletes who want to gain extra energy or to speed up recovery after exercise often found to consume honey and eggs. ...
Conference Paper
The purpose of this study was to determine the effect of combining honey and eggs as an additional supplement into improving the endurance of badminton athletes. This study is a pre-experimental study which is used to find a cause-and-effect relationship and not uses control group so using research design of one-group pre-posttest design, with the number of samples counted 15 people. Based on the results of data analysis, it was found that supplementary addition of honey and eggs before the test was done to give a significant effect compared to the initial test conducted on the same sample without intervention. Provision of honey and eggs was made one hour before the exercise activity resulted in maximal endurance performance of the data showed that the mean value of endurance after being given honey and egg combination supplement on badminton athlete was 41.627 ml/kg/min, higher than the value The average initial resistance at the badminton athlete before the intervention is 37.407 ml/kg/min, so it can be concluded that there is significant influence from supplementary supplement combination of honey and egg to increase endurance athlete.
... The biological plausibility of a lack of an unfavorable effect of a higher intake of eggs over the risk of CHD and stroke is provided by RCTs that did not find a worsening in CVD risk markers (lipid profile, body weight) in greater consumers of eggs (up to 1 egg/day) [107]. An increase of the intake of cholesterol with the diet does not have a negative impact on the lipid profile because in about 75% of the population leads to a reduction of the absorption of the same and/or of its synthesis and therefore a moderate or absent difference in serum cholesterol (normal or hypo-responders subjects) [108]. In hyper-responding subjects, the dietary increase of cholesterol leads to an increase of LDL cholesterol but also of HDL cholesterol with minimal effects on the LDL/HDL ratio [109]. ...
Article
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In the last decade, a number of meta-analyses of mostly observational studies evaluated the relation between the intake of food groups and the risk of noncommunicable diseases (NCDs). In this study, we systematically reviewed dose-response meta-analyses of prospective studies with the aim to derive the quantities of food to consume to attain a protective (Mediterranean food) or a non-adverse (non-Mediterranean food) effect toward selected NCDs such as cardiovascular disease (CVD) including coronary heart disease (CHD) and stroke, type 2 diabetes (T2DM), colorectal (CRC) and breast cancer. These derived quantities, wherever possible, were suggested for a quantification of food servings of the Mediterranean Diet Pyramid proposed for Italian People (MDPPI). This pyramid came from the Modern Mediterranean Diet Pyramid developed in 2009 for Italian people. A weekly menu plan was built on the advice about frequency of intakes and serving sizes of such pyramid and the nutritional composition of this diet was compared with the Reference Italian Mediterranean Diet followed in 1960 in Nicotera. The diet built according the advice of MDPPI was very similar to that of Nicotera in the late 1950s that has been chosen as Italian Reference Mediterranean Diet with the exception of percentage of energy provided by cereals that was lower and of fruits and vegetables that was higher. Saturated fatty acids were only the 6% of daily energy intake. Also the Mediterranean Adequacy Index (MAI) was very similar to that of the aforementioned diet.
... It is an important determinant of hypercholesterolemia, including total serum cholesterol and Low Density Lipoprotein cholesterol (LDL-c), both of which are well accepted intermediate biomarkers for CVD [6,7] in all age groups. The effect of dietary cholesterol intake to hypercholesterolemia, however, remains controversial and the need for specific nutritional guidelines for cholesterol limits or intake of specific food intake remains debatable, although some large health organizations such as the British Heart foundation [8] and the American Diabetes Association [8] have lifted specific limits, based on recent findings [9-12], and Dietary Guidelines for Americans do not report specific levels, but continue to advise on low dietary cholesterol intake while consuming a healthy diet [13]. ...
Article
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Background: Gaps remain on the safety of egg intake on cardiovascular health, setting the study's aim to investigate the association between quantity and frequency of egg consumption, with established dyslipidemia. Methods: Study participants (N = 3558, 40.3% males) included individuals from the Hellenic National and Nutrition Health Survey (HNNHS), of national representation. Quantity and frequency of egg consumption was determined. Minimally adjusted, multivariable logistic and linear analysis were used to assess egg consumption and dyslipidemia. Results: The more frequent egg consumption compared to no or rare egg consumption significantly decreased the odds of dyslipidemia in the minimally adjusted (Odds Ratio (OR) for frequency: 0.83; 95% Confidence Interval (CI): 0.752, 0.904; OR for quantified frequency: 0.87; 95% CI: 0.796, 0.963) and the fully adjusted models (OR for frequency: 0.80; 95% CI: 0.718, 0.887; OR for quantified frequency: 0.85; 95%CI: 0.759, 0.945). Level of serum cholesterol and LDL-c were significantly lower with higher frequency and quantified frequency of egg consumption in all models. Conclusion: Eggs do not increase the risk of dyslipidemia and can be consumed as part of a healthy diet that is high in fiber and low in saturated fat, without excessive energy intake, by all individuals.
... The two main sports disciplines involve different types of muscle metabolism. Sprint and other sports that require explosive power require anaerobic muscle metabolism, while endurance exercise depends on aerobic metabolism [2]. ...
... Previous dietary recommendations suggested that egg consumption be limited because of the high cholesterol content of eggs; however, recent evidence demonstrated increases in serum HDL-C as well as LDL-C with egg consumption. Moreover, eggs are also a rich source of xanthophyll carotenoids, which have been shown to have anti-inflammatory activities (43)(44)(45) . The number of servings of foods from the 'meat' food group consumed by residents was within the recommended guidelines of 2-2·5 servings daily, so within recommended levels these foods had a positive effect on serum HDL-C levels. ...
Article
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CVD is common in older adults. Consumption of ‘meat’ (beef, pork, lamb, game, poultry, seafood, eggs) and dairy foods (milk, cheese, yoghurt) is encouraged in older adults as these foods provide protein and nutrients such as essential fatty acids, Ca, Fe, Zn and vitamins A, D and B 12 required for healthy ageing. However, these foods also contain saturated fats considered detrimental to cardiovascular health. To determine the effect of their consumption on CVD risk we assessed associations between fat intake from ‘meat’ and dairy foods and serum cholesterol levels in 226 aged-care residents (mean age 85·5 years, 70 % female). Dietary intake was determined over 2 d using visual estimation of plate waste. Fat content of foods was determined using nutrition analysis software (Xyris, Australia). Fasting serum total cholesterol (TC), LDL-cholesterol and HDL-cholesterol were measured, and the TC:HDL-cholesterol ratio calculated. Associations were determined using random-effect models adjusted for CVD risk factors using STATA/IC 13.0. Total fat and saturated fat from ‘meat’ and dairy foods were associated with higher serum HDL-cholesterol levels, and dairy fat intake and number of servings were associated with a lower TC:HDL-cholesterol ratio. Every 10 g higher intake of fat and saturated fat from dairy products, and each additional serving was associated with a −0·375 (95 % CI −0·574, −0·175; P = 0·0002), a −0·525 (95 % CI −0·834, −0·213; P = 0·001) and a −0·245 (95 % CI −0·458, −0·033; P = 0·024) lower TC:HDL-cholesterol ratio, respectively. Provision of dairy foods and ‘meat’ in recommended amounts to institutionalised older adults potentially improves intakes of key nutrients with limited detriment to cardiovascular health.
... The effects of dietary cholesterol and egg intake, as a part of the usual diet, on disease risk and longevity have been debated for decades. Eggs contain essential amino acids, B vitamins, unsaturated fatty acids, choline, lutein, and zeaxanthin (2), some of which (e.g., choline) have CVDprotective effects. However, eggs are also a rich source of dietary cholesterol (186 mg of cholesterol per egg) (3). ...
Article
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Objective This systematic review and meta-analysis of prospective cohort studies examined the associations between egg and dietary cholesterol intake and the risk of mortality from all causes, including cardiovascular disease (CVD) and cancer. Methods We searched PubMed, Scopus, ISI Web of Knowledge, and Google Scholar until April 2021, as well as references to the relevant articles retrieved. Random-effects models were used to calculate summary relative risk (RR) and 95% confidence intervals (CIs) for the highest vs. lowest categories of egg and dietary cholesterol intake. Also, linear and non-linear dose–response analyses were conducted to examine the dose-response relationships. Results We included 55 studies, comprising data from 2,772,486 individuals with 228,425, 71,745, and 67,211 cases of all-cause, CVD, and cancer mortality, respectively. Intake of each additional egg per day was associated with a 7% higher risk of all-cause (1.07, 95% CI: 1.02–1.12, I ² = 84.8%) and a 13% higher risk of cancer mortality (1.13, 95% CI: 1.06–1.20, I ² = 54.2%), but was not associated with CVD mortality (1.00, 95% CI: 0.92–1.09, I ² = 81.5%). Non-linear analyses showed increased risks for egg consumption of more than 1.5 and 0.5 eggs/day, respectively. Each 100 mg/day increment in dietary cholesterol intake was associated with a 6% higher risk of all-cause mortality (1.06, 95% CI: 1.03–1.08, I ² = 34.5%) and a 6% higher risk of cancer mortality (1.06, 95% CI: 1.05–1.07, I ² = 0%), but was not associated with CVD mortality (1.04, 95% CI: 0.99–1.10, I ² = 85.9%). Non-linear analyses demonstrated elevated risks of CVD and cancer mortality for intakes more than 450 and 250 mg/day, respectively. Conclusions and Relevance High-dietary intake of eggs and cholesterol was associated with all-cause and cancer mortality. Little evidence for elevated risks was seen for intakes below 0.5 egg/day or 250 mg/day of dietary cholesterol. Our findings should be considered with caution because of small risk estimates and moderate between-study heterogeneity. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=252564 , PROSPERO, identifier: CRD42021252564.
... Another report examining six original studies of egg consumption and CVD risk in patients with or at risk for type 2 diabetes concluded that consumption of up to twelve eggs weekly had no effect on major CVD risk factors including TC, LDL-C, TAG, fasting glucose, insulin and C-reactive protein (28) . Another review has pointed out that in most studies, egg consumption has had no negative effects on glycaemic control when tested in various populations including those who are obese or diabetic (29) . Therefore, more research is needed to clarify inconsistencies between studies, but there is currently insufficient evidence to support egg restriction among diabetics or those at risk for diabetes to reduce CVD risk (30) . ...
Article
Objective Whole eggs are rich sources of several micronutrients. However, it is not well known how egg consumption contributes to overall nutrient adequacy and how it may relate to CVD risk factors. Therefore, the present study aimed to determine how whole egg consumption contributes to nutrient intakes and to assess its association with CVD risk factors in US adults. Design Cross-sectional study. Setting The study was conducted using data from the National Health and Nutrition Examination Survey (NHANES) 2003–2012, a nationally representative survey of the US civilian population. Participants Adults who completed two dietary recalls and provided information on relevant sociodemographic factors were included in the study ( n 21 845). Results Approximately 73 % of adults were classified as whole egg consumers. Egg consumption was associated with greater intakes of protein, saturated fat, mono- and polyunsaturated fats, Fe, Zn, Ca, Se, choline, and several other vitamins and minerals. Egg consumption was associated with a higher likelihood of meeting or exceeding recommendations for several micronutrients. Egg intake was positively associated with dietary cholesterol consumption, but not with serum total cholesterol (TC) when adjusted for multiple potential confounders. In multiple linear regression analyses, TAG, TAG:HDL-cholesterol and TC:HDL-cholesterol were significantly lower with greater egg consumption. Egg consumption had no significant relationship with LDL-cholesterol or C-reactive protein, but was associated with higher BMI and waist circumference. Conclusions Whole eggs are important dietary contributors of many nutrients and had either beneficial or non-significant associations with most CVD risk biomarkers examined.
... The link between egg-derived cholesterol and disease is subject to much investigation. Many population studies and clinical interventions show that egg intake does not increase the risk for cardiovascular diseases despite being rich in dietary cholesterol [1][2][3]. Recently, the Dietary Guidelines for Americans released by USDA in January 2016 removed the 300 mg/d limits for dietary cholesterol, shifting the focus to other components of eggs that may positively influence health [4]. Egg yolks contain the bioavailable forms of the potent antioxidant carotenoids lutein and zeaxanthin, which protect against the development of metabolic diseases by increasing the mRNA expression of antioxidant enzymes and decreasing pro-inflammatory cytokines [5]. ...
Article
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We previously demonstrated that intake of three eggs/d for 4 weeks increased plasma choline and decreased inflammation in subjects with metabolic syndrome (MetS). The purpose of the current study was to further explore the effects of phosphatidylcholine (PC) provided by eggs versus a choline bitartrate (CB) supplement on the gut microbiota, trimethylamine N-oxide (TMAO) formation, and plasma carotenoids lutein and zeaxanthin in MetS. This randomized, controlled crossover clinical trial included 23 subjects with MetS. Following a washout period of 2 weeks without consuming any choline-containing foods, subjects were randomly allocated to consume either three eggs/d or a CB supplement for 4 weeks (both diets had a choline equivalent of 400 mg/day). DNA was extracted from stool samples to sequence the 16S rRNA gene region for community analysis. Operational taxonomic units (OTUs) and the α-diversity of the community were determined using QIIME software. Plasma TMAO, methionine, betaine, and dimethylglycine (DMG) were quantified by stable isotope dilution liquid chromatography with tandem mass spectrometry. Plasma carotenoids, lutein, and zeaxanthin were measured using reversed-phase high-performance liquid chromatography. There were significant increases in plasma lutein and zeaxanthin after egg intake compared to the baseline or intake of CB supplement (p < 0.01). In contrast, TMAO was not different between treatments compared to the baseline (p > 0.05). Additionally, while diet intervention had no effects on microbiota diversity measures or relative taxa abundances, a correlation between bacterial biodiversity and HDL was observed. Following egg intake, the observed increases in plasma lutein and zeaxanthin may suggest additional protection against oxidative stress, a common condition in MetS.
... A randomized, double-blind, placebo-controlled study conducted by Made et al (2014) showed no different between 2 intervention groups (egg group and control group). According to Clayton et al (2016), in a review study about egg consumption and heart health, it is important to utilize various approaches for future studies to understand how eggs affect human health. Results from two randomized controlled crossover trials conducted by Kim and Campbell (2017) indicated that the dietary cholesterol in whole eggs was not well absorbed and did not affect plasma total cholesterol concentration. ...
Article
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Hypercholesterolemia, the presence of high levels of cholesterol in the blood, is one of the major risk factor for cardiovascular disease (CVD). One of the key recommendation in the Dietary Guidelines for Americans 2010, is to consume less than 300 mg of dietary cholesterol per day. The same amount is also adopted in Indonesia (BPOM, 2016) until today. However, in the latest Dietary Guidelines for Americans 2015-2020, dietary cholesterol is no longer included in the list of specific foods that should be limited. The added sugars, sodium, saturated fats and trans fats remain on the list of food components that should be reduced. Generally, foods that are higher in dietary cholesterol are also higher in saturated fats. But there are also some foods that are higher in cholesterol but not in saturated fats. According to the latest recommendation, this kind of foods can be consumed without any specific restriction. In this review, some of clinical studies related to the association between dietary cholesterol and blood cholesterol levels are selected. The findings from those studies will be summarized to consider whether the same recommendation should be implemented in other countries, especially in Indonesia.
... The average large whole egg (50 g), contains only 1.56 g of saturated fat, 1.83 g monounsaturated fat and 0.96 g polyunsaturated fat (Table 1). Egg yolk is also rich in dietary choline (147 mg) [14], which is an essential nutrient for human liver and muscle functions [15]. Choline intake is inadequate in 9 out of 10 American Adults [16]. ...
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Cardiovascular disease (CVD) is the leading cause of death in the United States. For years, dietary cholesterol was implicated in increasing blood cholesterol levels leading to the elevated risk of CVD. To date, extensive research did not show evidence to support a role of dietary cholesterol in the development of CVD. As a result, the 2015⁻2020 Dietary Guidelines for Americans removed the recommendations of restricting dietary cholesterol to 300 mg/day. This review summarizes the current literature regarding dietary cholesterol intake and CVD. It is worth noting that most foods that are rich in cholesterol are also high in saturated fatty acids and thus may increase the risk of CVD due to the saturated fatty acid content. The exceptions are eggs and shrimp. Considering that eggs are affordable and nutrient-dense food items, containing high-quality protein with minimal saturated fatty acids (1.56 gm/egg) and are rich in several micronutrients including vitamins and minerals, it would be worthwhile to include eggs in moderation as a part of a healthy eating pattern. This recommendation is particularly relevant when individual’s intakes of nutrients are suboptimal, or with limited income and food access, and to help ensure dietary intake of sufficient nutrients in growing children and older adults.
... In recent years, the role of dietary cholesterol in the incidence of complications attributed to atherosclerosis has been questioned in such a way that the American Heart Association has ceased to consider limiting the intake of eggs for protection against cardiovascular atherosclerotic disease (CHD). In this sense, the 2015-2020 Dietary Guidelines for Americans have removed the recommendation of limiting cholesterol intake to no more than 300 mg per day [122]. However, they do suggest that dietary cholesterol remains important to consider in order to build healthy eating patterns [123]. ...
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Cholesterol is an essential molecule that exerts pleiotropic actions. Although its presence is vital to the cell, its excess can be harmful and, therefore, sustaining cholesterol homeostasis is crucial to maintaining proper cellular functioning. It is well documented that high plasma cholesterol concentration increases the risk of atherosclerotic heart disease. In the last decades, several studies have investigated the association of plasma cholesterol concentrations and the risk of cardiovascular diseases as well as the signaling pathways involved in cholesterol homeostasis. Here, we present an overview of several mechanisms involved in intestinal cholesterol absorption, the regulation of cholesterol synthesis and uptake. We also discuss the importance of reverse cholesterol transport and transintestinal cholesterol transport to maintain cholesterol homeostasis and prevent atherosclerosis development. Additionally, we discuss the influence of dietary cholesterol on plasma cholesterol concentration and the new recommendations for cholesterol intake in a context of a healthy dietary pattern.
... Since the US regulatory authorities claimed, several studies have been published with controversial conclusions (Berger et al. 2015;Freeman et al. 2017;Grundy 2016;Poggio et al. 2017;Rhee et al. 2017). Some of them were focus on how the egg intake modified the blood cholesterol levels (Clayton, Fusco, and Kern 2017;D ıez-Espino, et al. 2017;Eckel 2015;Kishimoto et al. 2017). ...
Article
Eggs are highly nutritious food whose high cholesterol content has been always an inconvenience due to concerns about the relationship between dietary cholesterol and atherosclerotic cardiovascular risk. As this remains uncertain, low cholesterol intake is recommended. This review deals with the techniques employed to reduce the cholesterol content in egg yolk once the egg is shelled. There are four main techniques: i) solvent extraction, ii) fractionation by centrifugation, iii) cholesterol chelates or adsorbents and iv) cholesterol biotransformation. Analyse of techniques, descriptions and recent advances are included in this review. Solvent extraction and cholesterol biotransformation allow to reduce up to 94.7% and 93.4%, respectively. However, both methods have not been scaled up due to food safety and economic reasons. Nowadays, fractionation by centrifugation and cholesterol chelates are the only feasible methods with industrial applications, obtaining up to 82% and 99%, respectively. Fractionation method can be considered the best because no substances are added.
... Therefore, the blood lipid response to dietary eggs may vary in different populations. [90] A diet including eggs more than the recommendations may be safe in the general population and even those at risk (patients with CVDs, CHD, type 2 diabetes). [91] In this context, a diet that includes high egg intake, along with a low SFA intake (PUFAs:SFAs >0.7) or replaced SFAs (with MUFAs and PUFAs), may result in lower or no changes in LDL-C; therefore, it might be considered safe. ...
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Cardiovascular diseases are the underlying cause of most deaths worldwide, and they are expected to rise in the following years. Cardiovascular diseases include diseases that affect the heart, cerebral, and peripheral vessels, resulting in ischemia. On the basis of cardiovascular disease pathophysiology, there are lipoprotein metabolism abnormalities, oxidative stress, chronic inflammation, endothelium damage, and atherothrombosis. Modifiable risk factors for cardiovascular health and diseases are blood pressure, blood lipid profile, oxidative stress, inflammation, and other factors (smoking, obesity, diabetes mellitus). Atherosclerotic plaque development, vascular calcification, and vascular stiffness are caused by a long-term endothelial dysfunction and inflammatory response, which can be prevented and controlled by the diet. Fat and cholesterol are the commonly considered dietary factors in the association of the nutrition and the cardiovascular disease, although other macronutrients, especially carbohydrates and proteins, also have major effects. Nowadays, other macronutrients and micronutrients (minerals and vitamins) have roles in regulating the indicated processes (blood pressure, calcification, oxidative stress, inflammation, etc.) in cardiovascular disease prognosis. Other dietary compounds (sterols, stanols, polyphenols, carotenoids, etc.) that exist in small amounts in foods might have a role in regulating these mechanisms as well. There are also new insights about walnuts, garlic, ginger, and hawthorn as parts of a healthy diet against cardiovascular diseases. So far, there have not appeared any reviews that combine the impact of a wide variety of dietary components on cardiovascular diseases. Thus, the novel nutritional targets and interventions that focus on nutrients and other dietary compounds on potential mechanisms underlying cardiovascular diseases are discussed in this review.
... Eggs are a major source of dietary choline and consumption results in increased exposure to trimethylamine-N-oxide, a metabolite linked to atherosclerosis Senthong et al., 2016). At the same time, egg yolks are a source of bioavailable xanthophyll carotenoids with anti-inflammatory, anti-oxidative and anti- atherosclerotic effects that may possibly promote cardiovascular health (Clayton et al., 2017). ...
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Background: Despite growing evidence for food-based dietary patterns’ potential to reduce cardiovascular disease risk, knowledge about the amounts of food associated with the greatest change in risk of specific cardiovascular outcomes and about the quality of meta-evidence is limited.Therefore, the aim of this meta-analysis was to synthesize the knowledge about the relation between intake of 12 major food groups (whole grains, refined grains, vegetables, fruit, nuts, legumes, eggs, dairy, fish, red meat, processed meat, and sugar-sweetened beverages [SSB]) and the risk of coronary heart disease (CHD), stroke and heart failure (HF). Methods: We conducted a systematic search in PubMed and Embase up to March 2017 for prospective studies. Summary risk ratios (RRs) and 95% confidence intervals (95% CI) were estimated using a random effects model for highest versus lowest intake categories, as well as for linear and non-linear relationships. Results: Overall, 123 reports were included in the meta-analyses. An inverse association was present for whole grains (RRCHD: 0.95 (95% CI: 0.92-0.98), RRHF: 0.96 (0.95-0.97)), vegetables and fruits (RRCHD: 0.97 (0.96-0.99), and 0.94 (0.90-0.97); RRstroke: 0.92 (0.86-0.98), and 0.90 (0.84-0.97)), nuts (RRCHD: 0.67 (0.43-1.05)), and fish consumption (RRCHD: 0.88 (0.79-0.99), RRstroke: 0.86 (0.75-0.99), and RRHF: 0.80 (0.67-0.95)), while a positive association was present for egg (RRHF: 1.16 (1.03-1.31)), red meat (RRCHD: 1.15 (1.08-1.23), RRstroke: 1.12 (1.06-1.17), RRHF: 1.08 (1.02-1.14)), processed meat (RRCHD: 1.27 (1.09-1.49), RRstroke: 1.17 (1.02-1.34), RRHF: 1.12 (1.05-1.19)), and SSB consumption (RRCHD: 1.17 (1.11-1.23), RRstroke: 1.07 (1.02-1.12), RRHF: 1.08 (1.05-1.12)) in the linear dose-response meta-analysis. There were clear indications for non-linear dose-response relationships between whole grains, fruit, nuts, dairy, and red meat and CHD. Conclusion: An optimal intake of whole grains, vegetables, fruit, nuts, legumes, dairy, fish, red and processed meat, eggs and SSB showed an important lower risk of CVD.
... Public interests in dietary cholesterol had increased considerably due to the association of plasma cholesterol levels with the risk of heart diseases. As around 20e25% of cholesterol in our body comes from the food of animal origin, such as egg, meat, milk products, etc., it is important to know the cholesterol concentration in our dietary intake [23]. Food nutritional information need to be provided by laboratories to food producers for precise food labeling, as a nutrition food label has to inform customers about healthy eating and appropriate food choices to reduce nutrient-related diseases [24]. ...
Article
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Cholesterol is an important lipid molecule in cell membranes and lipoproteins. Cholesterol is also a precursors of steroid hormones, bile acids, and vitamin D. Abnormal levels of cholesterol or its precursors have been observed in various human diseases, such as heart diseases, stroke, type II diabetes, brain diseases and many others. Therefore, accurate quantification of cholesterol is important for individuals who are at increased risk for these diseases. Multiple analytical methods have been developed for analysis of cholesterol, including classical chemical methods, enzymatic assays, gas chromatography (GC), liquid chromatography (LC), and mass spectrometry (MS). Strategy known as ambient ionization mass spectrometry (AIMS), operating at atmospheric pressure, with only minimal sample pretreatments for real time, in situ, and rapid interrogation of the sample has also been employed for quantification of cholesterol. In this review, we summarize the most prevalent methods for cholesterol quantification in biological samples and foods. Nevertheless, we highlight several new technologies, such as AIMS, used as alternative methods to measure cholesterol that are potentially next-generation platforms. Representative examples of molecular imaging of cholesterol in tissue sections are also included in this review article.
... Due to their amino-acid content and bioavailability, eggs are among the best sources of protein (39) . In the 1990s, and even at the beginning of the 21st century, their consumption was questioned for their cholesterol contentbetween 300 and 400 mg per 100 geven though there is not enough evidence to state that dietary cholesterol is a risk factor for the development of CVD (45)(46)(47)(48) . According to the National Poultry Farmers Fund of Colombia (Fondo Nacional de Avicultores de Colombia) and the National Poultry Fund (Fondo Nacional Avícola (FENAVI)), the egg industry has been growing steadily in the last 9 years. ...
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The present study aimed to (a) establish the frequency of consumption of red meat and eggs; (b) determine serum ferritin levels (μg/l); and (c) establish the relationship between serum ferritin and the consumption of red meat and eggs. In Colombia during 2014–2018, an analytical study was conducted in 13 243 Colombian children between the ages of 5 and 17 years, based on cross-sectional data compiled by ENSIN-2015 (Encuesta Nacional de la Situación Nutricional en Colombia-2015) on serum ferritin levels and dietary consumption based on a questionnaire of the frequency of consumption. Using simple and multiple linear regression, with the serum ferritin level as the dependent variable and the frequency of consumption as the main explanatory variable, the crude and adjusted partial regression coefficients (β) between serum ferritin levels and consumption were calculated. The frequency of habitual consumption of red meat was 0⋅49 (95 % CI 0⋅47, 0⋅51) times/d. The frequency of habitual egg consumption was 0⋅76 (95 % CI 0⋅74, 0⋅78) times per d. The mean serum ferritin level in men was 41⋅9 (95 % CI 40⋅6, 43⋅1) μg/l and in women, 35⋅7 (95 % CI 34⋅3, 37⋅7) μg/l ( P < 0⋅0001). The adjusted β between the consumption of red meat and eggs and serum ferritin levels were β = 3⋅0 (95 % CI 1⋅2, 4⋅7) and β = 2⋅5 (95 % CI 1⋅0, 3⋅9) for red meat and eggs, respectively. In conclusion, red meat and eggs are determinants of serum ferritin levels in Colombia and, therefore, could be considered public policy options to reduce anaemia and Fe deficiency.
... Eggs are a major source of dietary choline and consumption results in increased exposure to trimethylamine-N-oxide, a metabolite linked to atherosclerosis Senthong et al., 2016). At the same time, egg yolks are a source of bioavailable xanthophyll carotenoids with anti-inflammatory, anti-oxidative and anti- atherosclerotic effects that may possibly promote cardiovascular health (Clayton et al., 2017). ...
... College of Cardiology (ACC) emphasized restriction of dietary cholesterol (Clayton, Fusco, & Kern, 2017). In the current Dietary Guidelines for Americans (2015)(2016)(2017)(2018)(2019)(2020), the recommendations for healthy individuals to limit dietary cholesterol intake has been removed, due to poor relationships between dietary cholesterol and increased CVD risk (2015-2020 Dietary Guidelines for Americans. ...
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Diverse notions exist regarding egg intake, which is one of the main sources of dietary cholesterol, and its effect on blood lipids. We conducted this study to update the previous meta‐analysis for their flaw in calculated effect size. PubMed, Scopus, ISI, and Cochrane were searched up to April 2019, for relevant randomized controlled clinical trials. Mean changes in total cholesterol (TC), LDL‐cholesterol (LDL‐C), HDL‐cholesterol (HDL‐C), triglyceride (TG), very low‐density lipoprotein cholesterol (VLDL‐C), LDL‐C/HDL‐C, TC/HDL‐C, apolipoprotein (apo)A1, and apoB100 were assessed. Meta‐analysis of 66 RCTs with 3,185 participants revealed that egg consumption can significantly increase TC, LDL‐C, HDL‐C, TC/HDL‐C, apoA1/and B100, but there was no significant effect on other serum lipids. Dose‐response analysis showed a linear effect for TC, HDL‐C, ApoA1, ApoB100, and nonlinear for LDL‐C, and TC/HDL‐C. In conclusion, intake of more than one egg daily in less than 12 weeks may increase some blood lipids without any changes in the ratio of LDL‐C/HDL‐C. Practical applications There are controversies reports for egg intake, which is one of the main sources of dietary cholesterol. This study provides comprehensive information about the effect of the number of eggs consumed per day (dietary cholesterol) on blood lipids for nutritionists, physicians, researchers, and the general population. In this regard, our results indicated that there is a linear correlation between consumption of greater than one egg per day in a short time (no long time) and increasing lipid profiles which may increase the risk of cardiovascular diseases. However, consumption of one egg daily can be safe and this can be a useful recommendation for prevention of cardiovascular disease and promotion of healthy life which indeed are the potential or actual uses of this research.
... High cardiovascular risk participants who consumed 2-4 eggs per week had no increased CVD risk (24). No more than four yolks per week are also suggested by Dietary Approaches to Stop Hypertension (DASH) diet (25). Since the Lithuanian FBDG does not provide specific quantities for egg consumption a week, we decided to follow other EU countries (19) that had defined this frequency, and chose "optimal" consumption as 2-4 times per week (e.g., Belgium (Flanders region), Ireland-no more than seven, Greece, Romania-up to 4, Spain−4-5, Croatia−3-4, Italy, Malta−2-4, Cyprus, the Netherlands, Austria, Finland-up to three eggs per week). ...
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A healthy and balanced diet is an important factor contributing to overall health and wellness. The aim of this study was to develop a Healthy Diet Index (HDI) score and assess its association with various chronic diseases and lifestyle risk factors. A cross-sectional survey included 1,111 adults aged 18 years and older. Information on dietary habits was collected using a questionnaire. Additional demographic, socioeconomic and lifestyle risk factors data were also collected. Sixteen food groups were used to develop the HDI score for the residents of Kaunas city, Lithuania based on the national recommendations, World Health Organization (WHO) and other guidance on a healthy diet. We used logistic regression models to assess the association of the HDI score with chronic diseases, obesity and lifestyle risk factors. We found that both males and females were lacking the optimal consumption of the base components of a healthy diet–fruits and vegetables, starchy carbohydrates, and proteins. We also observed significant associations between the HDI score and several outcomes such as hypertension, arrhythmia, physical activity, and obesity. The suggested HDI score could serve as a valuable tool in assessing and improving dietary habits beneficial for promoting health and preventing many diseases.
... Nutritional risk factors have been considered of paramount importance to prevent the global burden of CVD [2,3]. Among the many factors widely studied over the last decades, dietary cholesterol has been the focus of major attention due to the relationship between blood cholesterol and increased risk of CVD firstly observed in the Framingham Heart Study nearly half century ago and ever since considered as risk factor [4]. Eggs, as major sources of dietary cholesterol (200-300 mg/100 g, about 180 mg per medium egg), have been subsequently advised to be consumed in moderation to lower dietary cholesterol intake [5]. However, current evidence on the association between dietary cholesterol and CVD risk is not consistent [6]. ...
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Purpose: Cardiovascular disease (CVD) is a leading cause of mortality globally and is strongly influenced by dietary risk factors. The aim was to assess the association between egg consumption and risk of CVD risk/mortality, including coronary heart disease (CHD), stroke, and heart failure. Methods: MEDLINE, Embase, and Web of Science databases were searched through April 2020 for prospective studies. Two independent reviewers screened and extracted the data through standardized methods. Size effects were calculated as summary relative risks (SRRs) in a dose-response fashion through random-effects meta-analyses. Results: Thirty-nine studies including nearly 2 million individuals and 85,053 CHD, 25,103 stroke, 7536 heart failure, and 147,124 CVD cases were included. The summary analysis including 17 datasets from 14 studies conducted on CVD (incidence and/or mortality) showed that intake of up to six eggs per week is inversely associated with CVD events, when compared to no consumption [for four eggs per week, SRR = 0.95 (95% CI: 0.90; 1.00)]; a decreased risk of CVD incidence was observed for consumption of up to one egg per day [SRR = 0.94 (95% CI: 0.89; 0.99)]. The summary analysis for CHD incidence/mortality including 24 datasets from 16 studies showed a decreased risk up to two eggs per week [(SRR = 0.96 (95% CI: 0.91; 1.00)]. No associations were retrieved with risk of stroke. The summary analysis for heart failure risk including six datasets from four studies showed that intake of one egg per day was associated with increased risk raising for higher intakes compared to no consumption [for 1 egg per day, SRR = 1.15 (95% CI:1.02; 1.30)]. After considering GRADE criteria for strength of the evidence, it was rated low for all outcomes but stroke, for which it was moderate (yet referring to no risk). Conclusion: There is no conclusive evidence on the role of egg in CVD risk, despite the fact that higher quality studies are warranted to obtain stronger evidence for a possible protection of CVD associated with moderate weekly egg consumption compared to no intake; equally, future studies may strengthen the evidence for increased heart failure risk associated with high regular egg consumption.
... Egg yolk is also rich in choline (147 mg), an essential nutrient for liver and muscle functions. 25,448 The impact of egg consumption on lipid profile is quite variable. 449 In healthy adolescents, the consumption of more than 3 eggs per week is not associated with changes in lipid profile. ...
... Dietary recommendations in relation to egg consumption have evolved over time. For many years, dietary guidelines suggested restricting dietary cholesterol intake and avoiding eggs to reduce cardiovascular disease (CVD) risk, but this is no longer the case (Clayton et al. 2017). In the UK, there is no specific recommendation or limit for egg consumption; eggs are now recognised as nutritious, and a good choice as part of a healthy, balanced diet (NHS 2018a). ...
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Dietary habits are constantly evolving with changes in culture, economics and the food supply. In the UK, red meat intakes have been declining for more than a decade, while egg consumption has increased in tandem with interest in healthy, sustainable diets. To explore current dietary habits of egg consumers and non‐consumers and potential implications for nutrition and health, we analysed dietary records from 647 adults participating in Year 9 (2017) of the UK National Diet and Nutrition Survey (NDNS). Mean consumption of eggs and egg dishes was 29 g/day (3.5 eggs/week). Female egg consumers (n = 224; mean 46 g/day, 5 eggs/week) ate more fruit, vegetables and fish and had significantly higher dietary intakes of protein, monounsaturated fatty acids, n‐3 polyunsaturated fatty acids and most micronutrients, notably vitamin D, most B vitamins, vitamin C, iron, zinc and selenium, compared with non‐consumers (n = 150). They also had higher plasma levels of 25‐hydroxyvitamin D, total carotenoids, selenium and ferritin and were less likely to be anaemic. Female egg consumers had a lower mean body mass index and waist circumference, despite reporting a higher mean energy intake than non‐consumers. Male egg consumers (n = 159; mean 54 g/day, 6 eggs/week) had higher dietary intakes of vitamin D, biotin, iodine and selenium but similar micronutrient status and bodyweight to non‐consumers (n = 114). There were no significant differences in cardiometabolic risk factors for either sex. Egg consumption appears to be associated with signs of higher dietary quality, better nutritional status, and slightly lower body mass index among women participating in the latest NDNS.
... Both are rich in proteins and protected with different layers of thin membranes. It is commonly consumed in boiled, fried, poached, cooked, or raw form (Clayton, Fusco, & Kern, 2017). Despite many health advantages, the chicken egg appears as one of the important eight food allergens. ...
Article
Immune-mediated food allergy and non-immune mediated food intolerance are categorized as the most common adverse reactions resulting from the ingestion of certain foods. As there is no standard treatment, the possible remedy to avoid exposure to these adverse reactions is adhering to a strict diet that eliminates allergic and intolerant foods. The commonly consumed foods including dairy products, egg, fish, shellfish, tree nuts, peanut, soybean, and wheat-based products are proven to cause food allergy. Foods containing lactose, gluten, high FODMAPs, biogenic amines, and certain food additives leads to potential health risks in intolerant individuals. Besides, there are various foods whose mechanism of action in triggering food allergy and intolerance is yet to be defined. However, the public in-depth understanding of natural foods, processed foods, and packaged food products that induce allergic reactions and intolerance remains low. Therefore, awareness of diet that partially or completely excludes the intake of certain foods associated with these reactions should be widespread among the consumers.
... It has been linked with the high cholesterol diet mimicking the modern Western diet (Morgantini et al., 2018). One of the rich dietary cholesterol sources is egg yolk containing 141-234 mg per egg, relying on the size and type of egg yolk (Clayton et al., 2017). This study used Quail egg yolk to disrupt total cholesterol metabolism. ...
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Purpose This study aims to evaluate the effect of the combination of tempeh and red ginger flour in hypercholesterolemic rats. Design/methodology/approach Sprague Dawley male rats ( n = 30; body weight 150-200 g) were randomly divided by five groups ( n = 6), consist of negative control (K−) group: group fed by normal diet (laboratory standard diet laboratory, 4.35 kcal/g, 0% cholesterol); positive control (K+) group: group fed by high cholesterol diet (5.28 kcal/g, 12.1% cholesterol); Treatment 1 (P1) group: group fed by high cholesterol diet and treated by tempeh flour (TF) 1.9 g/200 g body weight; Treatment 2 (P2) group: group fed by high cholesterol diet and treated by red ginger flour (RGF) 0.036 g/200 g body weight; and Treatment 3 (P3) group: group fed by high cholesterol diet and treated by a combination TF 0.95 g/200 g body weight and red ginger 0.018 g/200 g body weight. The lipid profiles and malondialdehyde (MDA) were assessed. Findings The combination of tempeh and red ginger has successfully exerted the total cholesterol (121.9 ± 3.41 mg/dL; p < 0.01), triglycerides (TG) (89.3 ± 2.94 mg/dL; p < 0.01), low-density lipoprotein (39.1 ± 1.59 mg/dL) and MDA (2.0 ± 0.24 mg/dL; p < 0.01) lower than the other treatments. Also, the combination of tempeh and red ginger treatment appeared the highest high-density lipoprotein concentration (63.4 ± 2.26 mg/dL; p < 0.01) compared to the other treatment groups. Total cholesterol and TG were predicted as the increasing of MDA concentration. Originality/value The combination treatments successfully improved the lipid profiles and MDA. Furthermore, the combination of tempeh and red ginger could be effective in supporting therapy as the hypolipidemic condition.
Article
Objective: Longitudinal data on cardiometabolic effects of egg intake during adolescence are lacking. The current analyses aim to evaluate the impact of usual adolescent egg consumption on lipid levels, fasting glucose, and insulin resistance during late adolescence (age 17–20 years). Methods: Data from 1392 girls, aged 9 to 10 at baseline and followed for 10 years, in the National Heart, Lung, and Blood Institute’s National Growth and Health Study were used to examine the association between usual egg intake alone and in combination with other healthy lifestyle factors and late adolescent lipid levels, fasting glucose, and insulin resistance, measured as homeostasis model assessment of insulin resistance (HOMA-IR). Diet was assessed using 3-day food records during eight examination cycles. Girls were classified according to usual weekly egg intake, ages 9–17 years: <1 egg/wk (n = 361), 1 to <3 eggs/wk (n = 703), and ≥3 eggs/wk (n = 328). Analysis of covariance modeling was used to control for confounding by other behavioral and biological risk factors. Results: Girls with low, moderate, and high egg intakes had adjusted low-density lipoprotein cholesterol levels of 99.7, 98.8, and 95.5 mg/dL, respectively (p = 0.0778). In combination with higher intakes of fiber, dairy, or fruits and vegetables, these beneficial effects were stronger and statistically significant. There was no evidence that ≥3 eggs/wk had an adverse effect on lipids, glucose, or HOMA-IR. More active girls who consumed ≥3 eggs/wk had the lowest levels of insulin resistance. Conclusion: These results suggest that eggs may be included as part of a healthy adolescent diet without adverse effects on glucose, lipid levels, or insulin resistance.
Article
Cholesterol is a vital building block for animal cell membranes and participates in the synthesis of various hormones. Accurate quantitation of cholesterol in food is crucial for healthy diets. Here, we describe an enzyme-assisted reactive matrix-assisted laser desorption/ionization mass spectrometry (ReMALDI-MS) assay for the quantification of cholesterol in food. First, cholesterol was converted to 4-cholesten-3-one using the cholesterol oxidase, and then reacted with a reactive matrix, 4-hydrazinoquinazoline (4-HQ), to form a hydrazone bond. Utilizing 4-HQ significantly improved the ionization efficiency of cholesterol, which possesses poor ionization efficiency in MALDI-MS, and no additional tedious derivatization/purification steps were needed. Thus, the proposed assay was successfully used for the quantification of cholesterol in bovine milk and cream. The standard recovery tests show a recovery range of 95.3−103.0% with a relative standard deviation of 0.3−3.1%. Therefore, the proposed enzyme-assisted ReMALDI-MS assay has great potential for quantification of cholesterol in other foods. {Maekawa, 2015 #4}
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El huevo es un alimento con una gran cantidad de nutrientes para ser utilizados por nuestro organismo. El objetivo de la revisión es suministrar información general sobre el huevo de gallina y su relación con la salud; además, revisar el estado de los tratamientos térmicos y tecnologías emergentes aplicadas con el fin de generar valor en productos del sector avícola. La revisión se realizó sobre bases de datos de revistas científicas adscritas a Science Direct, Scopus, Scielo y Redalyc, durante un periodo comprendido entre 2013 y 2020. Dado que el huevo se considera un alimento de alto riesgo para la salud y un producto con una variedad de propiedades funcionales, en los últimos años, se ha identificado una tendencia en aplicar tratamientos térmicos que permitan obtener un producto seguro microbiológicamente para los consumidores y con el menor efecto en dichas propiedades para ser utilizado por la industria. En general, el huevo es una materia prima fácilmente procesable a través de diferentes tecnologías, que permiten obtener productos líquidos o sólidos para ser utilizados en nuevos productos procesados. El uso de estas tecnologías permite reducir los costos operativos y mejorar la calidad del producto.
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Hepatitis C virus (HCV) is a major cause of chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC) worldwide. Among the structural proteins of HCV, the HCV core protein has the ability to regulate gene transcription, lipid metabolism, cell proliferation, apoptosis, and autophagy, all of which are closely related to the development of HCC. Transgenic mice carrying the HCV core gene exhibited age-dependent insulin resistance, hepatic steatosis, and HCC that resembled the clinical characteristics of chronic hepatitis C patients. Several dietary modifications, including calorie restriction and diets rich in saturated fatty acids (SFAs), trans fatty acids (TFAs), or cholesterol, were found to influence hepatic steatogenesis and tumorigenesis in HCV core gene transgenic mice. These strategies modulated hepatocellular stress and proliferation, in addition to hepatic fibrotic processes and the microenvironment, thereby corroborating a close interconnection between dietary habits and steatosis-related hepatocarcinogenesis. In this review, we summarize the findings obtained from mouse models transgenic for the HCV genome, with a special focus on HCV core gene transgenic mice, and discuss the mechanisms of steatogenesis and hepatocarcinogenesis induced by the HCV core protein and the impact of dietary habits on steatosis-derived HCC development.
Article
Background: Dietary recommendations regarding egg intake remain controversial topic for public health. We hypothesized that there was a positive association between egg consumption and all-cause mortality. Methods: To test this hypothesis, we enrolled 9885 adults from a community-based cohort in Anhui Province, China during 2003-05. Egg consumption was assessed by food questionnaire. Stratified analyses were performed for age, sex, body mass index (BMI), blood pressure, smoking, drinking and laboratory tests. Results: After an average follow-up of 14.1 years, 9444 participants were included for analysis. A total of 814 deaths were recorded. Participants' BMI and lipid profile had no significantly difference between three egg consumption groups. BMI was 21.6±2.7 of the whole population, especially BMI>24 was only 17.3%. A bivariate association of egg consumption >6/week with increased all-cause mortality was observed compared with ≤6/week (RR: 1.35, 95% CI: 1.05, 1.73, P = 0.018). A significant interaction was observed for BMI ≥ 21.2 kg/m2 vs. BMI<21.2 kg/m2 (P for interaction: 0.001). No other significant interactions were found. Conclusions: In this study, consuming >6 eggs/week increased risk of all-cause mortality, even among lean participants, especially who with BMI ≥ 21.2 kg/m2. Eggs are an easily accessible and constitute an affordable food source in underdeveloped regions. Consuming <6 eggs/week may be the most suitable intake mode.
Article
The effects of dietary garlic oil coated granules (GOCG) on egg production, egg quality, yolk antioxidant capacity, yolk cholesterol, yolk fatty acids, blood biochemistry and hepatic enzyme activities were investigated. Forty 36-week-old Hisex brown laying hens were randomly assigned to one of the five dietary treatment groups including: (1) basal diet+0 g GOCG/kg diet (GOCG0, control), (2) basal diet+7.5 g GOCG/kg diet (GOCG7.5), (3) basal diet+15 g GOCG/kg diet (GOCG15), (4) basal diet+30 g GOCG/kg diet (GOCG30) and (5) basal diet+60 g GOCG/kg diet (GOCG60), for four weeks. It was found that egg production, egg mass and feed conversion ratio (FCR) improved linearly (P < 0.05) with increasing dietary GOCG levels. Egg weight, albumen weight, yolk color intensity and Haugh units increased linearly (P < 0.05) and there were quadratic effects (P < 0.05) on yolk weight, shell weight, shell thickness and albumen pH. Dietary GOCG increased yolk antioxidant capacity measured by the phosphomolybdenum method and lowered thiobarbituric acid reactive substances (TBARS) (linearly, P < 0.05). Significant decreases were especially noted in terms of mg/100 g yolk of yolk cholesterol at 7, 14, and 28 days, and overall (quadratic P < 0.05, linearly P < 0.05, linear and quadratic P < 0.05 and linear and quadratic P < 0.05, respectively). Yolk fatty acid compositions, however, did not differ by treatment. Serum total cholesterol (Total-C) and triglyceride decreased linearly (P < 0.05) at 28 days. Hepatic 3-hydroxy-3-methylglutaryl-CoA reductase (HMGRC) activity due to treatment decreased (linear and quadratic, P < 0.05), but fatty acid synthase (FAS) activity increased linearly (P < 0.05). Pearson's correlations with mg/100 g yolk of yolk cholesterol at 28 days were statistically significant (P < 0.01) for the reduction of HMGCR activity. Hence, based on the minimum content of yolk cholesterol (mg/100 g yolk) and dietary GOCG levels tested, a dietary GOCG30 is recommended, as this had no negative impacts on other important parameters of egg production for consumption.
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Background and aims: We evaluated the association of egg consumption with liver tests (LTs) and non-alcoholic fatty liver disease (NAFLD). This relationship is poorly documented. Methods: The National Health and Nutrition Examination Survey (NHANES, 2005-2010) database was used. Analysis of covariance, adjusted linear and logistic regression models were used. Results: Of the 14,369 participants, 46.8% were men and 45.2% had NAFLD. After correction for several variables including: age, gender, race, education, poverty to income ratio, alcohol intake, energy intake, smoking, and physical activity - fatty liver index (FLI), serum aspartate aminotransferase (AST) alanine aminotransferase (ALT) were 36.9, 25.8 (U/L) and 23.9 (U/L), respectively, in the first tertile (T1) reaching 68.7, 34.9 and 36.5, respectively, in the third tertile (T3) (p<0.001 for all comparisons). In the model with same covariates, there was significant positive linear relationship between FLI (standard β coefficient (β): 0.196), AST (β: 0.099) and ALT (β: 0.112) with egg consumption and participants in the highest tertile (T3) of egg consumption had 11% higher chance of NAFLD compared with T1 (odds ratio: 1.11 and 95% confidence interval: 1.07-1.17). Of note, after more correction for triglycerides, hypertension and diabetes, the significant link between egg consumption and LTs and/or NAFLD attenuated and disappeared. Conclusion: Our findings highlight the adverse role of egg consumption on LTs and likelihood of NAFLD. These associations seem to be attributable to cardio-metabolic risk factors. These findings require confirmation to improve our understanding of the role of egg consumption in the pathogenesis of NAFLD.
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Animal-derived protein production is one of the major traditional protein supply methods, which continues to face increasing challenges to satisfy global needs due to population growth, augmented individual protein consumption, and aggravated environmental pollution. Thus, ensuring a sustainable protein source is a considerable challenge. The emergence and development of food synthetic biology has enabled the establishment of cell factories that effectively synthesize proteins, which is an important way to solve the protein supply problem. This review aims to discuss the existing problems of traditional protein supply and to elucidate the feasibility of synthetic biology in the process of protein synthesis. Moreover, using artificial bioengineered milk and artificial bioengineered eggs as examples, the progress of food protein supply transition based on synthetic biology has been systematically summarized. Additionally, the future of food synthetic biology as a potential source of protein has been also discussed. By strengthening and innovating the application of food synthetic biology technologies, including genetic engineering and high-throughput screening methods, the current limitations of artificial foods for protein synthesis and production should be addressed. Therefore, the development and industrial production of new food resources should be explored to ensure safe, high-quality, and sustainable global protein supply.
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This study evaluated the associations between selected dietary habits and lipid profiles in a group of 800 randomly selected patients hospitalized in the Nitra Cardio Center, Slovakia. Patients were aged 20–101 years (only men, the average age was 61.13 ± 10.47 years). The data necessary for the detection of dietary habits were obtained by a questionnaire method in closed-ended format. Data collection was carried out simultaneously with the somatometric and biochemical examinations of the respondents ensured by the Nitra Cardio Center. The following parameters were evaluated: total cholesterol (T-C), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, and blood glucose. Statistical comparisons between groups were performed using one-way analysis of variance (one-way ANOVA), followed by Tukey’s post hoc test. We detected significant differences (p < 0.05) in the influence of the number of daily meals on T-C and LDL-C, which were higher in men who consumed 1–2 meals compared with 3–4 or 5–6 meals. In the consumption of meat, eggs, and fish, there was no significant effect on the biochemical parameters of blood (p > 0.05). We recorded a significant effect (p < 0.001) on T-C and LDL-C levels between low-fat and whole-fat milk consumption. Except for the impact of fruit consumption on the HDL-C level (p < 0.001), the different frequencies of fruit consumption showed non-significant changes for the lipid profile levels. We detected a significant effect (p = 0.017) of the consumption of vegetables 1–2 times/week on LDL-C in favor of daily consumption. Our results support that monitoring the lipid profile is an important determinant in the prevention and treatment of cardiovascular disease. The conducted research emphasizes the importance of diet dependence on the improvement of the quality of treatment and nutrition of people with this type of disease.
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There is a great debate regarding the association of cholesterol intake from egg consumption and the incidence of cardiovascular disease (CVD). Most studies show that moderate egg consumption is not associated with a significant increase in CVD, stroke, heart failure, and type 2 diabetes mellitus (T2DM), whereas others dispute this fact and state that there is an association with increased egg consumption, especially if they are consumed with saturated fats. In addition, the recent relaxation of cholesterol intake to > 300 mg/day by the American College of Cardiology/American Heart Association Nutritional Guidelines has fueled this debate. In order to get a current perspective on the significance of moderate egg consumption with the primary incidence of CVD, a focused Medline search of the English language literature was conducted between 2010 and March 2020 using the terms, cholesterol intake, egg consumption, coronary artery disease, CVD, T2DM. Nineteen pertinent papers were retrieved, and these, together with collateral literature, will be discussed in this review article. The analysis of data from the papers retrieved indicated that several studies showed moderate egg consumption (1 egg/day) is not associated with adverse cardiovascular effects in subjects free of CVD or T2DM, whereas other studies showed a positive association, especially in patients with preexisting CVD or T2DM. Therefore, at present, there is no unanimous agreement on this subject, and the controversy will continue until new confirmatory evidence becomes available.
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Egg consumption has been an area of controversy regarding its impact on human health largely due to the content in cholesterol and its potential role in cardio-metabolic outcomes. This study aimed to summarise the level of evidence of egg consumption on various health outcomes. A systematic search for meta-analyses was performed: study design, dose–response relationship, heterogeneity and agreement of results over time, and identification of potential confounding factors were considered to assess the level of evidence. Results from this umbrella review showed a substantial no association between egg consumption and a number of health outcomes, including cancer, cardiovascular and metabolic disorders. In contrast, evidence of possible beneficial effects toward stroke risk has been found. In conclusions, egg may be part of a healthy diet; however, additional studies exploring confounding factors are needed to ascertain the potential detrimental effects.
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The purpose of this study was to investigate the effects of different drying methods, including ultrasonic vacuum drying, vacuum drying, vacuum freeze-drying, hot-air drying and spray drying, on the structure and emulsifying capacity of egg yolk lecithin based on Raman spectra. The results showed that ultrasonic vacuum drying and spray drying can induce the vibration of C–N bonds in the polar O–C–C–N⁺ head skeleton of egg yolk lecithin. The shift of the peak attributed to the C–N bond from 717 cm⁻¹ to 774 and 772 cm⁻¹ indicated that the vibration of some C–N bonds in the O–C–C–N⁺ skeleton had transformed from gauche to trans. Ultrasonic vacuum drying exerted the most intense effect on the C–C skeleton of egg yolk lecithin, with the greatest vibration peaks at 1062 cm⁻¹, 1128 cm⁻¹, and 1097 cm⁻¹ in the Raman spectra of egg yolks. Specifically, it relieved gauche vibration and strengthened trans vibration in the C–C skeleton. Hence, the Igauche/Itrans ratio of the egg yolk lecithin processed through ultrasonic vacuum drying decreased. Ultrasonic vacuum drying and spray drying decreased the I2850/I2878 ratio of the vibration peak of C–H bonds in the lipid chains of egg yolk lecithin. The weakening of the symmetric stretching vibration of the C–H bond and the strengthening of antisymmetric stretching vibration indicated that orderliness among the molecular chains of lipid bilayer membranes had increased, whereas liquidity had decreased. The emulsifying capacities were highly significantly different among various egg yolk lecithin samples, in which the highest emulsifying capacity (49.58 m²/g) was shown for the egg yolk lecithin prepared through vacuum freeze-drying, and ultrasonic vacuum drying produced the lowest emulsifying capacity (14.77 m²/g). This study demonstrated that ultrasonic vacuum drying and spray drying drastically affected the structure of egg yolk lecithin. The appropriate drying method can be selected based on sample volume and production situation. © 2020, Chinese Society of Agricultural Engineering. All rights reserved.
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High plasma choline has been associated with the metabolic syndrome and risk of chronic diseases, including cardiovascular disease. However, dietary choline is not correlated with choline plasma concentrations, and there are few studies and contradictory evidence regarding dietary choline and cardiovascular events. In addition, a recommended dietary allowance for choline has not been established and remains a point of contention. This study assessed the association between dietary choline, including choline forms, and risk of incident acute myocardial infarction (AMI) in patients with suspected stable angina pectoris (SAP). In total 1981 patients (80% men, median age 62) from the Western Norway B Vitamin Intervention Trial were included in this analysis. Information on dietary choline was obtained using a 169-item food frequency questionnaire. The Cardiovascular Disease in Norway project provided data on AMI. Risk associations were estimated using Cox-regression analysis using energy-adjusted choline intake. Median (25th, 75th percentile) total energy-adjusted choline intake was 288 (255, 326) mg/d. During a median (25th, 75th percentile) follow-up of 7.5 (6.3, 8.8) years, 312 (15.7%) patients experienced at least one AMI. Increased intakes of energy-adjusted choline (HR [95% CI] per 50 mg increase 1.11 [1.03, 1.20]), phosphatidylcholine (HR per 50 mg increase 1.24 [1.08, 1.42]) and sphingomyelin (HR per 5 mg increase 1.16 [1.02, 1.31]) were associated with higher AMI risk. Higher dietary intakes of total choline, phosphatidylcholine and sphingomyelin were associated with increased risk of AMI in patients with SAP. Future studies are necessary to explore underlying mechanisms for this observation.
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The association of egg consumption and serum cholesterol concentrations in healthy people has been discussed for a long time. In this study, we aimed to explore association of egg consumption with on low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) concentrations and the LDL-c/HDL-c ratio through meta-analysis. This systematic review only included randomized controlled trials (RCTs) investigating egg consumption in healthy populations without combination therapy. We extracted mean and standard deviation for LDL-c/HDL-c ratio, LDL-c/HDL-c. The extracted data were pooled in a random-effects model and were presented as mean difference (MD) with 95% confidence interval (CI). Moreover, subgroup analyses were conducted for understanding effects of more egg consumption (MEC) on different intervention periods, egg-consumption levels, classification of responders. Overall, 17 RCTs met the eligibility criteria and pooled results showed MEC group had a higher LDL-c/HDL-c ratio than the control group (MD = 0.14, p = 0.001, I 2 = 25%). The MEC group also had higher LDL-c than the control group (MD = 8.14, p < 0.0001, I 2 = 18%). Moreover, for the subset of intervention over two months, the MEC group seemed to have a larger effect size than the subset of intervention within two months. This synthesis, the largest meta-analysis on this topic, shows the impact of egg consumption on lipid profiles among healthy subjects. Notably, longer time with MEC may lead to higher LDL-c/HDL-c ratio and LDL-c. However, RCTs with long tern follow-up are needed to guarantee the association between egg consumption and human health.
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Non‐alcoholic fatty liver disease (NAFLD) is a major cause of cardiovascular disease. The relationship between egg consumption and NAFLD is still controversial for its high cholesterol content. In this study, we examined the effects of different egg components (egg white (EW), egg yolk (EY), and whole egg (WE)) on NAFLD using oleic acid (OA)‐induced HepG2 cells with UPLC‐ESI‐MS/MS approach. The results showed EY could affect the lipid profile effectively by increasing phosphocholine (PC), phosphatidylglycerol (PG), and carnitine (CAR). Orthogonal projections to latent structures−discriminate analysis (OPLS‐DA) combined with S‐plot analysis selected 10, 82, and 20 potential biomarkers in EW, EY, and WE group, respectively. Up‐regulated TG, DG and down‐regulated lysophosphatidylcholines (lysoPC), lysophosphatidylethanolamine (lysoPE) biomarkers were found in EY group, while down‐regulated regulated TG and FFA were found in EW and WE group. Glycerolipid and choline metabolism were the most involved pathways affected by EY and WE. In addition, the mechanism was associated with the expression of Pla2g15, Pnpla6‐1, Gad1 and involved lipogenic genes ABC1 and PPARα. Our study suggests that WE treatment could ameliorate OA‐induced hepatic steatosis by inhibiting TG accumulation, while EY seems slightly accelerate hepatic steatosis. Furthermore, the effects are closely associated with its effects on glycerolipid metabolism. Practical applications : Nonalcoholic fatty liver disease (NAFLD) is a worldwide disease, while the associations between egg consumption and NAFLD are still poorly understood. This study investigated the effects of egg components on NAFLD in oleic acid (OA)‐induced HepG2 cells based on a targeted lipidomics approach. The results indicate that WE (whole egg) treatment could ameliorate OA‐induced hepatic steatosis by inhibiting TG and FFA accumulation, which was closely associated with glycerolipid metabolism. The results provide knowledge and understanding of the effects of egg on NAFLD and involved mechanism, and further provided nutritional guidelines for egg consumption. This article is protected by copyright. All rights reserved
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Background: Several systematic reviews and meta-analyses have assessed the association between egg consumption and human health, but the evidence is often conflicting. Methods: We conducted a systematic literature search to find all systematic reviews and meta-analyses that assess the association between egg consumption and any type of health outcome. We used AMSTAR to evaluate the methodological quality of the reviews, and GRADE to determine the quality of evidence. We visualized the results using a human anatomy diagram and evidence mapping. Results: Our search revealed 29 systematic reviews and meta-analyses. Eight studies were of high methodological quality, 16 studies of medium quality, and five studies of low quality. We identified 34 primary outcomes from the included 29 reviews, which were combined into a total of 22 different health outcomes. Two of the primary outcomes were based on high-quality evidence, 18 on moderate-quality evidence, and 14 on low-quality evidence. Egg consumption was associated with an increased risk of two diseases and decreased risk of six outcomes. For ten outcomes, no significant association was found, and for four outcomes, different reviews came to conflicting conclusions. Conclusions: The association between egg consumption and the risk of cancer, diabetes, cardiovascular diseases and other related diseases has been studied in several meta-analyses. The evidence from different studies on the same topic was often conflicting, which can complicate the making of dietary recommendations.
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The 1968 American Heart Association announced a dietary recommendation that all individuals consume less than 300 mg of dietary cholesterol per day and no more than three whole eggs per week. This recommendation has not only significantly impacted the dietary patterns of the population, but also resulted in the public limiting a highly nutritious and affordable source of high quality nutrients, including choline which was limited in the diets of most individuals. The egg industry addressed the egg issue with research documenting the minimal effect of egg intake on plasma lipoprotein levels, as well as research verifying the importance of egg nutrients in a variety of issues related to health promotion. In 2015 dietary cholesterol and egg restrictions have been dropped by most health promotion agencies worldwide and recommended to be dropped from the 2015 Dietary Guidelines for Americans.
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Egg consumption is often discouraged due to cholesterol content; however, recent studies have not demonstrated a clear adverse influence of eggs on blood lipids. Furthermore, exercise training promotes improved lipids and blood pressure. The purpose of the study was to examine the effect of eating an isoenergetic (400 kcal) egg-based (including two eggs per day) versus bagel-based breakfasts, daily, combined with resistance training three times per week, prior to breakfast, on plasma lipids, glucose, insulin, insulin sensitivity and blood pressure in untrained individuals. Twenty-five healthy adult men and women (18-35 years of age) participated in the twelve week study following random assignment to study groups. Lipids and blood pressure were examined at baseline and after 6 and 12 weeks. Plasma triglycerides (TG) decreased significantly in the egg- based breakfast (EBB) group from baseline to six weeks (p = 0.011) and from six to twelve weeks (p = 0.045). A significant (p = 0.033) decrease in insulin sensitivity was observed in the bagel-based breakfast (BBB) group from zero to six weeks. No significant effects on systolic blood pressure, diastolic blood pressure, total cholesterol, high density lipoprotein- cholesterol or low density lipoprotein cholesterol were detected. Overall, daily breakfasts including two eggs for twelve weeks did not adversely affect lipids during a resistance training program and promoted improvements in plasma TG.
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Egg yolk contains bioactive components that improve plasma inflammatory markers and HDL profiles in metabolic syndrome (MetS) under carbohydrate restriction. We further sought to determine whether egg yolk intake affects peripheral blood mononuclear cell (PBMC) inflammation and cholesterol homeostasis in MetS, as HDL and its associated lipid transporter ATP-binding cassette transporter A1 (ABCA1) reduce the inflammatory potential of leukocytes through modulation of cellular cholesterol content and distribution. Thirty-seven men and women classified with MetS consumed a moderate carbohydrate-restricted diet (25%–30% of energy) for 12 weeks, in addition to consuming either three whole eggs per day (EGG) or the equivalent amount of yolk-free egg substitute (SUB). Interestingly, lipopolysaccharide-induced PBMC IL-1β and TNFα secretion increased from baseline to week 12 in the SUB group only, despite increases in PBMC toll-like receptor 4 (TLR4) mRNA expression in the EGG group. Compared to baseline, ABCA1 and 3-hydroxy-3-methyl-glutaryl (HMG)-CoA reductase mRNA expression increased by week 12 in the EGG group only, whereas changes in PBMC total cholesterol positively correlated with changes in lipid raft content. Together, these findings suggest that intake of whole eggs during carbohydrate restriction alters PBMC inflammation and cholesterol homeostasis in MetS.
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The prevalence of diabetes increases with age, driven in part by an absolute increase in incidence among adults aged 65 years and older. Individuals with diabetes are at higher risk for cardiovascular disease, and age strongly predicts cardiovascular complications. Inflammation and oxidative stress appear to play some role in the mechanisms underlying aging, diabetes, cardiovascular disease, and other complications of diabetes. However, the mechanisms underlying the age-associated increase in risk for diabetes and diabetes-related cardiovascular disease remain poorly understood. Moreover, because of the heterogeneity of the older population, a lack of understanding of the biology of aging, and inadequate study of the effects of treatments on traditional complications and geriatric conditions associated with diabetes, no consensus exists on the optimal interventions for older diabetic adults. The Association of Specialty Professors, along with the National Institute on Aging, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Heart, Lung, and Blood Institute, and the American Diabetes Association, held a workshop, summarized in this Perspective, to discuss current knowledge regarding diabetes and cardiovascular disease in older adults, identify gaps, and propose questions to guide future research.
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Background: It is important to understand whether eating eggs, which are a major source of dietary choline, results in increased exposure to trimethylamine-N-oxide (TMAO), which is purported to be a risk factor for developing heart disease. Objective: We determined whether humans eating eggs generate TMAO and, if so, whether there is an associated increase in a marker for inflammation [ie, high-sensitivity C-reactive protein (hsCRP)] or increased oxidation of low-density lipoprotein (LDL). Design: In a longitudinal, double-blind, randomized dietary intervention, 6 volunteers were fed breakfast doses of 0, 1, 2, 4, or 6 egg yolks. Diets were otherwise controlled on the day before and day of each egg dose with a standardized low-choline menu. Plasma TMAO at timed intervals (immediately before and 1, 2, 4, 8, and 24 h after each dose), 24-h urine TMAO, predose and 24-h postdose serum hsCRP, and plasma oxidized LDL were measured. Volunteers received all 5 doses with each dose separated by >2-wk washout periods. Results: The consumption of eggs was associated with increased plasma and urine TMAO concentrations (P < 0.01), with ∼14% of the total choline in eggs having been converted to TMAO. There was considerable variation between individuals in the TMAO response. There was no difference in hsCRP or oxidized LDL concentrations after egg doses. Conclusions: The consumption of ≥2 eggs results in an increased formation of TMAO. Choline is an essential nutrient that is required for normal human liver and muscle functions and important for normal fetal development. Additional study is needed to both confirm the association between TMAO and atherosclerosis and identify factors, microbiota and genetic, that influence the generation of TMAO before policy and medical recommendations are made that suggest reduced dietary choline intake.
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The effects of breakfast type on body weight and blood lipids were evaluated in university freshman. Seventy-three subjects were instructed to consume a breakfast with eggs (Egg Breakfast, EB, n = 39) or without (Non-Egg Breakfast, NEB, n = 34), five times/week for 14 weeks. Breakfast composition, anthropometric measurements and blood lipids were measured at multiple times. During the study, mean weight change was 1.6 ± 5.3 lbs (0.73 ± 2.41 kg), but there was no difference between groups. Both groups consumed similar calories for breakfast at all time-points. The EB group consumed significantly more calories at breakfast from protein, total fat and saturated fat, but significantly fewer calories from carbohydrate at every time-point. Cholesterol consumption at breakfast in the EB group was significantly higher than the NEB group at all time points. Breakfast food choices (other than eggs) were similar between groups. Blood lipids were similar between groups at all time points, indicating that the additional 400 mg/day of dietary cholesterol did not negatively impact blood lipids.
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There is a direct relationship between chronically elevated cholesterol levels (dyslipidaemia) and coronary heart disease. A reduction in total cholesterol is considered the gold standard in preventative cardiovascular medicine. Exercise has been shown to have positive impacts on the pathogenesis, symptomatology and physical fitness of individuals with dyslipidaemia, and to reduce cholesterol levels. The optimal mode, frequency, intensity and duration of exercise for improvement of cholesterol levels are, however, yet to be identified. This review assesses the evidence from 13 published investigations and two review articles that have addressed the effects of aerobic exercise, resistance training and combined aerobic and resistance training on cholesterol levels and the lipid profile. The data included in this review confirm the beneficial effects of regular activity on cholesterol levels and describe the impacts of differing volumes and intensities of exercise upon different types of cholesterol. Evidence-based exercise recommendations are presented, aimed at facilitating the prescription and delivery of interventions in order to optimize cholesterol levels.
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Aims: Eggs are a good source of lutein and zeaxanthin, carotenoids known for their antioxidant properties. Mexican children have been shown to consume limited amounts of fruit and vegetables. The purpose of the current study is to determine whether the inclusion of eggs in the diet increases plasma carotenoids in this population. Study Design: This study is a follow up on the effects of high egg intake on plasma lipids and atherogenic lipoproteins in children. Fifty four Mexican children (25 boys/29 girls) aged 8-12 y were randomly assigned to consume either 2 eggs/d (518 mg additional dietary cholesterol) (EGG period) or the equivalent amount of egg whites (SUB Period) in a cross-over design for 4 wk. After a 3 wk washout, children were crossed over to the alternate treatment. Methodology: 3-day dietary records, plasma carotenoids and apolipoproteins were measured at the end of the EGG and SUB Periods. Results: In agreement with the lack of effects of eggs in increasing atherogenic Research Article 2204 lipoprotein profiles, plasma apolipoprotein B concentrations did not change between periods indicating that increases in plasma cholesterol were not associated with higher number of LDL particles. Although the values for apo C-III were high compared to other pediatric populations, they were not affected by egg intake. Dietary records indicated low intake of carotenoids, especially during the SUB period. Plasma lutein and zeaxanthin were increased during the EGG period from 0.235 ± 0.071 to 0.280 ± 0.147 µmol/L (P<0.001) and 0.044 ± 0.019 to 0.051 ± 0.031 µmol/L (P<0.001), respectively. Conclusions: These results suggest that the eggs are a good source of lutein and zeaxanthin in this population and that the increases in LDL size during the egg period may also be related to a better transport of these carotenoids in plasma.
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BACKGROUND: The associations of egg consumption with cardiovascular disease (CVD) and diabetes are still unclear. OBJECTIVE: We aimed to quantitatively summarize the literature on egg consumption and risk of CVD, cardiac mortality, and type 2 diabetes by conducting a meta-analysis of prospective cohort studies. DESIGN: A systematic literature review was conducted for published studies in PubMed and EMBASE through March 2012. Additional information was retrieved through Google or a hand review of the reference from relevant articles. Studies were included if they had a prospective study design, were published in English-language journals, and provided HRs and 95% CIs for the associations of interest. Data were independently extracted by 2 investigators, and the weighted HRs and 95% CIs for the associations of interest were estimated by using a random-effects model. RESULTS: A total of 22 independent cohorts from 16 studies were identified, including participants ranging in number from 1600 to 90,735 and in follow-up time from 5.8 to 20.0 y. Comparison of the highest category (≥1 egg/d) of egg consumption with the lowest (<1 egg/wk or never) resulted in a pooled HR (95% CI) of 0.96 (0.88, 1.05) for overall CVD, 0.97 (0.86, 1.09) for ischemic heart disease, 0.93 (0.81, 1.07) for stroke, 0.98 (0.77, 1.24) for ischemic heart disease mortality, 0.92 (0.56, 1.50) for stroke mortality, and 1.42 (1.09, 1.86) for type 2 diabetes. Of the studies conducted in diabetic patients, the pooled HR (95% CI) was 1.69 (1.09, 2.62) for overall CVD. CONCLUSION: This meta-analysis suggests that egg consumption is not associated with the risk of CVD and cardiac mortality in the general population. However, egg consumption may be associated with an increased incidence of type 2 diabetes among the general population and CVD comorbidity among diabetic patients.
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Intestinal microbiota metabolism of choline and phosphatidylcholine produces trimethylamine (TMA), which is further metabolized to a proatherogenic species, trimethylamine-N-oxide (TMAO). We demonstrate here that metabolism by intestinal microbiota of dietary l-carnitine, a trimethylamine abundant in red meat, also produces TMAO and accelerates atherosclerosis in mice. Omnivorous human subjects produced more TMAO than did vegans or vegetarians following ingestion of l-carnitine through a microbiota-dependent mechanism. The presence of specific bacterial taxa in human feces was associated with both plasma TMAO concentration and dietary status. Plasma l-carnitine levels in subjects undergoing cardiac evaluation (n = 2,595) predicted increased risks for both prevalent cardiovascular disease (CVD) and incident major adverse cardiac events (myocardial infarction, stroke or death), but only among subjects with concurrently high TMAO levels. Chronic dietary l-carnitine supplementation in mice altered cecal microbial composition, markedly enhanced synthesis of TMA and TMAO, and increased atherosclerosis, but this did not occur if intestinal microbiota was concurrently suppressed. In mice with an intact intestinal microbiota, dietary supplementation with TMAO or either carnitine or choline reduced in vivo reverse cholesterol transport. Intestinal microbiota may thus contribute to the well-established link between high levels of red meat consumption and CVD risk.
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We recently demonstrated that daily whole egg consumption during moderate carbohydrate restriction leads to greater increases in plasma HDL-cholesterol (HDL-C) and improvements in HDL profiles in metabolic syndrome (MetS) when compared to intake of a yolk-free egg substitute. We further investigated the effects of this intervention on HDL composition and function, hypothesizing that the phospholipid species present in egg yolk modulate HDL lipid composition to increase the cholesterol-accepting capacity of subject serum. Men and women classified with MetS were randomly assigned to consume either three whole eggs (EGG, n = 20) per day or the equivalent amount of egg substitute (SUB, n = 17) throughout a 12-week moderate carbohydrate-restricted (25-30 % of energy) diet. Relative to other HDL lipids, HDL-cholesteryl ester content increased in all subjects, with greater increases in the SUB group. Further, HDL-triacylglycerol content was reduced in EGG group subjects with normal baseline plasma HDL-C, resulting in increases in HDL-CE/TAG ratios in both groups. Phospholipid analysis by mass spectrometry revealed that HDL became enriched in phosphatidylethanolamine in the EGG group, and that EGG group HDL better reflected sphingomyelin species present in the whole egg product at week 12 compared to baseline. Further, macrophage cholesterol efflux to EGG subject serum increased from baseline to week 12, whereas no changes were observed in the SUB group. Together, these findings suggest that daily egg consumption promotes favorable shifts in HDL lipid composition and function beyond increasing plasma HDL-C in MetS.
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To investigate and quantify the potential dose-response association between egg consumption and risk of coronary heart disease and stroke. Dose-response meta-analysis of prospective cohort studies. PubMed and Embase prior to June 2012 and references of relevant original papers and review articles. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Prospective cohort studies with relative risks and 95% confidence intervals of coronary heart disease or stroke for three or more categories of egg consumption. Eight articles with 17 reports (nine for coronary heart disease, eight for stroke) were eligible for inclusion in the meta-analysis (3 081 269 person years and 5847 incident cases for coronary heart disease, and 4 148 095 person years and 7579 incident cases for stroke). No evidence of a curve linear association was seen between egg consumption and risk of coronary heart disease or stroke (P=0.67 and P=0.27 for non-linearity, respectively). The summary relative risk of coronary heart disease for an increase of one egg consumed per day was 0.99 (95% confidence interval 0.85 to 1.15; P=0.88 for linear trend) without heterogeneity among studies (P=0.97, I(2)=0%). For stroke, the combined relative risk for an increase of one egg consumed per day was 0.91 (0.81 to 1.02; P=0.10 for linear trend) without heterogeneity among studies (P=0.46, I(2)=0%). In a subgroup analysis of diabetic populations, the relative risk of coronary heart disease comparing the highest with the lowest egg consumption was 1.54 (1.14 to 2.09; P=0.01). In addition, people with higher egg consumption had a 25% (0.57 to 0.99; P=0.04) lower risk of developing hemorrhagic stroke. Higher consumption of eggs (up to one egg per day) is not associated with increased risk of coronary heart disease or stroke. The increased risk of coronary heart disease among diabetic patients and reduced risk of hemorrhagic stroke associated with higher egg consumption in subgroup analyses warrant further studies.
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To evaluate the long term efficacy of diets in lowering serum cholesterol concentration. Descriptive overview of 16 published controlled trials of six months' duration or longer. Trials had been conducted in hospital clinics (6), industry (3), mental hospitals or institutions (3), and in general populations (4). Trials had been conducted in high risk subjects (5), in unselected healthy subjects (6), or for secondary prevention in patients with coronary heart disease (5). Women were included in only four trials. Diets equivalent to the step 1 diet were employed in eight trials, with individual intervention by dietitians (3) or occupational physicians (2) or with population advice (3). Intensive diets which were more rigorous than the step 2 diet were employed in eight trials. Net change in serum total cholesterol concentration in subjects receiving treatment with diet compared with values in control subjects after six months to 10 years. In five trials with the step 1 diet as individual intervention the net reduction in serum cholesterol concentration ranged from 0% to 4.0% over six months to six years. In trials with population education reductions in cholesterol concentrations were 0.6-2.0% over five to 10 years. When population and individual dietary advice were combined changes in cholesterol concentration ranged from a fall of 2.1% to a rise of 1.0% over four to 10 years. Diets more intensive than the step 2 diet reduced serum cholesterol concentration by 13% over five years in selected high risk men in the population; by 6.5-15.1% over two to five years in hospital outpatients; and by 12.8-15.5% over one to four and a half years in patients in institutions. The response to a step 1 diet is too small to have any value in the clinical management of adults with serum cholesterol concentrations above 6.5 mmol/l. Current guidelines recommend screening of serum cholesterol concentration in healthy subjects, followed by treatment with a step 1 diet. The guidelines should be reviewed to provide a more realistic estimate of the effect of a step 1 diet and of the likely need for lipid lowering drugs.
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Suboptimal nutrition is a leading cause of poor health. Nutrition and policy science have advanced rapidly, creating confusion yet also providing powerful opportunities to reduce the adverse health and economic impacts of poor diets. This review considers the history, new evidence, controversies, and corresponding lessons for modern dietary and policy priorities for cardiovascular diseases, obesity, and diabetes mellitus. Major identified themes include the importance of evaluating the full diversity of diet-related risk pathways, not only blood lipids or obesity; focusing on foods and overall diet patterns, rather than single isolated nutrients; recognizing the complex influences of different foods on long-term weight regulation, rather than simply counting calories; and characterizing and implementing evidence-based strategies, including policy approaches, for lifestyle change. Evidence-informed dietary priorities include increased fruits, nonstarchy vegetables, nuts, legumes, fish, vegetable oils, yogurt, and minimally processed whole grains; and fewer red meats, processed (eg, sodium-preserved) meats, and foods rich in refined grains, starch, added sugars, salt, and trans fat. More investigation is needed on the cardiometabolic effects of phenolics, dairy fat, probiotics, fermentation, coffee, tea, cocoa, eggs, specific vegetable and tropical oils, vitamin D, individual fatty acids, and diet-microbiome interactions. Little evidence to date supports the cardiometabolic relevance of other popular priorities: eg, local, organic, grass-fed, farmed/wild, or non-genetically modified. Evidence-based personalized nutrition appears to depend more on nongenetic characteristics (eg, physical activity, abdominal adiposity, gender, socioeconomic status, culture) than genetic factors. Food choices must be strongly supported by clinical behavior change efforts, health systems reforms, novel technologies, and robust policy strategies targeting economic incentives, schools and workplaces, neighborhood environments, and the food system. Scientific advances provide crucial new insights on optimal targets and best practices to reduce the burdens of diet-related cardiometabolic diseases.
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Context Reduction in egg consumption has been widely recommended to lower blood cholesterol levels and prevent coronary heart disease (CHD). Epidemiologic studies on egg consumption and risk of CHD are sparse. Objective To examine the association between egg consumption and risk of CHD and stroke in men and women. Design and Setting Two prospective cohort studies, the Health Professionals Follow-up Study (1986-1994) and the Nurses' Health Study (1980-1994). Participants A total of 37,851 men aged 40 to 75 years at study outset and 80,082 women aged 34 to 59 years at study outset, free of cardiovascular disease, diabetes, hypercholesterolemia, or cancer. Main Outcome Measures Incident nonfatal myocardial infarction, fatal CHD, and stroke corresponding to daily egg consumption as determined by a food-frequency questionnaire. Results We documented 866 incident cases of CHD and 258 incident cases of stroke in men during 8 years of follow-up and 939 incident cases of CHD and 563 incident cases of stroke in women during 14 years of follow-up. After adjustment for age, smoking, and other potential CHD risk factors, we found no evidence of an overall significant association between egg consumption and risk of CHD or stroke in either men or women. The relative risks (RRs) of CHD across categories of intake were less than 1 per week (1.0), 1 per week (1.06), 2 to 4 per week (1.12), 5 to 6 per week (0.90), and ≥1 per day (1.08) (P for trend=.75) for men; and less than 1 per week (1.0), 1 per week (0.82), 2 to 4 per week (0.99), 5 to 6 per week (0.95), and ≥1 per day (0.82) (P for trend=.95) for women. In subgroup analyses, higher egg consumption appeared to be associated with increased risk of CHD only among diabetic subjects (RR of CHD comparing more than 1 egg per day with less than 1 egg per week among diabetic men, 2.02 [95% confidence interval, 1.05-3.87; P for trend=.04], and among diabetic women, 1.49 [0.88-2.52; P for trend=.008]). Conclusions These findings suggest that consumption of up to 1 egg per day is unlikely to have substantial overall impact on the risk of CHD or stroke among healthy men and women. The apparent increased risk of CHD associated with higher egg consumption among diabetic participants warrants further research.