BEIC statement on JAMA cholesterol paper

UK nutrition experts have challenged the conclusions of the paper ‘Associations of Dietary Cholesterol or Egg Consumption with Incident Cardiovascular Disease and Mortality’ published in the Journal of the American Medical Association (JAMA) today (15 March 2019).    

All UK health and heart advisory bodies, including the Department of Health and the British Heart Foundation, currently advise that dietary cholesterol from foods such as eggs does not increase the risk of heart disease for most people.  Previous limits on egg consumption were lifted in the UK more than ten years ago.  

“The findings of this new study are interesting but are inconsistent with the considerable weight of evidence from previous, robust, research showing that the consumption of an egg a day has no clinically significant effects on serum LDL cholesterol in most people,” says registered nutritionist Dr Juliet Gray. 

The associations reported in the JAMA paper are based on a ‘snapshot’ of self-reported diet, egg and cholesterol intake at baseline, with the ‘baseline’ itself ranging between 1985-2005, during which period there were considerable changes to the US diet. 

A number of assumptions were made in analysing dietary data from six different cohorts, using different dietary assessment methods to arrive at consumption frequencies of eggs and other foods.  Although the paper adjusted for many dietary and other lifestyle variables, the authors acknowledge that residual confounding was likely.   Recent research has highlighted the importance of separating egg from other food sources such as meat in order to assess their impact on disease endpoints (1).

“It is known that high egg consumers have historically also been high consumers of processed meat products such as sausages and bacon, as part of a traditional breakfasts and fast food meals,” says Dr Gray.  Processed meat contains large quantities of saturated fat, an acknowledged risk factor for CVD.  

The new paper itself highlights a number of significant limitations and emphasises that the findings are associations rather than cause and effect.  There was no measurement of serum LDL-cholesterol or other risk factors. No evidence of a mechanism is presented.  

The British Egg Industry Council has also highlighted that a study by Professor Frank Hu, published in the same journal (JAMA) in 1999 (2), reported insignificant risk for the association between eating 2-4 eggs a week and coronary heart disease.   The risks reported in the new study for the associations between eating 3.5-4.5 eggs/week and CVD risk/deaths are in fact lower than the risk data, interpreted as ‘insignificant’, published 20 years ago.   

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For further information please contact the British Egg Information Service on 020 7052 8899.

References
1.    Sabaté J, Burkholder-Cooley NM, Segovia-Siapco G et al. (2018) Unscrambling the relations of egg and meat consumption with type 2 diabetes risk. Am J Clin Nutr. 108(5): 1121-28
2.    Hu FB, Stampfer MJ, Rimm WB et al. (1999) A prospective study of egg consumption and risk of cardiovascular disease in men and women. JAMA 28(15): 1387-94