by H Kuang - 2018 - Cited by 14 - Related articles
Aug 23, 2018 - Daily intake of eggs and egg products in US children and adults accounts for ... The nutrients to energy density ratio of one egg i6.3. Effect of Egg Intake on Blood Cholesterol and CVD in Human Studies
The
effects of egg intake on blood cholesterol and CVD have been discussed
in several meta-analysis studies using research data collected over 60
years [15, 21–23, 180, 194].
Large epidemiological works have been conducted to investigate the
effect of egg intake on blood cholesterol levels and risk of CVD in
children [123], young people [16, 20, 47, 124], women [12–14, 125, 195, 196], men [12–14, 125, 195–199], and older adults [12–14, 125, 195–200].
Some have shown that egg consumption did influence the blood
cholesterol level but did not increase the risk of CVD in healthy
people. Meanwhile, other studies reported that high dietary cholesterol
intake due to egg consumption is a risk factor for CVD and diabetes [180, 194, 197, 199, 201–204].
The results of epidemiological studies and human intervention studies
on the relationship of dietary egg intake and CVD risks are summarized
in Table 3.
Even though AHA and DGAC have removed the restriction of dietary
cholesterol for healthy people in USA, there still are different
conclusions due to differences in race, genetic makeup, physical
fitness, and especially physiological status.
Among the
19 prospective studies investigating the effect of dietary egg intake
on CVD risks, 6 studies reported positive correlation between egg
consumption and different types of CVD incidents or mortality in healthy
people [126, 195, 197, 205, 208, 209]. Pang (2017) reported the positive correlation with total cholesterol [211], and Spence (2012) reported the positive correlation with plaque area [212].
However, other studies (11 out of 19) reported no difference on the CVD
risks affected by the amount of egg intake. The adverse effect of egg
consumption is observed in population with high risk of CVD, including
people with diabetes or hypercholesterolemia, and who are sensitive to
dietary cholesterol [12, 13, 126, 131, 210, 213].
Diabetic populations are in the high risk of CVD with two to four folds
higher than healthy people. These studies also showed that diabetic
people are more vulnerable to CVD after egg consumption [13, 208], with a doubling of coronary risk with an egg per day in US population [12, 13], and 5-fold risk in Greece population [213]. Meanwhile, some studies found that high egg consumption increased the risk of gestational diabetes mellitus [214], insulin resistance [215], and the risk of diabetes [202–204]. Therefore, the effect of egg consumption on CVD might be mediated by diabetes.
Almost
all human intervention studies showed the serum LDL and HDL cholesterol
levels increased in high egg consuming groups (1 to 3 eggs per day
comparing to no egg or with egg substitute), while the ratio of serum
LDL to HDL (LDL/HDL) is unchanged (Table 3).
Most of these papers concluded that egg consumption is not a risk
factor for CVD, based on the fact that the LDL/HDL ratio is unchanged
because this ratio is thought to be a stronger risk factor for CVD.
However, serum LDL level alone should still be considered as a risk
factor for CVD. This is especially true for those people whose blood
cholesterol level is more sensitive to dietary cholesterol consumption.
There are good reasons for the recommendation that persons at risk of
vascular disease limit cholesterol to 200 mg/day [186].
The very high cholesterol content of egg yolk (237 mg in a 65-gram egg)
is a problem in itself, and even one large egg yolk exceeds that limit.
Other studies reported the high cholesterol and high lipid diet could
induce the inflammation in plasma, which is thought to contribute to
atherosclerosis [216], and the susceptibility of LDL to be oxidized could be increased by dietary cholesterol [217].
7. Outlook
Interestingly,
current studies have tended to show that the consumption of eggs is not
a risk factor of CVD in healthy people. However, people who are at high
risk of CVD such as those with diabetes or hypertension need to have
caution with dietary cholesterol intake, especially egg intake. Also,
some people seem to be more sensitive to dietary cholesterol whose blood
cholesterol level is highly correlated to dietary intake. Therefore,
even though the recommendation of restricting cholesterol and egg
consumption in AHA and DGAC has been eliminated, we still need to have
caution with them based on the physiological status of people. On the
other hand, the studies on the egg components impacting CVD risk showed
that some egg components have potential protective effects on CVD, while
others may have adverse effects. Due to the lack of complete data, the
components of eggs that regulate cholesterol absorption and metabolism
have not been extensively studied systematically. To solve the mystery
of the relationship between egg cholesterol and blood cholesterol, it is
essential to understand intestinal absorption of cholesterol from eggs
and study the effect of cholesterol in eggs, and nutrients and
cholesterol interactions in eggs. Also, the function of gut microbiota
needs to be taken into consideration as well. Overall, in order to
strengthen the basic research of egg functional components,
understanding of the nutritional value of eggs can provide theoretical
data for reasonable determination of the intake of eggs.
Acknowledgments
Funding for open access to this article was provided by University of Tennessee's Open Publishing Support Fund.
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