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EGG NUTRITION CENTER Cardiovascular Disease Specialist Dr. Mubashar A Choudry MD


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;24:401-431 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):1478-1484


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

• Cholesterol • Total fat • Saturated fat

• Calories • Carbohydrates

No change in CVD 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;71:1478-1484 Posner 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


Origins of the Dietary Cholesterol Misconception • Animal Studies • Epidemiological Surveys • Clinical Investigation


What Does the Newer Science Tell Us About Cholesterol, Eggs & CVD? HP Follow-up Study • Men: 37,851 • Followed for 8 years • Cases of CHD: 866

Nurses’ Health Study • 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.


Re lati ve Risk

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

1.2 1 0.8 0.6 0.4 0.2 0

Males <1

Females 1

2-4

5-6

>7

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: â&#x20AC;˘ Strong evidence supports a protective effect of vegetables, nuts, and the Mediterranean diet and a harmful effect of trans fats â&#x20AC;˘ 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 â&#x20AC;˘ 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 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 Year 2009

Country Canada

Dietary fat guidelines Limit saturated fat < 10%

Dietary Cholesterol Guidelines 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 of saturated fat

No mention of dietary cholesterol

Source: 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 â&#x20AC;˘ High refined carbohydrates stimulate insulin, which promotes inflammation, obesity, and CVD. â&#x20AC;˘ Replacing refined carbohydrates with protein promotes a more favorable metabolic response.

Profile for Mubashar A Choudry MD

Lesser risk for death and heart disease to those who eat fewer eggs - Mubashar A Choudry MD  

Yes, it is true that lesser risk for death and heart disease to those who eat fewer eggs according to Mubashar A Choudry MD. So for your hea...

Lesser risk for death and heart disease to those who eat fewer eggs - Mubashar A Choudry MD  

Yes, it is true that lesser risk for death and heart disease to those who eat fewer eggs according to Mubashar A Choudry MD. So for your hea...

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