Abstract
Eggs are rich in nutrients and a source of essential fatty- and amino acids, and the food item with highest cholesterol content. Since the 1970s dietary recommendations have advised limiting egg intake to 2–4 a week for the healthy population, and in those diagnosed with cardiovascular disease (CVD) and type 2 diabetes (T2D) an even more restricted consumption. The aim of the present paper was to assess the recommendation to lower the dietary intake of cholesterol and especially the intake of egg to reduce the risk of CVD and T2D. We performed three web-based literature searches on human studies (observational and interventional) published within the past 10 years during spring 2015. High-quality intervention studies have found nonsignificant effects of increasing the consumption of eggs on risk markers for CVD and T2D in healthy subjects and subjects with T2D. The risk associations found in the observational studies are more likely to be attributed to a dietary pattern often accompanying high egg intake and/or the cluster of other risk factors in people with high egg consumption. Dietary patterns, physical activity and genetics affect the predisposition of CVD and T2D more than a single food item as eggs. In conclusion, up to seven eggs per week can safely be consumed, but in patients with established CVD or T2D only with special emphasis on a healthy lifestyle.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on SpringerLink
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Department of Health. Nutrient Analysis of Eggs—Summary Report. United Kingdom 2012.
Report of the dietary guidelines advisory committee on the dietary guidelines for Americans, 2010, to the Secretary of Agriculture and the Secretary of Health and Human Services. Secretary of Agriculture and Secretary of Health and Human Services 2010.
US Department of Health and Human Services Dietary Guidelines for Americans, 2005. US Department of Health and Human Services: USA, 2005.
GLOBAL POULTRY TRENDS 2013: European Egg Consumption Linked to Production and Population. The Poultry Site: 5m Publishing 2014.
McGuire S . Scientific report of the 2015 Dietary Guidelines Advisory Committee. Washington, DC: US Departments of Agriculture and Health and Human Services, 2015. Adv Nutr 2016; 7: 202–204.
2015-2020 Dietary Guidelines for Americans, 8th edn. US Department of Health and Human Services and US Department of Agriculture, USA 2015.
Nissen SE . US dietary guidelines: an evidence-free zone. Ann Intern Med 2016; 164: 558–559.
McNamara DJ . The fifty year rehabilitation of the egg. Nutrients 2015; 7: 8716–8722.
Nordic Nutrition Recommendations 2012: Integrating Nutrition and Physical Activity. Nordic Council of Ministers: Copenhagen, 2014.
Nordic Nutrition Recommendations 2004: Integrating Nutrition and Physical Activity. Nordic Council of Ministers: Copenhagen, 2005.
Lopez-Jimenez F, Eggs: Are they Good or Bad for My Cholesterol? Mayo Clinic 2014.
Gohlke H, Cholesterin: Wie können sich Herzpatienten schützen? Deutsche Herzstiftung 2010.
Gray J, Griffin B . Eggs and dietary cholesterol–dispelling the myth. Nutr Bull 2009; 34: 66–70.
Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ et al. AHA dietary guidelines revision 2000: a statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation 2000 102: 2284–2299.
Eckel RH, Jakicic JM, Ard JD, De Jesus JM, Miller NH, Hubbard VS et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63: 2960–2984.
British Heart Foundation. It's a Myth that Eggs are Bad for your Heart 2015.
The Australian Heart Foundation. Eggs. Australian Heart Foundation: Australia, 2015.
Det er ægge let. Hjerteforeningen 2012.
Tang WW, Wang Z, Levison BS, Koeth RA, Britt EB, Fu X et al. Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. N Engl J Med 2013; 368: 1575–1584.
Miller CA, Corbin KD, da Costa K-A, Zhang S, Zhao X, Galanko JA et al. Effect of egg ingestion on trimethylamine-N-oxide production in humans: a randomized, controlled, dose-response study. Am J Clin Nutr 2014; 100: 778–786.
Hazen SL, Brown JM . Eggs as a dietary source for gut microbial production of trimethylamine-N-oxide. Am J Clin Nutr 2014; 100: 741–743.
Senthong V, Li XS, Hudec T, Coughlin J, Wu Y, Levison B et al. Plasma trimethylamine N-oxide, a gut microbe–generated phosphatidylcholine metabolite, is associated with atherosclerotic burden. J Am Coll Cardiol 2016; 67: 2620–2628.
Zheng Y, Li Y, Rimm EB, Hu FB, Albert CM, Rexrode KM et al. Dietary phosphatidylcholine and risk of all-cause and cardiovascular-specific mortality among US women and men. Am J Clin Nutr 2016; 104: 173–180.
Bernstein AM, Pan A, Rexrode KM, Stampfer M, Hu FB, Mozaffarian D et al. Dietary protein sources and the risk of stroke in men and women. Stroke 2012; 43: 637–644.
Djoussé L, Gaziano JM . Egg consumption and risk of heart failure in the Physicians’ Health Study. Circulation 2008; 117: 512–516.
Hu FB, Stampfer MJ, Rimm EB, Manson JE, Ascherio A, Colditz GA et al. A prospective study of egg consumption and risk of cardiovascular disease in men and women. JAMA 1999; 281: 1387–1394.
Nakamura Y, Okamura T, Tamaki S, Kadowaki T, Hayakawa T, Kita Y et al. Egg consumption, serum cholesterol, and cause-specific and all-cause mortality: the National Integrated Project for Prospective Observation of Non-communicable Disease and Its Trends in the Aged, 1980 (NIPPON DATA80). Am J Clin Nutr 2004; 80: 58–63.
Nakamura Y, Iso H, Kita Y, Ueshima H, Okada K, Konishi M et al. Egg consumption, serum total cholesterol concentrations and coronary heart disease incidence: Japan Public Health Center-based prospective study. Br J Nutr 2006; 96: 921–928.
Qureshi AI, Suri MFK, Ahmed S, Nasar A, Divani AA, Kirmani JF . Regular egg consumption does not increase the risk of stroke and cardiovascular diseases. Med Sci Technol 2006; 13: CR1–CR8.
Sauvaget C, Nagano J, Allen N, Grant EJ, Beral V . Intake of animal products and stroke mortality in the Hiroshima/Nagasaki Life Span Study. Int J Epidemiol 2003; 32: 536–543.
Scrafford CG, Tran NL, Barraj LM, Mink PJ . Egg consumption and CHD and stroke mortality: a prospective study of US adults. Public Health Nutr. 2011; 14: 261–270.
Spence JD, Jenkins DJ, Davignon J . Egg yolk consumption and carotid plaque. Atherosclerosis 2012; 224: 469–473.
Choi Y, Chang Y, Lee JE, Chun S, Cho J, Sung E et al. Egg consumption and coronary artery calcification in asymptomatic men and women. Atherosclerosis 2015; 241: 305–312.
Chagas P, Caramori P, Galdino TP, de Barcellos CdS, Gomes I, Schwanke CHA . Egg consumption and coronary atherosclerotic burden. Atherosclerosis 2013; 229: 381–384.
Goldberg S, Gardener H, Tiozzo E, Kuen CY, Elkind MS, Sacco RL et al. Egg consumption and carotid atherosclerosis in the Northern Manhattan Study. Atherosclerosis 2014; 235: 273–280.
Djoussé L, Petrone AB, Hickson DA, Talegawkar SA, Dubbert PM, Taylor H et al. Egg consumption and risk of type 2 diabetes among African Americans: The Jackson Heart Study. Clin Nutr 2016; 35: 679–684.
Kurotani K, Nanri A, Goto A, Mizoue T, Noda M, Oba S et al. Cholesterol and egg intakes and the risk of type 2 diabetes: The Japan Public Health Center-based Prospective Study. Br J Nutr 2014; 112: 1636–1643.
Radzevičienė L, Ostrauskas R . Egg consumption and the risk of type 2 diabetes mellitus: a case–control study. Public Health Nutr 2012; 15: 1437–1441.
Virtanen JK, Mursu J, Tuomainen T-P, Virtanen HE, Voutilainen S . Egg consumption and risk of incident type 2 diabetes in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Am J Clin Nutr 2015; 101: 1088–1096.
Tran NL, Barraj LM, Heilman JM, Scrafford CG . Egg consumption and cardiovascular disease among diabetic individuals: a systematic review of the literature. Diabetes Metab Syndr Obes 2014; 7: 121.
Li Y, Zhou C, Zhou X, Li L . Egg consumption and risk of cardiovascular diseases and diabetes: a meta-analysis. Atherosclerosis 2013; 229: 524–530.
Rong Y, Chen L, Zhu T, Song Y, Yu M, Shan Z et al. Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies. BMJ 2013; 346: e8539.
Shin JY, Xun P, Nakamura Y, He K . Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis. Am J Clin Nutr 2013; 98: 146–159.
Larsson SC, Åkesson A, Wolk A . Egg consumption and risk of heart failure, myocardial infarction, and stroke: results from 2 prospective cohorts. Am J Clin Nutr 2015; 102: 1007–1013.
Robbins JM, Petrone AB, Ellison RC, Hunt SC, Carr JJ, Heiss G et al. Association of egg consumption and calcified atherosclerotic plaque in the coronary arteries: the NHLBI Family Heart Study. e-SPEN J 2014; 9: e131–e135.
Virtanen JK, Mursu J, Virtanen HE, Fogelholm M, Salonen JT, Koskinen TT et al. Associations of egg and cholesterol intakes with carotid intima-media thickness and risk of incident coronary artery disease according to apolipoprotein E phenotype in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Am J Clin Nutr 2016; 103: 895–901.
Njike VY, Ayettey RG, Rajebi H, Treu JA, Katz DL . Egg ingestion in adults with type 2 diabetes: effects on glycemic control, anthropometry, and diet quality—a randomized, controlled, crossover trial. BMJ Open Diabetes Res Care 2016; 4: e000281.
Berger S, Raman G, Vishwanathan R, Jacques PF, Johnson EJ . Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis. Am J Clin Nutr 2015; 102: 276–294. ajcn100305.
Djoussé L, Khawaja OA, Gaziano JM . Egg consumption and risk of type 2 diabetes: a meta-analysis of prospective studies. Am J Clin Nutr 2016; 103: 474–480.
Alexander DD, Miller PE, Vargas AJ, Weed DL, Cohen SS . Meta-analysis of egg consumption and risk of coronary heart disease and stroke. J Am Coll Nutr 2016; 35: 1–13.
Fuller NR, Caterson ID, Sainsbury A, Denyer G, Fong M, Gerofi J et al. The effect of a high-egg diet on cardiovascular risk factors in people with type 2 diabetes: the Diabetes and Egg (DIABEGG) study—a 3-mo randomized controlled trial. Am J Clin Nutr 2015; 101: 705–713.
Harman NL, Leeds AR, Griffin BA . Increased dietary cholesterol does not increase plasma low density lipoprotein when accompanied by an energy-restricted diet and weight loss. Eur J Nutr 2008; 47: 287–293.
van der Made SM, Kelly ER, Berendschot TT, Kijlstra A, Lütjohann D, Plat J . Consuming a buttermilk drink containing lutein-enriched egg yolk daily for 1 year increased plasma lutein but did not affect serum lipid or lipoprotein concentrations in adults with early signs of age-related macular degeneration. J Nutr 2014; 144: 1370–1377.
Vander Wal J, Gupta A, Khosla P, Dhurandhar N . Egg breakfast enhances weight loss. Int J Obes 2008; 32: 1545–1551.
Vislocky LM, Pikosky MA, Rubin KH, Vega-López S, Gaine PC, Martin WF et al. Habitual consumption of eggs does not alter the beneficial effects of endurance training on plasma lipids and lipoprotein metabolism in untrained men and women. J Nutr Biochem 2009; 20: 26–34.
Pearce KL, Clifton PM, Noakes M . Egg consumption as part of an energy-restricted high-protein diet improves blood lipid and blood glucose profiles in individuals with type 2 diabetes. Br J Nutr 2011; 105: 584–592.
Bunger M, Quataert M, Kamps L, Versloot P, Hulshof PJ, Togtema A et al. Bioavailability of lutein from a lutein-enriched egg-yolk beverage and its dried re-suspended versions. Int J Food Sci Nutr 2014; 65: 903–909.
Baumgartner S, Kelly ER, van der Made S, Berendschot TT, Husche C, Lütjohann D et al. The influence of consuming an egg or an egg-yolk buttermilk drink for 12 wk on serum lipids, inflammation, and liver function markers in human volunteers. Nutrition 2013; 29: 1237–1244.
Iglay H, Apolzan J, Gerrard D, Eash J, Anderson J, Campbell W . Moderately increased protein intake predominately from egg sources does not influence whole body, regional, or muscle composition responses to resistance training in older people. J Nutr Health Aging 2009; 13: 108–114.
Wenzel AJ, Gerweck C, Barbato D, Nicolosi RJ, Handelman GJ, Curran-Celentano J . A 12-wk egg intervention increases serum zeaxanthin and macular pigment optical density in women. J. Nutr. 2006; 136: 2568–2573.
Greene CM, Zern TL, Wood RJ, Shrestha S, Aggarwal D, Sharman MJ et al. Maintenance of the LDL cholesterol: HDL cholesterol ratio in an elderly population given a dietary cholesterol challenge. J Nutr 2005; 135: 2793–2798.
Nissinen MJ, Gylling H, Miettinen TA . Responses of surrogate markers of cholesterol absorption and synthesis to changes in cholesterol metabolism during various amounts of fat and cholesterol feeding among healthy men. Br J Nutr 2008; 99: 370–378.
Burns-Whitmore B, Haddad E, Sabaté J, Rajaram S . Effects of supplementing n-3 fatty acid enriched eggs and walnuts on cardiovascular disease risk markers in healthy free-living lacto-ovo-vegetarians: a randomized, crossover, free-living intervention study. Nutr J 2014; 13: 29.
Goodrow EF, Wilson TA, Houde SC, Vishwanathan R, Scollin PA, Handelman G et al. Consumption of one egg per day increases serum lutein and zeaxanthin concentrations in older adults without altering serum lipid and lipoprotein cholesterol concentrations. J Nutr 2006; 136: 2519–2524.
Vishwanathan R, Goodrow-Kotyla EF, Wooten BR, Wilson TA, Nicolosi RJ . Consumption of 2 and 4 egg yolks/d for 5 wk increases macular pigment concentrations in older adults with low macular pigment taking cholesterol-lowering statins. Am J Clin Nutr 2009; 90: 1272–1279.
Rueda JM, Khosla P . Impact of breakfasts (with or without eggs) on body weight regulation and blood lipids in university students over a 14-week semester. Nutrients 2013; 5: 5097–5113.
Mutungi G, Ratliff J, Puglisi M, Torres-Gonzalez M, Vaishnav U, Leite JO et al. Dietary cholesterol from eggs increases plasma HDL cholesterol in overweight men consuming a carbohydrate-restricted diet. J Nutr 2008; 138: 272–276.
Blesso CN, Andersen CJ, Barona J, Volek JS, Fernandez ML . Whole egg consumption improves lipoprotein profiles and insulin sensitivity to a greater extent than yolk-free egg substitute in individuals with metabolic syndrome. Metabolism 2013; 62: 400–410.
Katz DL, Gnanaraj J, Treu JA, Ma Y, Kavak Y, Njike VY . Effects of egg ingestion on endothelial function in adults with coronary artery disease: a randomized, controlled, crossover trial. Am Heart J 2015; 169: 162–169.
Njike V, Faridi Z, Dutta S, Gonzalez-Simon AL, Katz DL . Daily egg consumption in hyperlipidemic adults—effects on endothelial function and cardiovascular risk. Nutr J 2010; 9: 28.
Quality Assessent of Controlled Intervention Sstudies. National Institut of Health 2014.
GRADEWorkingGroup. Grading quality of evidence and strength of recommendations. Br Med J 2004; 328: 1490.
Olver TD, Thomas GW, Hamilton CD, Spence N . Putting eggs and cigarettes in the same basket; are you yolking? Atherosclerosis 2013; 227: 184–185.
Zampelas A . Still questioning the association between egg consumption and the risk of cardiovascular diseases. Atherosclerosis 2012; 224: 318–319.
Lucan SC . Egg on their faces (probably not in their necks); the yolk of the tenuous cholesterol-to-plaque conclusion. Atherosclerosis 2013; 227: 182–183.
Knopp RH, Retzlaff B, Fish B, Walden C, Wallick S, Anderson M et al. Effects of insulin resistance and obesity on lipoproteins and sensitivity to egg feeding. Arterioscler Thromb Vasc Biol 2003; 23: 1437–1443.
Mayurasakorn K, Srisura W, Sitphahul P, Hongto P . High-density lipoprotein cholesterol changes after continuous egg consumption in healthy adults. J Med Assoc Thai 2008; 91: 400–407.
Hegsted D . Serum-cholesterol response to dietary cholesterol: a re-evaluation. Am J Clin Nutr 1986; 44: 299–305.
Kannel WB, Castelli WP, Gordon T, McNamara PM . Serum cholesterol, lipoproteins, and the risk of coronary heart disease: the Framingham Study. Ann Intern Med 1971; 74: 1–12.
Dawber TR, Nickerson RJ, Brand FN, Pool J . Eggs, serum cholesterol, and coronary heart disease. Am J Clin Nutr 1982; 36: 617–625.
Shi Z, Yuan B, Zhang C, Zhou M, Holmboe-Ottesen G . Egg consumption and the risk of diabetes in adults, Jiangsu, China. Nutrition 2011; 27: 194–198.
Stender S, Dyerberg J . Influence of trans fatty acids on health. Ann Nutr Metab 2004; 48: 61–66.
Dyerberg J, Eskesen D, Andersen P, Astrup A, Buemann B, Christensen J et al. Effects of trans-and n-3 unsaturated fatty acids on cardiovascular risk markers in healthy males. An 8 weeks dietary intervention study. Eur J Clin Nutr 2004; 58: 1062–1070.
Bendsen NT, Christensen R, Bartels EM, Astrup A . Consumption of industrial and ruminant trans fatty acids and risk of coronary heart disease: a systematic review and meta-analysis of cohort studies. Eur J Clin Nutr 2011; 65: 773–783.
Astrup A, Raben A, Geiker N . The role of higher protein diets in weight control and obesity-related comorbidities. Int J Obes 2015; 39: 721–726.
Paddon-Jones D, Westman E, Mattes RD, Wolfe RR, Astrup A, Westerterp-Plantenga M . Protein, weight management, and satiety. Am J Clin Nutr 2008; 87: 1558S–1561S.
Nicklas TA, O’Neil CE, Fulgoni VL . Differing statistical approaches affect the relation between egg consumption, adiposity, and cardiovascular risk factors in adults. J Nutr 2015; 145: 170S–176S.
The Australian Heart Foundation. Cholesterol in Food. Australian Heart Foundation: Australia, 2016.
The New Zealand Heart Foundation. Eggs Healthier than Cracked Up to be. New Zealand Heart Foundation: New Zealand, 2016.
Acknowledgements
NRWG and AA initiated the review. The literature search was performed by NRWG, reviewed and discussed by all authors. All authors contributed to the content and NRWG collected the individual contributions and drafted the manuscript; all authors critically reviewed and endorsed the final manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The work of NRWG has been funded by the Danish Egg Association. The funders had no influence on design, execution, data handling of the investigation, on interpretation or dissemination. The remaining authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Geiker, N., Larsen, M., Dyerberg, J. et al. Egg consumption, cardiovascular diseases and type 2 diabetes. Eur J Clin Nutr 72, 44–56 (2018). https://doi.org/10.1038/ejcn.2017.153
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ejcn.2017.153
This article is cited by
-
The effect of whole egg consumption on weight and body composition in adults: a systematic review and meta-analysis of clinical trials
Systematic Reviews (2023)
-
Eggs and Cardiovascular Disease Risk: An Update of Recent Evidence
Current Atherosclerosis Reports (2023)
-
The association of egg consumption with blood pressure levels and glycated hemoglobin in Spanish adults according to body mass index
Scientific Reports (2022)
-
Associations between exploratory dietary patterns and incident type 2 diabetes: a federated meta-analysis of individual participant data from 25 cohort studies
European Journal of Nutrition (2022)
-
Effects of Quality and Quantity of Protein Intake for Type 2 Diabetes Mellitus Prevention and Metabolic Control
Current Nutrition Reports (2020)