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A comparison of egg consumption with other modifiable coronary heart disease lifestyle risk factors: a relative risk apportionment study. Barraj L, Tran N, Mink P. Risk Anal. 2009 Mar;29(3):401-15. Epub 2008 Nov 4. PMID: 19000074 DOI: 10.1111/j.1539-6924.2008.01149.x Guidelines from the American Heart Association (AHA) recommend that healthy adults limit their intake of dietary cholesterol to less than 300 mg per day. Since a large egg contains about 71% of that amount, the AHA recommends restricting egg consumption unless dietary cholesterol intakes from other sources are limited. We applied a risk apportionment approach to estimate the contribution of egg consumption and other modifiable lifestyle risk factors (e.g., smoking, poor diet, minimal exercise, and alcohol intake) to coronary heart disease (CHD) risk at the population level. Specifically, we categorized the U.S. adult population ages 25+ into distinct risk groups based on the prevalence of modifiable lifestyle risk factors and applied an apportionment model, typically used to assess risk contribution at the individual level, to estimate the contribution of egg intake to CHD risk. Our analysis shows that the combination of modifiable lifestyle risk factors accounts for less than 40% of the population CHD mortality. For the majority of U.S. adults age 25+, consuming one egg a day accounts for <1% of CHD risk. Hence, focusing on decreasing egg intake as an approach to modify CHD risk would be expected to yield minimal results relative to changing other behaviors such as smoking and other dietary habits.

Biochemical effects of consumption of eggs containing omega-3 polyunsaturated fatty acids. Ohman M, Akerfeldt T, Nilsson I, Rosen C, Hansson LO, Carlsson M, Larsson A. Ups J Med Sci. 2008;113(3):315-23.P MID: 18991244 Today, eggs with an increased content of -3 fatty acids are available but there are few publications on the effects of consumption of such eggs on the lipoproteins and acute phase markers in humans. The aim of the present study was to evaluate the effects of consumption of standard eggs and -3 enriched eggs on lipoproteins, glucose and inflammation markers. Nineteen healthy volunteers consumed one extra egg per day of either standard eggs or omega-3 enriched eggs in a double-blind, cross-over study. The duration of each period was 1 month. The effects of the different egg diets on apolipoprotein A1 and B (Apo A1 and B), lipoprotein (a), creatinine, cystatin C, C-reactive protein, serum amyloid protein A, interleukin 6, triglycerides, glucose, total-, high-density lipoprotein and low-density lipo-protein cholesterol concentrations were analyzed. Addition of one regular egg per day to the normal diet had no negative impact on blood lipids or inflammation markers. Consumption of omega-3 enriched eggs resulted in higher levels of ApoA1, lower ApoB/ApoA1 ratio and lower plasma glucose. These effects have been associated in previous studies with a reduced risk for cardiovascular mortality and diabetes.

A prospective study of egg consumption and risk of cardiovascular disease in men and women. Hu FB, Stampfer MJ, Rimm EB, Manson JE, Ascherio A, Colditz GA, Rosner BA, Spiegelman D, Speizer FE, Sacks FM, Hennekens CH, Willett WC. JAMA. 1999 Apr 21;281(15):1387-94. PMID: 10217054 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.

Single food focus dietary guidance: lessons learned from an economic analysis of egg consumption. Schmier JK, Barraj LM, Tran NL. Cost Eff Resour Alloc. 2009 Apr 14;7:7. PMID: 19366457 Methods A risk apportionment model estimated the increased risk for coronary heart disease (CHD) attributable to egg cholesterol content, the decreased risk for other conditions (age-related macular degeneration (AMD), cataract, neural tube defects, and sarcopenia) associated with egg consumption, and a literature search identified the cost of illness of each condition. The base 795 case scenario calculated the costs or savings of each condition attributable to egg cholesterol or nutrient content. Results Given the costs associated with CHD and the benefits associated with the other conditions, the most likely scenario associated with eating an egg a day is savings of $2.82 billion annually with uncertainty ranging from a net cost of $756 million to net savings up to $8.50 billion. Conclusion This study evaluating the economic impact of egg consumption suggests that public health campaigns promoting limiting egg consumption as a means to reduce CHD risk would not be cost-effective from a societal perspective when other benefits are considered. Public health intervention that focuses on a single dietary constituent, and foods that are high in that constituent, may lead to unintended consequences of removing other beneficial constituents and the net effect may not be in its totality a desirable public health outcome. As newer data become available, the model should be updated.

Egg consumption in relation to cardiovascular disease and mortality: the Physicians' Health Study. Djoussé L, Gaziano JM. Am J Clin Nutr. 2008 Apr;87(4):964-9. PMID: 18400720 Results: In an average follow-up of 20 y, 1550 new myocardial infarctions (MIs), 1342 incident strokes, and 5169 deaths occurred. Egg consumption was not associated with incident MI or stroke in a multivariate Cox regression. In contrast, adjusted hazard ratios (95% CI) for mortality were 1.0 (reference), 0.94 (0.87, 1.02), 1.03 (0.95, 1.11), 1.05 (0.93, 1.19), and 1.23 (1.11, 1.36) for the consumption of < 0.0001). This association was stronger among diabetic subjects, in whom the risk of death in a comparison of the highest with the lowest category of egg consumption was twofold (hazard ratio: 2.01; 95% CI: 1.26, 3.20; P for interaction = 0.09). Conclusions: Infrequent egg consumption does not seem to influence the risk of CVD in male physicians. In addition, egg consumption was positively related to mortality, more strongly so in diabetic subjects, in the study population.

A review of scientific research and recommendations regarding eggs. Kritchevsky SB. J Am Coll Nutr. 2004 Dec;23(6 Suppl):596S-600S. Review. PMID: 15640512 For much of the past 40 years, the public has been warned away from eggs because of a concern over coronary heart disease risk. This concern is based on three observations: 1. eggs are a rich source of dietary cholesterol; 2. when fed experimentally, dietary cholesterol increases serum cholesterol and; 3. high serum cholesterol predicts the onset of coronary heart disease. However, data from free-living populations show that egg consumption is not associated with higher cholesterol levels. Furthermore, as a whole, the epidemiologic literature does not support the idea that egg consumption is a risk factor for coronary disease. Within the nutritional community there is a growing appreciation that health derives from an overall pattern of diet rather than from the avoidance of particular foods, and there has been a shift in the tone in recent dietary recommendations away from "avoidance" messages to ones that promote healthy eating patterns. The most recent American Heart Association guidelines no longer include a recommendation to limit egg consumption, but recommend the adoption of eating practices associated with good health. Based on the epidemiologic evidence, there is no reason to think that such a healthy eating pattern could not include eggs.

Egg consumption and risk of type 2 diabetes in men and women. Djoussé L, Gaziano JM, Buring JE, Lee IM. Diabetes Care. 2009 Feb;32(2):295-300. Epub 2008 Nov 18. PMID: 1901777 doi: 10.2337/dc08-1271 RESULTS-During mean follow-up of 20.0 years in men and 11.7 years in women, 1,921 men and 2,112 women developed type 2 diabetes. Compared with no egg consumption, multivariable adjusted hazard ratios for type 2 diabetes were 1.09 (95% CI 0.87-1.37), 1.09 (0.88-1.34), 1.18 (0.95-1.45), 1.46 (1.14-1.86), and 1.58 (1.25-2.01) for consumption of <0.0001). CONCLUSIONS-These data suggest that high levels of egg consumption (daily) are associated with an increased risk of type 2 diabetes in men and women. Confirmation of these findings in other populations is warranted.

A comparison of egg consumption with other modifiable coronary heart disease lifestyle risk factors: a relative risk apportionment study. Barraj L, Tran N, Mink P. Risk Anal. 2009 Mar;29(3):401-15. Epub 2008 Nov 4. PMID: 19000074 DOI: 10.1111/j.1539-6924.2008.01149.x Our analysis shows that the combination of modifiable lifestyle risk factors accounts for less than 40% of the population CHD mortality. For the majority of U.S. adults age 25+, consuming one egg a day accounts for <1% of CHD risk. Hence, focusing on decreasing egg intake as an approach to modify CHD risk would be expected to yield minimal results relative to changing other behaviors such as smoking and other dietary habits.

A prospective study of egg consumption and risk of cardiovascular disease in men and women. Hu FB, Stampfer MJ, Rimm EB, Manson JE, Ascherio A, Colditz GA, Rosner BA, Spiegelman D, Speizer FE, Sacks FM, Hennekens CH, Willett WC. JAMA. 1999 Apr 21;281(15):1387-94. PMID: 10217054 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.

Egg consumption and risk of heart failure in the Physicians' Health Study. Djoussé L, Gaziano JM. Circulation. 2008 Jan 29;117(4):512-6. Epub 2008 Jan 14. PMID: 18195171 doi: 10.1161/CIRCULATIONAHA.107.734210 CONCLUSIONS: Our data suggest that infrequent egg consumption is not associated with the risk of HF. However, egg consumption of > or = 1 per day is related to an increased risk of HF among US male physicians.

Dietary cholesterol and the risk of cardiovascular disease in patients: a review of the Harvard Egg Study and other data. Jones PJ. Int J Clin Pract Suppl. 2009 Oct;(163):1-8, 28-36. English, French. PMID: 19751443 For many years, both the medical community and the general public have incorrectly associated eggs with high serum cholesterol and being deleterious to health, even though cholesterol is an essential component of cells and organisms. It is now acknowledged that the original studies purporting to show a linear relation between cholesterol intake and coronary heart disease (CHD) may have contained fundamental study design flaws, including conflated cholesterol and saturated fat consumption rates and inaccurately assessed actual dietary intake of fats by study subjects. Newer and more accurate trials, such as that conducted by Frank B. Hu of the Harvard School of Public Health (1999), have shown that consumption of up to seven eggs per week is harmonious with a healthful diet, except in male patients with diabetes for whom an association in higher egg intake and CHD was shown. The degree to which serum cholesterol is increased by dietary cholesterol depends upon whether the individual's cholesterol synthesis is stimulated or down-regulated by such increased intake, and the extent to which each of these phenomena occurs varies from person to person. Several recent studies have shed additional light on the specific interplay between dietary cholesterol and cardiovascular health risk. It is evident that the dynamics of cholesterol homeostasis, and of development of CHD, are extremely complex and multifactorial. In summary, the earlier purported adverse relationship between dietary cholesterol and heart disease risk was likely largely over-exaggerated.

Egg consumption in relation to cardiovascular disease and mortality: the Physicians' Health Study. Djoussé L, Gaziano JM. Am J Clin Nutr. 2008 Apr;87(4):964-9. PMID: 18400720 Conclusions: Infrequent egg consumption does not seem to influence the risk of CVD in male physicians. In addition, egg consumption was positively related to mortality, more strongly so in diabetic subjects, in the study population.

Meat and egg consumption and risk of breast cancer among Chinese women. Zhang CX, Ho SC, Chen YM, Lin FY, Fu JH, Cheng SZ. Cancer Causes Control. 2009 Jun 17. [Epub ahead of print] PMID: 19533390 Conclusions This study suggested that processed meat intake was associated with a possible increased risk of breast cancer. There was no significant association between consumption of total and red meat, poultry, fish, or egg with breast cancer risk

Egg consumption and coronary heart disease: an epidemiologic overview. Kritchevsky SB, Kritchevsky D. J Am Coll Nutr. 2000 Oct;19(5 Suppl):549S-555S. Review. PMID: 11023006 When dietary confounders were considered, no association was seen between egg consumption at levels up to 1 + egg per day and the risk of coronary heart disease in non-diabetic men and women.

[Egg intake and cardiovascular risk] Schärer M, Schulthess G. Ther Umsch. 2005 Sep;62(9):611-3. Review. German. PMID: 16218496 The egg - rich in proteins, unsaturated fatty acids, vitamins and minerals - should be part of our nutrition, and it is not justified to recommend a general limitation of egg intake. However, we do not advice unbalanced high egg consumption. A cardioprotective diet is characterized by high variability and contains plenty of fruits, vegetables, and complex carbohydrates.

Egg consumption and risk of type 2 diabetes in men and women. Djoussé L, Gaziano JM, Buring JE, Lee IM. Diabetes Care. 2009 Feb;32(2):295-300. Epub 2008 Nov 18. PMID: 19017774 DOI: 10.2337/dc08-1271 CONCLUSIONS-These data suggest that high levels of egg consumption (daily) are associated with an increased risk of type 2 diabetes in men and women. Confirmation of these findings in other populations is warranted.

Biochemical effects of consumption of eggs containing omega-3 polyunsaturated fatty acids. Ohman M, Akerfeldt T, Nilsson I, Rosen C, Hansson LO, Carlsson M, Larsson A. Ups J Med Sci. 2008;113(3):315-23. PMID: 18991244 Addition of one regular egg per day to the normal diet had no negative impact on blood lipids or inflammation markers. Consumption of omega-3 enriched eggs resulted in higher levels of ApoA1, lower ApoB/ApoA1 ratio and lower plasma glucose. These effects have been associated in previous studies with a reduced risk for cardiovascular mortality and diabetes.

Meat, eggs, dairy products, and risk of breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Pala V, Krogh V, Berrino F, Sieri S, Grioni S, Tjønneland A, Olsen A, Jakobsen MU, Overvad K, Clavel-Chapelon F, Boutron-Ruault MC, Romieu I, Linseisen J, Rohrmann S, Boeing H, Steffen A, Trichopoulou A, Benetou V, Naska A, Vineis P, Tumino R, Panico S, Masala G, Agnoli C, Engeset D, Skeie G, Lund E, Ardanaz E, Navarro C, Sánchez MJ, Amiano P, Svatetz CA, Rodriguez L, Wirfält E, Manjer J, Lenner P, Hallmans G, Peeters PH, van Gils CH, Bueno-de-Mesquita HB, van Duijnhoven FJ, Key TJ, Spencer E, Bingham S, Khaw KT, Ferrari P, Byrnes G, Rinaldi S, Norat T, Michaud DS, Riboli E. Am J Clin Nutr. 2009 Sep;90(3):602-12. Epub 2009 Jun 2. PMID: 19491385 doi:10.3945/ajcn.2008.27173 Conclusions: We have not consistently identified intakes of meat, eggs, or dairy products as risk factors for breast cancer. Future studies should investigate the possible role of high-temperature cooking in the relation of red meat intake with breast cancer risk.

Egg consumption in relation to cardiovascular disease and mortality: the story gets more complex. Eckel RH. Am J Clin Nutr. 2008 Apr;87(4):799-800. PMID: 1840069

Dietary cholesterol from eggs increases plasma HDL cholesterol in overweight men consuming a carbohydrate-restricted diet. Mutungi G, Ratliff J, Puglisi M, Torres-Gonzalez M, Vaishnav U, Leite JO, Quann E, Volek JS, Fernandez ML. J Nutr. 2008 Feb;138(2):272-6. PMID: 18203890 Carbohydrate-restricted diets (CRD) significantly decrease body weight and independently improve plasma triglycerides (TG) and HDL cholesterol (HDL-C) . [..] Eighteen subjects were classified as having the metabolic syndrome (MetS) at the beginning of the study, whereas 3 subjects had that classification at the end. These results suggest that including eggs in a CRD results in increased HDL-C while decreasing the risk factors associated with MetS.