Cardiometabolic Health

Cardiometabolic health is a relatively new term that encompasses cardiovascular and metabolic diseases, including type 2 diabetes and metabolic syndrome. Collectively, such conditions are the leading cause of preventable death worldwide. They all share similar risk factors (e.e., overweight/obesity, elevated blood pressure) which can be modified by diet and lifestyle choices. The available evidence indicates that eggs, when consumed as part of an overall healthy diet pattern, do not affect risk factors for cardiometabolic disease. Recent recommendations from the American Heart Association, American College of Cardiology and American Diabetes Association do not limit egg or cholesterol intake, a change from earlier guidance from these organizations. In fact, several global health organizations, including Health Canada, the Canadian Heart and Stroke Foundation, the Australian Heart Foundation and the Irish Heart Foundation, promote eggs as part of a heart-healthy diet.

Given the public health significance of understanding cardiometabolic diseases, research on risk reduction remains an active area of pursuit. For example:

  • A randomized controlled study in people with metabolic syndrome showed that those consuming three whole eggs per day as part of a reduced carbohydrate diet experienced favorable changes in HDL-cholesterol, insulin sensitivity, and other aspects of the lipoprotein lipid profile (1,2)
  • A randomized controlled weight loss trial in people with diagnosed type 2 diabetes showed improved lipid and glucose markers following consumption of 2 eggs per day for 12 weeks. (3)
  • An egg-based breakfast, rich in protein (35% energy; 26.1 g egg protein), promoted glycemic control in people with type 2 diabetes and pre-diabetes relative to a high-carbohydrate breakfast. (4)

For a full list of recent research on eggs and cardiometabolic disease, please visit

  1. Blesso et al. Effects of carbohydrate restriction and dietary cholesterol provided by eggs on clinical risk factors in metabolic syndrome. J ClinLipidol. 2013;7:463-71.
  2. Blesso et al. 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;62:400-10.
  3. Pearce KL et al. Egg consumption as part of an energy-restricted high-protein diet improves blood lipid and blood glucose profiles in individuals with type 2 diabetes. Brit J Nutr2011;30:584-592.
  4. Park YM et al. A high-protein breakfast induces greater insulin and glucose-dependent insulinotropic peptide responses to a subsequent lunch meal in individuals with type 2 diabetes. J Nutr. 2015;145:452-8.

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Eggs Fit into a Diabetes Diet

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References:
1. USDA ARS, Nutrient Data Laboratory. USDA National Nutrient Database for Standard Reference, Release 28.
2. Campbell B et al. International society of sports nutrition position stand: protein and exercise. J Int Soc Sport Nutr. 2007;4:8
3. 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;90:1272-9.
4. Egg Nutrition Center. 2016 Health Professional Tracking Survey: http://www.eggnutritioncenter.org/content/uploads/2017/03/2016-HP-Tracking-Survey-Recap_web.pdf

Eggs & Cholesterol: Getting to the Heart of the Matter

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Featured article in the Spring 2017 Issue of Nutrition Close-Up; written by Lynn Cofer-Chase, MSN, CLS, FAHA, FPCNA, FNLA

It is well-known that high cholesterol levels in our blood, particularly high low-density lipoprotein cholesterol (LDL-C) (i.e., the “bad” cholesterol) levels, increase our risk for heart disease, bypass surgery, etc. And it seems logical that eating animal foods that have atypically high amounts of cholesterol, such as egg yolks and organ meats, would worsen blood cholesterol levels thereby increasing our risk for heart attack.

Continue reading “Eggs & Cholesterol: Getting to the Heart of the Matter”

New Research Further Confirms that Egg Intake Does Not Raise the Risk for Heart Disease

eggs

In 2016, the long-standing limit on cholesterol intake was lifted with the release of the 2015-2020 Dietary Guidelines for Americans, a decision based on years of research suggesting the connection between dietary and plasma cholesterol is minimal. This was welcome news for egg-enthusiasts everywhere, but came with one caveat: a compound called trimethylamine-N-oxide (TMAO) that appears to increase risk for heart disease. TMAO is a byproduct of choline, an important nutrient of which eggs are an excellent source. The prevailing hypothesis is that choline-containing foods, such as eggs, may elevate plasma TMAO. The good news is that it’s not quite so straightforward. Continue reading “New Research Further Confirms that Egg Intake Does Not Raise the Risk for Heart Disease”

Daily Egg Consumption Does Not Affect Glucose Markers in Type 2 Diabetes

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Featured article in the January, 2017 Issue of Nutrition Research Update; written by Dr. Valentine Njike, Assistant Director of Research and Evaluation at the Yale Griffin Prevention Research Center.

Adhering to a healthful diet is paramount to control blood glucose levels in type 2 diabetes (1). Weight reduction is an important goal as well when controlling blood glucose levels (2). Specifically, a 5 to 7 percent reduction in body weight can improve insulin sensitivity, decrease fasting glucose levels, and reduce the need for some diabetes medications (3-7). Foods with little or no effect on blood glucose levels are typically recommended to control blood glucose in persons with Type 2 diabetes (8). Despite the fact that eggs have little or no effect on a person’s blood glucose level, their inclusion in a healthful diet for adults with type 2 diabetes has been questioned because some epidemiological studies have shown that people who include eggs in their diets have a higher incidence of type 2 diabetes (9-10). A recent large-scale study that combined and analyzed the results of several studies has found an association between egg consumption and the incidence of type 2 diabetes in U.S.-based studies. However, this association has not been observed in studies conducted outside of the U.S. (11).

In our own recent controlled trial, we assessed the effects of daily egg consumption (in comparison to daily exclusion from the diet) for a 3-month period on blood sugar levels, body measures (i.e. body weight, belly fat and waistline), and overall diet quality among a group of 34 adults with type 2 diabetes (12). These study participants took part in two phases of the study: egg inclusion and egg exclusion. During the egg inclusion phase, they met with a registered dietitian and were asked to incorporate 2 eggs a day into their regular diets while maintaining their usual overall calorie intake during that phase. The dietitian provided individualized and specific instruction on how to maintain the same overall daily calorie intake while consuming the extra 2 eggs a day.  During the egg exclusion phase, the study dietitian asked the participants to exclude eggs and/or any egg-containing products from their diets.

Analysis of the study results revealed that after 3 months of including eggs in their diets, participants experienced reductions in body weight, belly fat and waistline, which are all indicators for high risk of Type 2 diabetes, high blood pressure, high cholesterol, and heart disease. We also observed a favorable trend in reducing systolic blood pressure and three-month average blood glucose levels with the inclusion of eggs in the diets of these diabetic participants.

In summary, eggs are a satiating and protein-rich food, and are relatively low in calories. Therefore, they have the potential to help regulate calorie intake for weight control.  Eggs may also have the ability to reduce the extent to which diet affects a person’s blood glucose level, which may be especially important for people with type 2 diabetes. Furthermore, incorporating eggs into a regular diet has the potential to improve overall dietary quality. This study suggests that short-term inclusion of eggs in the diets of adults with Type 2 diabetes may improve body weight and belly fat, and may also lower blood glucose levels and systolic blood pressure.

Research funding was provided by the Egg Nutrition Center.

 References

  1. National Diabetes Statistics Report 2014 3/11/2016]; Available from: http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf.
  2. American Diabetes Association, North American Association for the Study of Obesity, American Society for Clinical Nutrition. “Weight Management Using Lifestyle. Modification in the Prevention and Management of Type 2 Diabetes: Rationale and Strategies.” Clinical Diabetes 23(3):130-136.
  3. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. “10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study.” Lancet. 2009. 374(9702):1677-86.
  4. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. “Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.” N Engl J Med. 346:393-403.
  5. Pronk NP. “Systematic review with meta analysis: structured diet and physical activity programmes provide strong evidence of effectiveness for type 2 diabetes prevention and improvement of cardiometabolic health.” Evid Based Med http://ebm.bmj.com/content/early/2015/10/22/ebmed-2015-110292.full
  6. Ackermann RT. “Diabetes prevention at the tipping point: aligning clinical and public health recommendations.” Ann Intern Med. 2015;163(6):475-476.
  7. Balk EM, Earley A, Raman G, Avendano EA, Pittas AG, Remington PL. “Combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: a systematic review for the Community Preventive Services Task Force.” Ann Intern Med 2015 Sep 15;163(6):437-51.
  8. http://www.thecommunityguide.org/diabetes/combineddietandpa.html.
  9. 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(1):146-59.
  10. 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(2):474-80.
  11. Tamez M, Virtanen JK, Lajous M. “Egg consumption and risk of incident type 2 diabetes: a dose-response meta-analysis of prospective cohort studies.” Br J Nutr. 115(12):2212-8.
  12. 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.

 

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