Egg Nutrition CenterCardiovascular Disease Presentation

AHA Guidelines in 1968:Limit Dietary Cholesterol

“Dietary cholesterol – the cholesterol found in foods like eggs and shrimp – be limited to no more than 300 mg

per day, and recommended that individuals eat no more than 3 egg

yolks per week.” - AHA

Guidelines, 1968

Source: Kritchevsky. History of recommendations to the public about dietary fat. J Nutr. 1998; 128:449S-452S

Eggs Become Icon for Cholesterol and Heart Disease

News Impacts Per Capita Egg Consumption

Source: www.ers.usda.gov/data/foodconsumption/foodavailspreadsheets.htm. Accessed October 2, 2013

Dietary Patterns Changed Significantly Over the Past 30 years

• Grains • Fruit juices• Sodas• Snack foods

• Red meat• Dairy• Eggs

Sources: Briefel RR, Johnson CL. Secular trends in dietary intake in the United States, Annu Rev Nutr. 2004;24:401-431Harnack et al. Temporal trends in energy intake in the United States: an ecologic perspective 1’2’3. Am J Clin Nutr. 2000;71(6):1478-1484

Dietary Guidance Intended to Reduce CVD Risk, No Change in Heart Disease Incidence

• Cholesterol • Total fat • Saturated fat

Sources: Stephen & Wald. Trends in individual consumption of dietary fat in the United States, 1920-1984. Am J Clin Nutr. 1990;52:457-469. Harnack et al. Temporal trends in energy intake in the United States: an ecologic perspective 1’2’3. Am J Clin Nutr. 2000;71:1478-1484Posner B.M, et al. Secular trends in diet and risk factors for cardiovascular disease: The Framingham Study. J Am Diet Assoc.1995;95:171-179

• Calories• Carbohydrates

No change in CVD

Origins of the Dietary Cholesterol Misconception

• Animal Studies• Epidemiological

Surveys• Clinical

Investigation

What Does the Newer Science Tell Us About Cholesterol, Eggs & CVD?

• Men: 37,851• Followed for 8

years • Cases of CHD: 866

• Women: 80,082• Followed for 14

years • Cases of CHD: 939

What is the relationship between egg consumption per week and CVD

risk?Source: Hu et al. A prospective study of egg consumption and risk of cardiovascular disease in men and women JAMA. 1999; 281:1387-1394.

HP Follow-up Study

Nurses’ Health Study

Results: Up to 1 Egg/day Does not Increase CVD Risk

Males Females0

0.2

0.4

0.6

0.8

1

1.2

<1 1 2-4 5-6 >7

Rela

tive

Risk

Source: Hu et al. A prospective study of egg consumption and risk of cardiovascular disease in men and women JAMA 1999; 281:1387-1394.

Dietary Cholesterol and CVD Risk

Newer and more accurate trials suggest:• Serum cholesterol levels modestly increase with increased dietary

cholesterol

• In the case of egg consumption, both serum HDL- and LDL-cholesterol tend to increase, so the LDL/HDL ratio (a marker of CVD risk) does not change significantly

• The degree to which dietary cholesterol influences serum cholesterol varies person to person

“In summary, the earlier purported adverse relationship between dietary cholesterol and heart disease risk was likely largely over-exaggerated.”

Source: PJ Jones. Dietary cholesterol and the risk of cardiovascular disease in patients: A review of the Harvard Egg Study and other data. Int J Clin Pract, 2009, (Suppl. 163), 1–8

Links Between Dietary Factors and CHD

In 2009, a review of the scientific evidence concluded that there are different levels of support for certain dietary factors and heart disease risk:

• Strong evidence supports a protective effect of vegetables, nuts, and the Mediterranean diet and a harmful effect of trans fats

• Moderate evidence suggests a protective effect of fish, marine-3 fatty acids, folate, whole grains, dietary sources of vitamins E and C, beta carotene, alcohol, fruit ,and fiber

• Insufficient evidence of association is present for intakes of supplementary vitamin E and C, saturated and polyunsaturated fatty acids, total fat, linolenic acid, meat, eggs and milk Source: Mente et. al. A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease.

Arch Intern Med. 2009; 169(7):659-669

Saturated Fat, Carbohydrate and CVD

• “Dietary efforts to improve the increasing burden of CVD risk…. should primarily emphasize the limitation of refined carbohydrate intakes and the reduction in excess adiposity”

Source: Siri-Tarino P, et al. Saturated fat, carbohydrate, and cardiovascular disease. Am J Clin Nutr 2010; 91:502–9

2002: A Change of Heart

There no longer is a specificrecommendation on thenumber of egg yolks a person may consume

per week-American Heart Association, 2002

Dietary Guidelines for Saturated Fat and Dietary Cholesterol

Year Country Dietary fat guidelinesDietary Cholesterol

Guidelines2009 Canada Limit saturated fat <

10%No recommendation for

dietary cholesterol

2007 Europa Limit saturated fat < 10% total energy

No recommendation for dietary cholesterol

2010 India Limit saturated fat and total fat

No recommendation for dietary cholesterol

2008 Korea Total fat < 20% No recommendation for dietary cholesterol

2003 New Zealand Limit saturated fat < 12% total energy

No recommendation for dietary cholesterol

.

2006 United states(AHA Scientific

Committee)

Limit saturated fat < 7%

< 300mg/d

2009 United states (AHA Special Report)

Limit saturated fat and trans fat

No mention of dietary cholesterol

2010 United States (AHA Pediatric & Adult Nutrition Guidelines)

Limit amount ofsaturated fat

No mention of dietary cholesterolSource: Adapted Fernandez & Calle: Atherosclerosis Reviews 2010; 4:259-269

Death of an Icon

1984 1999 2003

Eggs are no longer the icon for cholesterol

New Evidence Suggests an Alternative Dietary Pattern for

Better Health• High refined

carbohydrates stimulate insulin, which promotes inflammation, obesity, and CVD.• Replacing refined carbohydrates with protein promotes a more favorable metabolic response.