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Egg consumption and the risk of cardiovascular disease and all-cause mortality: Guangzhou Biobank Cohort Study and meta-analyses

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Abstract

Purpose

Eggs are highly nutritious but concerns over their cholesterol content have led to dietary avoidance among many. There are also important international differences in relevant dietary guidance. We conducted the first prospective study in China investigating the association of egg consumption, cardiovascular disease (CVD) mortality, and a meta-analysis.

Methods

We included 28,024 participants without CVD at baseline (2003-8) in Guangzhou Biobank Cohort Study. All-cause and CVD mortality were identified through record linkage. We used Cox proportional hazards regression. We followed the Meta-analysis Of Observational Studies in Epidemiology reporting guidelines.

Results

During 275,343 person-years follow-up (average 9.8 years), we found 2685 all-cause and 873 CVD deaths. We found no significant difference in all-cause mortality between higher (7+ eggs/week) and low consumption (< 1 egg/week) [adjusted hazard ratio (HR) 1.08, 95% confidence interval (CI) 0.93–1.24], and mortality from CVD (0.99, 95% CI 0.76–1.27), ischemic heart disease (IHD) (0.92, 95% CI 0.63–1.36), or stroke (0.88, 95% CI 0.57–1.35). The updated meta-analyses including our results showed that 7+ eggs/week was not associated with all-cause mortality (HR 1.09, 95% CI 0.997–1.200) or IHD (HR 0.97, 95% CI 0.90–1.05), but associated with a small reduction in stroke (HR 0.91. 95% CI 0.85–0.98).

Conclusions

Eating one egg daily is not associated with increase in CVD or all-cause mortality. The small observed reduction in stroke risk needs to be confirmed. Our findings support current guidelines recommending eggs as part of a healthy diet, and should be considered in other dietary recommendations.

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References

  1. Hopkins PN (1992) Effects of dietary cholesterol on serum cholesterol: a meta-analysis and review. Am J Clin Nutr 55(6):1060–1070

    Article  CAS  PubMed  Google Scholar 

  2. Shekelle RB, Stamler J (1989) Dietary cholesterol and ischaemic heart disease. Lancet 1(8648):1177–1179

    Article  CAS  PubMed  Google Scholar 

  3. Berger S, Raman G, Vishwanathan R, Jacques PF, Johnson EJ (2015) Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis. Am J Clin Nutr 102(2):276–294. https://doi.org/10.3945/ajcn.114.100305

    Article  CAS  PubMed  Google Scholar 

  4. Jones PJ (2009) Dietary cholesterol and the risk of cardiovascular disease in patients: a review of the Harvard Egg Study and other data. Int J Clin Pract Suppl (163):1–8. https://doi.org/10.1111/j.1742-1241.2009.02136.x 28–36.

    Article  CAS  Google Scholar 

  5. https://health.gov/dietaryguidelines/2015/guidelines/. Accessed 26 July 2016

  6. Shin JY, Xun P, Nakamura Y, He K (2013) Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis. Am J Clin Nutr 98(1):146–159. https://doi.org/10.3945/ajcn.112.051318

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Rong Y, Chen L, Zhu T, Song Y, Yu M, Shan Z, Sands A, Hu FB, Liu L (2013) Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies. BMJ 346:e8539. https://doi.org/10.1136/bmj.e8539

    Article  PubMed  PubMed Central  Google Scholar 

  8. Li Y, Zhou C, Zhou X, Li L (2013) Egg consumption and risk of cardiovascular diseases and diabetes: a meta-analysis. Atherosclerosis 229(2):524–530. https://doi.org/10.1016/j.atherosclerosis.2013.04.003

    Article  CAS  PubMed  Google Scholar 

  9. World Health Organization (2015) http://www.who.int/mediacentre/factsheets/fs394/en/. Accessed 20 Sept 2016

  10. European Food Information Council http://www.eufic.org/article/en/expid/food-based-dietary-guidelines-in-europe/. Accessed 20 Sept 2016

  11. Food Standards Agency http://www.food.gov.uk/sites/default/files/multimedia/pdfs/nutrientinstitution.pdf. Accessed 20 Sept 2016

  12. Nakamura Y, Iso H, Kita Y, Ueshima H, Okada K, Konishi M, Inoue M, Tsugane S (2006) Egg consumption, serum total cholesterol concentrations and coronary heart disease incidence: Japan Public Health Center-based prospective study. Br J Nutr 96(5):921–928

    Article  CAS  PubMed  Google Scholar 

  13. Nakamura Y, Okamura T, Tamaki S, Kadowaki T, Hayakawa T, Kita Y, Okayama A, Ueshima H, Group NDR (2004) Egg consumption, serum cholesterol, and cause-specific and all-cause mortality: the National Integrated Project for Prospective Observation of Non-communicable Disease and Its Trends in the Aged, 1980 (NIPPON DATA80). Am J Clin Nutr 80(1):58–63

    Article  CAS  PubMed  Google Scholar 

  14. Sauvaget C, Nagano J, Allen N, Grant EJ, Beral V (2003) Intake of animal products and stroke mortality in the Hiroshima/Nagasaki Life Span Study. Int J Epidemiol 32(4):536–543

    Article  PubMed  Google Scholar 

  15. Jiang C, Thomas GN, Lam TH, Schooling CM, Zhang W, Lao X, Adab P, Liu B, Leung GM, Cheng KK (2006) Cohort profile: the Guangzhou Biobank Cohort Study, a Guangzhou-Hong Kong-Birmingham collaboration. Int J Epidemiol 35(4):844–852. https://doi.org/10.1093/ije/dyl131

    Article  PubMed  Google Scholar 

  16. Woo J, Leung S, Ho S, Lam T, Janus E (1997) A food frequency questionnaire for use in the Chinese population in Hong Kong: description and examination of validity. Nutr Res 17(11):1633–1641

    Article  CAS  Google Scholar 

  17. Winkleby MA, Jatulis DE, Frank E, Fortmann SP (1992) Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health 82(6):816–820

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Teo K, Lear S, Islam S, Mony P, Dehghan M, Li W, Rosengren A, Lopez-Jaramillo P, Diaz R, Oliveira G, Miskan M, Rangarajan S, Iqbal R, Ilow R, Puone T, Bahonar A, Gulec S, Darwish EA, Lanas F, Vijaykumar K, Rahman O, Chifamba J, Hou Y, Li N, Yusuf S, Investigators P (2013) Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high-, middle- and low-income countries: the Prospective Urban Rural Epidemiology (PURE) study. JAMA 309(15):1613–1621. https://doi.org/10.1001/jama.2013.3519

    Article  CAS  PubMed  Google Scholar 

  19. Leung S, Woo J, Ho S, Lam T, Janus E (1998) Hong Kong adult dietary survey, 1995. Aust J Nutr Diet 55(1):S11–S13

    Google Scholar 

  20. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283(15):2008–2012

    Article  CAS  Google Scholar 

  21. Higgins J, Green S (2015) Cochrane handbook for systematic reviews of interventions. 2011. Wiley. http://handbook-5-1.cochrane.org/. Accessed 21 Apr 2018

  22. Andersen PK, Abildstrom SZ, Rosthoj S (2002) Competing risks as a multi-state model. Stat Methods Med Res 11(2):203–215

    Article  PubMed  Google Scholar 

  23. Virtanen JK, Mursu J, Virtanen HE, Fogelholm M, Salonen JT, Koskinen TT, Voutilainen S, Tuomainen TP (2016) Associations of egg and cholesterol intakes with carotid intima-media thickness and risk of incident coronary artery disease according to apolipoprotein E phenotype in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Am J Clin Nutr 103(3):895–901. https://doi.org/10.3945/ajcn.115.122317

    Article  CAS  PubMed  Google Scholar 

  24. Larsson SC, Akesson A, Wolk A (2015) Egg consumption and risk of heart failure, myocardial infarction, and stroke: results from 2 prospective cohorts. Am J Clin Nutr 102(5):1007–1013. https://doi.org/10.3945/ajcn.115.119263

    Article  CAS  PubMed  Google Scholar 

  25. Katz DL, Gnanaraj J, Treu JA, Ma Y, Kavak Y, Njike VY (2015) Effects of egg ingestion on endothelial function in adults with coronary artery disease: a randomized, controlled, crossover trial. Am Heart J 169(1):162–169. https://doi.org/10.1016/j.ahj.2014.10.001

    Article  CAS  PubMed  Google Scholar 

  26. Blesso CN, Andersen CJ, Barona J, Volek JS, Fernandez ML (2013) Whole egg consumption improves lipoprotein profiles and insulin sensitivity to a greater extent than yolk-free egg substitute in individuals with metabolic syndrome. Metabolism 62(3):400–410. https://doi.org/10.1016/j.metabol.2012.08.014

    Article  CAS  PubMed  Google Scholar 

  27. Andersen CJ, Blesso CN, Lee J, Barona J, Shah D, Thomas MJ, Fernandez ML (2013) Egg consumption modulates HDL lipid composition and increases the cholesterol-accepting capacity of serum in metabolic syndrome. Lipids 48(6):557–567. https://doi.org/10.1007/s11745-013-3780-8

    Article  CAS  PubMed  Google Scholar 

  28. Pearce KL, Clifton PM, Noakes M (2011) Egg consumption as part of an energy-restricted high-protein diet improves blood lipid and blood glucose profiles in individuals with type 2 diabetes. Br J Nutr 105(4):584–592. https://doi.org/10.1017/S0007114510003983

    Article  CAS  PubMed  Google Scholar 

  29. Rouhani MH, Rashidi-Pourfard N, Salehi-Abargouei A, Karimi M, Haghighatdoost F (2018) Effects of egg consumption on blood lipids: a systematic review and meta-analysis of randomized clinical trials. J Am Coll Nutr 37(2):99–110. https://doi.org/10.1080/07315724.2017.1366878

    Article  CAS  PubMed  Google Scholar 

  30. Hu FB, Stampfer MJ, Rimm EB, Manson JE, Ascherio A, Colditz GA, Rosner BA, Spiegelman D, Speizer FE, Sacks FM, Hennekens CH, Willett WC (1999) A prospective study of egg consumption and risk of cardiovascular disease in men and women. JAMA 281(15):1387–1394

    Article  CAS  PubMed  Google Scholar 

  31. Tran NL, Barraj LM, Heilman JM, Scrafford CG (2014) Egg consumption and cardiovascular disease among diabetic individuals: a systematic review of the literature. Diabetes Metab Syndr Obes 7:121–137. https://doi.org/10.2147/DMSO.S58668

    Article  PubMed  PubMed Central  Google Scholar 

  32. Scrafford CG, Tran NL, Barraj LM, Mink PJ (2011) Egg consumption and CHD and stroke mortality: a prospective study of US adults. Public Health Nutr 14(2):261–270. https://doi.org/10.1017/S1368980010001874

    Article  PubMed  Google Scholar 

  33. Appel LJ, Sacks FM, Carey VJ, Obarzanek E, Swain JF, Miller ER III, Conlin PR, Erlinger TP, Rosner BA, Laranjo NM, Charleston J, McCarron P, Bishop LM, OmniHeart Collaborative Research G (2005) Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA 294(19):2455–2464. https://doi.org/10.1001/jama.294.19.2455

    Article  CAS  PubMed  Google Scholar 

  34. Zhu H, Chen Z-Y (2017) Do we no longer need to worry about dietary cholesterol? J Agric Food Chem 65(46):9931–9933. https://doi.org/10.1021/acs.jafc.7b04829

    Article  CAS  PubMed  Google Scholar 

  35. Watkins BA (1995) The nutritive value of the egg. Egg Sci Technol 4:177–194

    Google Scholar 

Download references

Funding

This work was supported by the University of Hong Kong Foundation for Educational Development and Research (SN/1f/HKUF-DC;C20400.28505200), the Health Medical Research Fund (Grant number: HMRF/13143241) in Hong Kong; the Guangzhou Public Health Bureau (201102A211004011) and the Guangzhou Science and Technology Bureau, Guangzhou, China (2002Z2-E2051; 2012J5100041; 2013J4100031); and the University of Birmingham, UK.

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Contributions

Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: LX, CQJ, THL, KKC, JW, WSZ, FZ, YLJ, GNT. Drafting the work or revising it critically for important intellectual content: LX, CQJ, THL, KKC, GNT, JW. Final approval of the version to be published: LX, CQJ, THL, KKC, WSZ, FZ, YLJ, GNT, JW. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: LX, CQJ, THL, KKC, JW, WSZ, FZ, YLJ, GNT.

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Correspondence to Tai Hing Lam or Chao Qiang Jiang.

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Xu, L., Lam, T.H., Jiang, C.Q. et al. Egg consumption and the risk of cardiovascular disease and all-cause mortality: Guangzhou Biobank Cohort Study and meta-analyses. Eur J Nutr 58, 785–796 (2019). https://doi.org/10.1007/s00394-018-1692-3

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