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1 Egg and Dairy Consumption: Impact on CVD Risk No conflicts of interest or disclosures Vasanti Malik, ScD Research Scientist Department of Nutrition Harvard School of Public Health Cardiovascular Disease Prevention International Symposium, Baptist Health South Florida Thursday February 19, 2015 Dietary protein types and sources My Plate Animal Protein - Complete protein - Higher concentration of protein vs. Vegetable Protein - Incomplete protein - Lower concentration of protein Sources: Sources: Meat Legumes Poultry Nuts Eggs Dairy Seeds Whole grains USDA, 2011 HSPH, Healthy Eating Plate Fish Vegetables

2 Egg Consumption and CVD Eggs and Risk of CHD: Meta-analysis of prospective cohort studies The summary relative risk of CHD for an increase of one egg per day HEART DISEASE Is 2013 Eating Eggs Really as Bad for Your Heart as Smoking? By Alexandra Sifferlin Aug. 16, Comments In a subgroup analysis of diabetic populations, the relative risk of CHD comparing the highest with the lowest egg consumption was 1.54 (1.14 to 2.09; P=0.01). BMJ 2013;346:e8539 Harvard cohorts Nurses Health Study (n=121,700, age 30-55) Eggs and risk of CVD (MI and stroke): Pooled results from 3 cohorts Diet Diet Diet Diet Diet Diet Diet Diet Nurses Health Study II (n=116,000, age 25-42) Diet Diet Diet Diet Health Professionals Follow-up Study (n=51,529, age 40-75) Diet Diet Diet Diet Diet Diet

3 Eggs and risk of CVD among patients with T2D: Pooled results from 3 cohorts Eggs and risk of Type 2 Diabetes: Meta-analysis of prospective cohort studies My Plate Meta-Analysis of 29 RCTs evaluating dairy and body weight Net change (95 CI) in body weight associated with dairy interventions expressed as the change (kg) during the intervention with dairy products minus the change during control regimen USDA, 2011 HSPH, Healthy Eating Plate Am J Clin Nutr Oct;96(4):735-47

4 ES (95CI) 0.94 (0.91, 0.98) 0.96 (0.90, 1.03) 0.79 (0.46, 1.35) 0.98 (0.89, 1.08) 0.98 (0.94, 1.02) 0.97 (0.84, 1.14) 1.0 (0.96, 1.04) 0.95 (0.77, 1.18) 0.81 (0.63, 1.04) 1.13 (0.96, 1.34) 1.03 (0.94, 1.12) 0.72 (0.61, 0.85) 0.98 (0.95, 1.01) 1.02 (0.99, 1.05) 0.98 (0.95, 1.01) 0.98 (0.96, 1.01) Meta-Analysis of RCTs evaluating dairy and body weight: stratified by energy restriction Net change (95 CI) by energy restriction in body weight associated with dairy interventions expressed as the change (kg) during the intervention with dairy products minus the change during the control regimen Meta-Analysis of RCTs evaluating dairy and body weight: stratified by duration Net change (95 CI) by study duration (short-term: <1 y; long-term: 1 y) in body weight (A) associated with dairy interventions expressed as the change (kg) during the intervention with dairy products minus the change during control regimens Am J Clin Nutr Oct;96(4): Am J Clin Nutr Oct;96(4): Individuals Foods and Body NHS: 50,422 NHS-II: 47,989 HPFS: 22,557 Relationships between Changes in Food and Beverage Consumption and Changes Every 4 Years, According to Study Cohort Total dairy intake and risk of type 2 diabetes: Metaanalysis of prospective cohort studies Study ID Liu et al van Dam et al Elwood et al Kirii et al Margolis et al Struijk et al Sluijs et al Louie et al Grantham et al Soedamah-Muthu et al Ericson et al Zong et al HPFS NHS I HRs for one serving per day increase in total dairy and risk of type 2 diabetes NHS II Overall (I-squared = 57.0, p = 0.003) ES (95 CI) 0.94 (0.91, 0.98) (0.90, 1.03) (0.46, 1.35) (0.89, 1.08) (0.94, 1.02) (0.84, 1.14) (0.96, 1.04) (0.77, 1.18) (0.63, 1.04) (0.96, 1.34) (0.94, 1.12) (0.61, 0.85) (0.95, 1.01) (0.99, 1.05) (0.95, 1.01) (0.96, 1.01) N Engl J Med 2011; 364: NOTE: s are from random effects analysis BMC Med Nov 25;12:215

5 NOTE: s are from random effects analysis ES (95CI) 1.53 (0.71, 3.34) 1.15 (0.63, 2.09) 0.16 (0.06, 0.41) 0.89 (0.78, 1.01) 0.76 (0.44, 1.31) 0.61 (0.42, 0.90) 0.85 (0.68, 1.06) 0.75 (0.65, 0.86) 0.94 (0.80, 1.10) 0.82 (0.70, 0.96) Yogurt intake and risk of type 2 diabetes: Metaanalysis of prospective cohort studies CVD risk according to quintile of total dairy intake in HPFS, NHS and NHS II HRs for one serving per day increase in yogurt and risk of type 2 diabetes Study ID ES (95 CI) Grantham et al Soedamah-Muth et al Sluijs et al Margolis et al Kirii et al Liu et al HPFS NHS I NHS II Overall (I-squared = 65.3, p = 0.003) 1.53 (0.71, 3.34) (0.63, 2.09) (0.06, 0.41) (0.78, 1.01) (0.44, 1.31) (0.42, 0.90) (0.68, 1.06) (0.65, 0.86) (0.80, 1.10) (0.70, 0.96) BMC Med Nov 25;12:215 Dairy consumption and CVD risk: Meta-analysis of prospective cohort studies 8 cohorts, 243,161 participants, 19,271 CVD Yogurt consumption and CVD risk: Meta-analysis of prospective cohort studies

6 Risk of CVD according to quintile of nonyogurt dairy intake in HPFS, NHS and NHS II Risk of CVD according to quintile of dairy fat ( of energy) in HPFS, NHS and NHS II HR and 95 for CVD associated with substitution of vegetable fat for dairy fat (5E) HR and 95 for CVD associated with substitution of polyunsaturated fat for dairy fat (2E)

7 Conclusions Eggs and dairy are widely consumed sources of (animal) protein in the US diet that also provide other important vitamins and minerals Despite the high cholesterol content, moderate egg consumption up to one a day does not increase CVD risk in healthy individuals and can be part of a healthy diet People who have diabetes or difficulty controlling their total and LDL cholesterol should choose foods made with egg whites and limit egg yolk consumption (i.e. no more than 3 yolks per week) Foods accompanying eggs should be chosen widely Intake of total dairy does not significantly impact long-term body weight or risk of diabetes and CVD Yogurt appears to have numerous health benefits While dairy fat itself was not associated with risk of CVD, substitution with vegetable fat or PUFA was associated with reduced risk, suggesting that food sources of these fats i.e. nuts and seeds may be better options Frank Hu Amanda Sands Mu Chen Walter Willett Acknowledgements

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