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Egg Nutrition Center

Egg Nutrition Center. Cardiovascular Disease Presentation. AHA Guidelines in 1968: Limit Dietary Cholesterol.

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Egg Nutrition Center

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  1. Egg Nutrition Center Cardiovascular Disease Presentation

  2. 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

  3. Eggs Become Icon for Cholesterol and Heart Disease

  4. News Impacts Per Capita Egg Consumption Source: www.ers.usda.gov/data/foodconsumption/foodavailspreadsheets.htm. Accessed October 2, 2013

  5. 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 ClinNutr. 2000;71(6):1478-1484

  6. 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 ClinNutr. 1990;52:457-469. Harnack et al. Temporal trends in energy intake in the United States: an ecologic perspective 1’2’3. Am J ClinNutr. 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

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

  8. What Does the Newer Science Tell Us About Cholesterol, Eggs & CVD? HP Follow-up Study Nurses’ Health Study • 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 womenJAMA. 1999; 281:1387-1394.

  9. 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 womenJAMA1999; 281:1387-1394.

  10. 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. IntJ ClinPract, 2009, (Suppl. 163), 1–8

  11. 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 evidencesupports a protective effect of vegetables, nuts, and the Mediterranean diet and a harmful effect of trans fats • Moderate evidencesuggests 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 evidenceof 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

  12. 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 ClinNutr2010; 91:502–9

  13. 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

  14. Dietary Guidelines for Saturated Fat and Dietary Cholesterol Source: Adapted Fernandez & Calle: Atherosclerosis Reviews 2010; 4:259-269

  15. 1984 1999 2003 Death of an Icon Eggs are no longer the icon for cholesterol

  16. 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.

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