Egg Nutrition Center Cardiovascular 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: Accessed October 2, 2013www.ers.usda.gov/data/foodconsumption/foodavailspreadsheets.htm

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: Harnack et al. Temporal trends in energy intake in the United States: an ecologic perspective 1’2’3. Am J Clin Nutr. 2000;71(6):

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, Am J Clin Nutr. 1990;52: Harnack et al. Temporal trends in energy intake in the United States: an ecologic perspective 1’2’3. Am J Clin Nutr. 2000;71: Posner B.M, et al. Secular trends in diet and risk factors for cardiovascular disease: The Framingham Study. J Am Diet Assoc.1995;95: 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: HP Follow-up StudyNurses’ Health Study

Results: Up to 1 Egg/day Does not Increase CVD Risk Source: Hu et al. A prospective study of egg consumption and risk of cardiovascular disease in men and women JAMA 1999; 281:

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):

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 specific recommendation on the number of egg yolks a person may consume per week -American Heart Association, 2002

Dietary Guidelines for Saturated Fat and Dietary Cholesterol YearCountryDietary fat guidelinesDietary Cholesterol Guidelines 2009CanadaLimit saturated fat < 10% No recommendation for dietary cholesterol 2007Europa Limit saturated fat < 10% total energy No recommendation for dietary cholesterol 2010India Limit saturated fat and total fat No recommendation for dietary cholesterol 2008KoreaTotal fat < 20% No recommendation for dietary cholesterol 2003New Zealand Limit saturated fat < 12% total energy No recommendation for dietary cholesterol 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 of saturated fat No mention of dietary cholesterol Source: Adapted Fernandez & Calle: Atherosclerosis Reviews 2010; 4:

Death of an Icon 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.