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Cardiovascular benefit of egg consumption is most unlikely
  1. J David Spence1,
  2. David Jenkins2
  1. 1 Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada
  2. 2 Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr J David Spence, Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, ON N6G 2V4, Canada; dspence{at}robarts.ca

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To the Editor

The conclusion of the recent report that egg consumption reduced cardiovascular risk1 is most unlikely to be valid. It has been clear for many years that dietary cholesterol increases coronary risk, and a single 65 g egg contains 237 mg of cholesterol, more than the 200 mg daily limit that is still wisely recommended in a number of guidelines.2

Besides the very high cholesterol content of egg yolk, phosphatidylcholine (~250 mg in one) leads to the formation of trimethylamine by intestinal bacteria, oxidised in the liver to trimethyalmine N-oxide (TMAO). Among patients referred to the Cleveland Clinic for coronary angiography, TMAO levels in the top quartile were associated with a 2.5-fold increase in the 3-year risk of stroke/myocardial infarction/vascular mortality.

Egg consumption increases the risk of diabetes, particularly in women. Studies in the USA found a doubling of coronary disease from a daily egg only among participants who became diabetic; however, the US diet is so bad that it is difficult to show that anything makes it worse; only 0.1% of Americans eat a healthy diet.3 In Greece, however, where the Mediterranean Diet is the norm, the harm from eggs is more obvious. Among Greek diabetics, an egg a day was associated with a fivefold increase in coronary risk, and even 10 g/day of egg (1/6th of a large egg) increased coronary risk by >50%.4

In the Chinese study,1 there were important differences in many recognised determinants of health, between the categories of egg consumption (table 1). Furthermore, in China, urban residence probably reflects very large differences in availability of healthcare.

Table 1

Differences in determinants of health between the groups with the lowest and highest egg intake in the study of Qin et al 1

A key issue is the statement below Table 1 of the article: education, household income and dietary patterns were categorised into three levels. If those variables were grouped in that way for the Cox proportional hazards reported in Table 2, then those important differences may have been obscured.

Furthermore, high egg consumption was less than one per day, and there may well be other confounders such as general nutritional status that influenced the result. Persons at risk of vascular disease should not consume egg yolks.

References

Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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