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Moderate egg consumption and all-cause and specific-cause mortality in the Spanish European Prospective into Cancer and Nutrition (EPIC-Spain) study

  • Raul Zamora-RosEmail author
  • Valerie Cayssials
  • Ramón Cleries
  • María Luisa Redondo
  • Maria-Jose Sánchez
  • Miguel Rodríguez-Barranco
  • Jose-Juan Sánchez-Cruz
  • Olatz Mokoroa
  • Leire Gil
  • Pilar Amiano
  • Carmen Navarro
  • María Dolores Chirlaque
  • José María Huerta
  • Aurelio Barricarte
  • Eva Ardanaz
  • Conchi Moreno-Iribas
  • Antonio Agudo
Original Contribution

Abstract

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.

Keywords

Egg Intake Mortality EPIC-Spain Cohort 

Abbreviations

CVD

Cardiovascular diseases

EPIC

European Prospective Investigation into Cancer and Nutrition

ICD

International Classification of Diseases

Notes

Acknowledgements

The authors thank all participants in the EPIC-Spain cohort for their invaluable contribution to the study.

Author contributions

RZ-R designed the research; VC and RC performed the statistical analysis; RZ-R drafted the manuscript; MLR, M-JS, MR-B, J-JS-C, OM, LG, PA, CN, MDC, JMH, AB, EA, CM-I, AA contributed to the design of the study, data collection, and quality control and analysis. All authors read, critically reviewed and approved the final manuscript.

Funding

This work has been awarded with the Spanish Institute for Egg Studies Research Award 2016. This study used data from the EPIC-Spain study, which has received financial support from the Health Research Fund (FIS, 02/0652) of the Spanish Ministry of Health, the ISCIII (RETIC-RD06/0020 and the CIBER en Epidemiología y Salud Pública), the Spanish Regional Government of Andalusia, Asturias, the Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology. Some authors are partners of ECNIS, a network of excellence of the EU 6FP. R.Z.R. would like to thank the “Miguel Servet” program (CP15/00100) from the Institute of Health Carlos III and the European Social Fund (ESF).

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Supplementary material

394_2018_1754_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 16 KB)
394_2018_1754_MOESM2_ESM.docx (16 kb)
Supplementary material 2 (DOCX 16 KB)
394_2018_1754_MOESM3_ESM.docx (19 kb)
Supplementary material 3 (DOCX 18 KB)

References

  1. 1.
    Clayton ZS, Fusco E, Kern M (2017) Egg consumption and heart health: a review. Nutrition 37:79–85.  https://doi.org/10.1016/j.nut.2016.12.014 CrossRefPubMedGoogle Scholar
  2. 2.
    Gray J, Griffin B (2009) Eggs and dietary cholesterol-Dispelling the myth. Nutr Bull 34:66–70.  https://doi.org/10.1111/j.1467-3010.2008.01735.x CrossRefGoogle Scholar
  3. 3.
    Food and Agricultural Organization of the United Nations (2009) Food based dietary guidelines by country. Internet: http://www.fao.org/nutrition/education/food-dietary-guidelines/en. Accessed 15 Nov 2017
  4. 4.
    Mediterranean Diet Foundation (2010) What’s the mediterranean diet? Internet: http://dietamediterranea.com/en/nutrition. Accessed 15 Nov 2017
  5. 5.
    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 98:146–159.  https://doi.org/10.3945/ajcn.112.051318 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Guo J, Hobbs DA, Cockcroft JR, Elwood PC, Pickering JE, Lovegrove JA, Givens DI (2017) Association between egg consumption and cardiovascular disease events, diabetes and all-cause mortality. Eur J Nutr.  https://doi.org/10.1007/s00394-017-1566-0 (Epub ahead of print) CrossRefPubMedGoogle Scholar
  7. 7.
    Farvid MS, Malekshah AF, Pourshams A, Poustchi H, Sepanlou SG, Sharafkhah M, Khoshnia M, Farvid M, Abnet CC, Kamangar F et al (2017) Dietary protein sources and all-cause and cause-specific mortality: the Golestan cohort study in Iran. Am J Prev Med 52:237–248.  https://doi.org/10.1016/j.amepre.2016.10.041 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Nakamura Y, Okamura T, Tamaki S, Kadowaki T, Hayakawa T, Kita Y, Okayama A, Ueshima H; NIPPON DATA80 Research Group (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 80:58–63CrossRefPubMedGoogle Scholar
  9. 9.
    Djousse L, Gaziano JM (2008) Egg consumption in relation to cardiovascular disease and mortality: the Physicians’ Health Study. Am J Clin Nutr 87:964–969CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Riboli E, Hunt KJ, Slimani N, Ferrari P, Norat T, Fahey M, Charrondière UR, Hémon B, Casagrande C, Vignat J et al (2002) European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr 5:1113–1124.  https://doi.org/10.1079/PHN2002394 CrossRefPubMedGoogle Scholar
  11. 11.
    Gonzalez CA, Navarro C, Martinez C, Quirós JR, Dorronsoro M, Barricarte A, Tormo MJ, Agudo A, Chirlaque MD, Amiano P et al (2004) The European prospective investigation about cancer and nutrition (EPIC). Rev Esp Salud Publica 78:167–176Google Scholar
  12. 12.
    EPIC Group of Spain (1997) Relative validity and reproducibility of a diet history questionnaire in Spain. I. Foods. Int J Epidemiol 26 Suppl 1:S91-S99Google Scholar
  13. 13.
    EPIC Group of Spain (1997) Relative validity and reproducibility of a diet history questionnaire in Spain. II. Nutrients. Int J Epidemiol 26 Suppl 1:S100-S109Google Scholar
  14. 14.
    EPIC Group of Spain (1997) Relative validity and reproducibility of a diet history questionnaire in Spain. III. Biochemical markers. Int J Epidemiol 26 Suppl 1:S110-S117Google Scholar
  15. 15.
    Slimani N, Deharveng G, Unwin I, Southgate DA, Vignat J, Skeie G, Salvini S, Parpinel M, Møller A, Ireland J et al (2007) The EPIC nutrient database project (ENDB): a first attempt to standardize nutrient databases across the 10 European countries participating in the EPIC study. Eur J Clin Nutr 61:1037–1056.  https://doi.org/10.1038/sj.ejcn.1602679 CrossRefPubMedGoogle Scholar
  16. 16.
    Buckland G, Gonzalez CA, Agudo A, Vilardell M, Berenguer A, Amiano P, Ardanaz E, Arriola L, Barricarte A, Basterretxea M et al (2009) Adherence to the Mediterranean diet and risk of coronary heart disease in the Spanish EPIC Cohort Study. Am J Epidemiol 170:1518–1529.  https://doi.org/10.1093/aje/kwp282 CrossRefPubMedGoogle Scholar
  17. 17.
    Brown CC, Kipnis V, Freedman LS, Hartman AM, Schatzkin A, Wacholder S (1994) Energy adjustment methods for nutritional epidemiology: the effect of categorization. Am J Epidemiol 139:323–338CrossRefPubMedGoogle Scholar
  18. 18.
    Wareham NJ, Jakes RW, Rennie KL, Schuit J, Mitchell J, Hennings S, Day NE (2003) Validity and repeatability of a simple index derived from the short physical activity questionnaire used in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Public Health Nutr 6:407–413.  https://doi.org/10.1079/PHN2002439 CrossRefPubMedGoogle Scholar
  19. 19.
    Zhou B, Latouche A, Rocha V, Fine J (2011) Competing risks regression for stratified data. Biometrics 67:661–670.  https://doi.org/10.1111/j.1541-0420.2010.01493.x CrossRefPubMedGoogle Scholar
  20. 20.
    Zhou B, Latouche A (2015) CrrSC: Competing risks regression for stritified and clustered data. Version 1.1. https://cran.r-project.org/web/packages/crrSC/crrSC.pdf. Accessed 15 Nov 2017
  21. 21.
    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 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Zazpe I, Beunza JJ, Bes-Rastrollo M, Warnberg J, de la Fuente-Arrillaga C, Benito S, Vázquez Z, Martínez-González MA, SUN Project Investigators (2011) Egg consumption and risk of cardiovascular disease in the SUN Project. Eur J Clin Nutr 65:676–682.  https://doi.org/10.1038/ejcn.2011.30 CrossRefPubMedGoogle Scholar
  23. 23.
    Diez-Espino J, Basterra-Gortari FJ, Salas-Salvado J, Buil-Cosiales P, Corella D, Schröder H, Estruch R, Ros E, Gómez-Gracia E, Arós F et al (2017) Egg consumption and cardiovascular disease according to diabetic status: The PREDIMED study. Clin Nutr 36:1015–1021.  https://doi.org/10.1016/j.clnu.2016.06.009 CrossRefPubMedGoogle Scholar
  24. 24.
    World Research Cancer Fund, American Institute for Cancer Research (2007) Food, nutrition, physical activity and the prevention of cancer: a global perspective. Washington, DCGoogle Scholar
  25. 25.
    Keum N, Lee DH, Marchand N, Oh H, Liu H, Aune D, Greenwood DC, Giovannucci EL (2015) Egg intake and cancers of the breast, ovary and prostate: a dose-response meta-analysis of prospective observational studies. Br J Nutr 2015 114:1099–1107.  https://doi.org/10.1017/S0007114515002135 CrossRefPubMedGoogle Scholar
  26. 26.
    Ylilauri MP, Voutilainen S, Lönnroos E, Mursu J, Virtanen HE, Koskinen TT, Salonen JT, Tuomainen TP, Virtanen JK (2017) Association of dietary cholesterol and egg intakes with the risk of incident dementia or Alzheimer disease: the Kuopio Ischaemic Heart Disease Risk Factor Study. Am J Clin Nutr 105:476–484.  https://doi.org/10.3945/ajcn.116.146753 CrossRefPubMedGoogle Scholar
  27. 27.
    Zeisel SH, Mar MH, Howe JC, Holden JM (2003) Concentrations of cholinecontaining compounds and betaine in common foods. J Nutr 133:1302–1307.  https://doi.org/10.1093/jn/133.5.1302 CrossRefPubMedGoogle Scholar
  28. 28.
    Goodrow EF, Wilson TA, Houde SC, Vishwanathan R, Scollin PA, Handelman G, Nicolosi RJ (2006) Consumption of one egg per day increases serum lutein and zeaxanthin concentrations in older adults without altering serum lipid and lipoprotein cholesterol concentrations. J Nutr 136:2519–2524.  https://doi.org/10.1093/jn/136.10.2519 CrossRefPubMedGoogle Scholar
  29. 29.
    Wallace TC (2018) A comprehensive review of eggs, choline, and lutein on cognition across the life-span. J Am Coll Nutr 37:269–285.  https://doi.org/10.1080/07315724.2017.1423248 CrossRefPubMedGoogle Scholar
  30. 30.
    Nurk E, Refsum H, Bjelland I, Drevon CA, Tell GS, Ueland PM, Vollset SE, Engedal K, Nygaard HA, Smith DA (2013) Plasma free choline, betaine and cognitive performance: the Hordaland Health study. Br J Nutr 109:511–519.  https://doi.org/10.1017/S0007114512001249 CrossRefPubMedGoogle Scholar
  31. 31.
    Ajana S, Weber D, Helmer C, Merle BM, Stuetz W, Dartigues JF, Rougier MB, Korobelnik JF, Grune T, Delcourt C et al (2018) Plasma concentrations of lutein and zeaxanthin, macular pigment optical density, and their associations with cognitive performances among older adults. Invest Ophthalmol Vis Sci 59:1828–1835.  https://doi.org/10.1167/iovs.17-22656 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Raul Zamora-Ros
    • 1
    Email author
  • Valerie Cayssials
    • 1
  • Ramón Cleries
    • 2
  • María Luisa Redondo
    • 3
  • Maria-Jose Sánchez
    • 4
    • 5
  • Miguel Rodríguez-Barranco
    • 4
    • 5
  • Jose-Juan Sánchez-Cruz
    • 4
    • 5
  • Olatz Mokoroa
    • 5
    • 6
  • Leire Gil
    • 5
    • 6
  • Pilar Amiano
    • 5
    • 6
  • Carmen Navarro
    • 5
    • 7
    • 8
  • María Dolores Chirlaque
    • 5
    • 7
    • 8
  • José María Huerta
    • 5
    • 7
  • Aurelio Barricarte
    • 5
    • 9
    • 10
  • Eva Ardanaz
    • 5
    • 9
    • 10
  • Conchi Moreno-Iribas
    • 9
    • 10
    • 11
  • Antonio Agudo
    • 1
  1. 1.Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO)Bellvitge Biomedical Research Institute (IDIBELL)BarcelonaSpain
  2. 2.Catalan Institute of Oncology (ICO)BarcelonaSpain
  3. 3.Public Health DirectorateAsturiasSpain
  4. 4.Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, GranadaHospitales Universitarios de Granada/Universidad de GranadaGranadaSpain
  5. 5.CIBER de Epidemiología y Salud Pública (CIBERESP)MadridSpain
  6. 6.Public Health Division of GipuzkoaRegional Government of the Basque CountryDonostiaSpain
  7. 7.Department of EpidemiologyMurcia Regional Health Council, IMIB-ArrixacaMurciaSpain
  8. 8.Department of Health and Social SciencesUniversidad de MurciaMurciaSpain
  9. 9.Navarra Public Health InstitutePamplonaSpain
  10. 10.IdiSNA, Navarra Institute for Health ResearchPamplonaSpain
  11. 11.REDISECC Red de Servicios de Salud Orientados a Enfermedades CrónicasMadridSpain

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