Association of egg intake with blood lipids, cardiovascular disease, and mortality in 177,000 people in 50 countries

Dehghan M 1 , Mente A 1 , Rangarajan S 1 , Mohan V 2 , Lear S 3 , Swaminathan S 4 Show all authors , Wielgosz A 5 , Seron P 6 , Avezum A 7 , Lopez-Jaramillo P 8 , Turbide G 9 , Chifamba J 10 , AlHabib KF 11 , Mohammadifard N 12 , Szuba A 13 , Khatib R 14 , Altuntas Y 15 , Liu X 16 , Iqbal R 17 , Rosengren A 18 , Yusuf R 19 , Smuts M 20 , Yusufali A 21 , Li N 22 , Diaz R 23 , Yusoff K 24 , Kaur M 25 , Soman B 26 , Ismail N 27 , Gupta R 28 , Dans A 29 , Sheridan P 1 , Teo K 1 , Anand SS 1 , Yusuf S 1

Affiliations 

  • 1 Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
  • 2 Dr. Mohan's Diabetes Specialities Centre, Gopalapuram, Chennai, India
  • 3 Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
  • 4 Division of Nutrition, St John's Research Institute, Koramangala, Bangalore, India
  • 5 Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  • 6 Faculty of Medicine, University of La Frontera, Temuco, Chile
  • 7 Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
  • 8 FOSCAL, Medical School, University of Santander, Bucaramanga, Colombia
  • 9 Heart and Lung Institute, Laval University, Quebec City, QC, Canada
  • 10 University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
  • 11 Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  • 12 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  • 13 Division of Angiology, Wroclaw Medical University, Wroclaw, Poland
  • 14 Institute for Community and Public Health, Birzeit University, Birzeit, Palestine
  • 15 Clinic of Endocrinology and Metabolism Sisli, Istanbul Sisli Hamidiye Etfal Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
  • 16 State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
  • 17 Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
  • 18 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
  • 19 School of Life Sciences, Independent University, Dhaka, Bangladesh
  • 20 Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
  • 21 Hatta Hospital, Dubai Medical University, Dubai Health Authority, Dubai, UAE
  • 22 Qingshan Lake Community Health Service Center, Nanchang City, China
  • 23 Clinical Studies Latin America, Rosario, Santa Fe, Argentina
  • 24 Department of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
  • 25 Post Graduate Institute of Medical Education and Research, School of Public Health, Chandigarh, India
  • 26 Health Action by People, Thiruvananthapuram, India
  • 27 Department of Community Health, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
  • 28 Eternal Heart Care Centre & Research Institute, Jaipur, India
  • 29 Department of Medicine, University of the Philippines, Manila, Philippines
Am J Clin Nutr, 2020 04 01;111(4):795-803.
PMID: 31965140 DOI: 10.1093/ajcn/nqz348

Abstract

BACKGROUND: Eggs are a rich source of essential nutrients, but they are also a source of dietary cholesterol. Therefore, some guidelines recommend limiting egg consumption. However, there is contradictory evidence on the impact of eggs on diseases, largely based on studies conducted in high-income countries.

OBJECTIVES: Our aim was to assess the association of egg consumption with blood lipids, cardiovascular disease (CVD), and mortality in large global studies involving populations from low-, middle-, and high-income countries.

METHODS: We studied 146,011 individuals from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study. Egg consumption was recorded using country-specific validated FFQs. We also studied 31,544 patients with vascular disease in 2 multinational prospective studies: ONTARGET (Ongoing Telmisartan Alone and in Combination with Ramipril Global End Point Trial) and TRANSCEND (Telmisartan Randomized Assessment Study in ACEI Intolerant Subjects with Cardiovascular Disease). We calculated HRs using multivariable Cox frailty models with random intercepts to account for clustering by study center separately within each study.

RESULTS: In the PURE study, we recorded 14,700 composite events (8932 deaths and 8477 CVD events). In the PURE study, after excluding those with history of CVD, higher intake of egg (≥7 egg/wk compared with <1 egg/wk intake) was not significantly associated with blood lipids, composite outcome (HR: 0.96; 95% CI: 0.89, 1.04; P-trend = 0.74), total mortality (HR: 1.04; 95% CI: 0.94, 1.15; P-trend = 0.38), or major CVD (HR: 0.92; 95% CI: 0.83, 1.01; P-trend = 0.20). Similar results were observed in ONTARGET/TRANSCEND studies for composite outcome (HR 0.97; 95% CI: 0.76, 1.25; P-trend = 0.09), total mortality (HR: 0.88; 95% CI: 0.62, 1.24; P-trend = 0.55), and major CVD (HR: 0.97; 95% CI: 0.73, 1.29; P-trend = 0.12).

CONCLUSIONS: In 3 large international prospective studies including ∼177,000 individuals, 12,701 deaths, and 13,658 CVD events from 50 countries in 6 continents, we did not find significant associations between egg intake and blood lipids, mortality, or major CVD events. The ONTARGET and TRANSCEND trials were registered at clinicaltrials.gov as NCT00153101. The PURE trial was registered at clinicaltrials.gov as NCT03225586.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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