Transcript Egg Nutrition Center

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: 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.
Results: Up to 1 Egg/day Does not
Increase CVD Risk
Relative 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 LDLcholesterol 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):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
• High refined carbohydrates
stimulate insulin, which
promotes inflammation,
obesity, and CVD.
• Replacing refined
carbohydrates with protein
promotes a more favorable
metabolic response.