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
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 1997 1999 2012 HEART DISEASE Is 2013 Eating Eggs Really as Bad for Your Heart as Smoking? By Alexandra Sifferlin Aug. 16, 2012 63 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 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 Diet Diet Diet Diet Diet Diet Diet Diet Nurses Health Study II (n=116,000, age 25-42) 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 Diet Diet Diet Diet Health Professionals Follow-up Study (n=51,529, age 40-75) 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 Diet Diet Diet Diet Diet Diet
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. 2012 Oct;96(4):735-47
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) 11.22 7.59 0.20 4.62 11.90 2.19 11.84 1.20 0.89 1.98 4.98 1.95 13.08 13.29 13.07 10.0 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. 2012 Oct;96(4):735-47 Am J Clin Nutr. 2012 Oct;96(4):735-47 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. 2006 van Dam et al. 2006 Elwood et al. 2007 Kirii et al. 2009 Margolis et al. 2011 Struijk et al. 2012 Sluijs et al. 2012 Louie et al. 2012 Grantham et al. 2013 Soedamah-Muthu et al. 2013 Ericson et al. 2013 Zong et al. 2013 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) 11.22 0.96 (0.90, 1.03) 7.59 0.79 (0.46, 1.35) 0.20 0.98 (0.89, 1.08) 4.62 0.98 (0.94, 1.02) 11.90 0.97 (0.84, 1.14) 2.19 1.00 (0.96, 1.04) 11.84 0.95 (0.77, 1.18) 1.20 0.81 (0.63, 1.04) 0.89 1.13 (0.96, 1.34) 1.98 1.03 (0.94, 1.12) 4.98 0.72 (0.61, 0.85) 1.95 0.98 (0.95, 1.01) 13.08 1.02 (0.99, 1.05) 13.29 0.98 (0.95, 1.01) 13.07 0.98 (0.96, 1.01) 100.00 N Engl J Med 2011; 364:2392-2404 NOTE: s are from random effects analysis 0.50 1 1.50 BMC Med. 2014 Nov 25;12:215
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) 3.45 5.27 2.39 19.88 6.1 9.61 15.71 19.16 18.42 10.0 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. 2013 Soedamah-Muth et al. 2013 Sluijs et al. 2012 Margolis et al. 2011 Kirii et al. 2009 Liu et al. 2006 HPFS NHS I NHS II Overall (I-squared = 65.3, p = 0.003) 1.53 (0.71, 3.34) 3.45 1.15 (0.63, 2.09) 5.27 0.16 (0.06, 0.41) 2.39 0.89 (0.78, 1.01) 19.88 0.76 (0.44, 1.31) 6.11 0.61 (0.42, 0.90) 9.61 0.85 (0.68, 1.06) 15.71 0.75 (0.65, 0.86) 19.16 0.94 (0.80, 1.10) 18.42 0.82 (0.70, 0.96) 100.00.0606 1 16.5 BMC Med. 2014 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
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)
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