Have we achieved “egg freedom” yet? From a cardiovascular point of view, how many eggs should you eat every day?

Author: Wang Yuwei Jindi Weifang Yidu Center Hospital

This article is published by Yimaitong authorized by the author, please do not reprint without authorization.


What are we worried about?

< p>If you are not allergic to eggs, if you have already lifted yourself out of poverty, if you don’t eat fast… It’s not a problem if you want to eat a few eggs a day, and it’s probably not going to make you “bankrupt” if you want to fill your stomach with eggs alone , from this perspective, you can indeed achieve “egg freedom”.

But if you consider the risk of cardiovascular disease, eating eggs is not so free. Eggs (especially egg yolks) are one of the main sources of cholesterol in the diet. Every 100g of eggs contains 585mg of cholesterol. Cholesterol is the reason why many people are afraid of eating eggs.


Cholesterol in eggs

Dietary sources of cholesterol include meat, eggs, etc., of which meat (poultry, red meat, processed meat, seafood) contributes about 42% of cholesterol %, eggs account for about 25%, and others account for about 1/3. The “Balanced Diet for Chinese Residents” model recommended by the Chinese Nutrition Society emphasizes food diversification and energy balance. It is recommended to consume 40-50g of eggs per day, which is equivalent to 1 egg.

The living standards of Chinese residents are constantly improving, and the dietary cholesterol intake is also increasing by leaps and bounds. In the past 20 years, the dietary cholesterol intake of Chinese residents has increased by 34% compared with the previous period. The average daily cholesterol intake of adults has reached 266.3mg, which is comparable to that of the United States, and the daily cholesterol intake of 1/3 of the population has exceeded the past. Recommended 300mg limit.

Restricting eggs can reduce dietary cholesterol intake and seems to reduce cardiovascular disease risk. Strange why I say “seems” as the relationship between dietary cholesterol intake and cardiovascular disease and death is currently still controversial!


Egg Controversy

In 2019, a study in the United States that included 29,615 subjects and followed up for a median of 17.5 years found that eating half an egg a day was associated with cardiovascular disease It was associated with a 6% increase in event occurrence and an 8% increase in all-cause mortality. After adjusting for dietary cholesterol intake, the relationship between egg intake and cardiovascular disease incidence and all-cause mortality was no longer statistically significant, suggesting that higher cholesterol or egg intake in American adults was associated with cardiovascular disease. There was a significant and dose-response relationship between occurrence and increased risk of death.

In addition, most studies have found that dietary cholesterol is associated with elevated plasma LDL-C, and some studies It was found that the effect of dietary cholesterol on plasma cholesterol was more pronounced in women than in men (for every 100 mg increase in dietary cholesterol, LDL-C increased by 1.5 mg/dl in men and by 2.1 mg/dl in women). If you think you can take “statin” to counteract the destruction of the cholesterol balance caused by excessive eggs, you should pay attention, and other research results suggest that the intake of eggs increases the risk of new diabetes!

When you start to fear these research results and never dare to eat eggs , then I will tell you the good news. There are still many studies and meta-analyses that egg (or even cholesterol) intake does not affect the risk of cardiovascular disease!

This is confusing! Should it be “one egg a day” or “four or five eggs” (unscrupulous)?


Do US guidelines really not limit cholesterol/eggs?

< p>There are rumors that US guidelines do not limit cholesterol intake, is this true? It is true that many observational studies do not support the association between dietary cholesterol and cardiovascular disease risk, and some guidelines have canceled the limit of dietary cholesterol due to insufficient evidence. The US guideline is one of them.

“USDA and HHS” from 1995 to 2010 , put forward the dietary guidelines from the 4th to the 7th editions, recommending dietary cholesterol intake be controlled below 300mg per day, and for high-risk groups such as cardiovascular diseases, it is recommended not to exceed 200mg per day, which is also the “most popular” standard in the world ; and the 8th edition of the Dietary Guidelines in 2015 specifically stated and canceled the restriction of “daily cholesterol intake less than 300mg”. It seems that “American guidelines do not limit cholesterol” is true.

However, are the U.S. guidelines truly unlimited cholesterol? No and no! (This question seems to be the same as the previous question, but it is actually different. This reflects the profoundness of Chinese!)

< p>Although the restriction on cholesterol has been lifted in the American Dietary Guidelines, the intake of total fat, saturated fatty acid and trans fatty acid is limited (no more than 35%, 10% and 1% of total energy respectively). The homology of fat and cholesterol, this model is actually equivalent to limiting the intake of dietary cholesterol. That is to say, the intake of fat is controlled, and the intake of cholesterol is generally not too high. According to the healthy dietary pattern in the American guidelines, the daily dietary cholesterol is about 100-300mg, which has actually achieved the purpose of limiting fat and cholesterol. , It can be said that “the plank road is built brightly, and the old warehouse is darkened”.

The American Guide didn’t let us let our appetite go a limiting method. Four years later (2019), the dietary recommendations given by the American AHA still require the intake of eggs: on the basis of following the current healthy dietary pattern, ordinary people consume 1 egg or the equivalent amount of cholesterol per day; If vegetarians have no other sources of cholesterol, they can appropriately increase the intake of dairy products and eggs; patients with hyperlipidemia, especially those at high risk of type 2 diabetes or heart failure, should be cautious when consuming high-cholesterol foods; those without hypercholesterolemia ; The elderly can appropriately increase the intake of eggs, no more than 2 per day.


Do Chinese guidelines limit cholesterol/egg intake?

< p>When it comes to this dietary pattern of limiting fat and not limiting cholesterol, our country also has a say.

It is recommended in the 2000 edition of “Chinese Residents Dietary Nutrient Reference Intakes” (DRIs) Dietary cholesterol intake is less than 300mg per day, and it is recommended to consume 25-50g of eggs per day, about 3.5-7 eggs per week.

The macronutrient intake range of dietary cholesterol has been canceled (this is 2 years earlier than the 8th edition of the US Dietary Guidelines). In the 2016 version of the dietary guidelines, the recommendation for egg intake “returned”, but it was raised to 280-350g per week, about 6-7 eggs per week (this is 3 years earlier than the 2019 US AHA guidelines, is it Is the guide of our country guiding the guide of the United States? Bo Jun smiled).

Afterwards, the 2020 “Guidelines for the Primary Prevention of Cardiovascular Diseases in China” again The intake restriction has been reiterated: the low-risk group of ASCVD should limit the daily cholesterol intake to <300mg; for the high-risk group or those with elevated blood cholesterol levels, the daily cholesterol intake should be <200mg.

Why my country’s guidelines returned to “conservative” after being “fashionable” ?

my country’s guidelines believe that reducing atherosclerotic lipoproteins is the most basic The most effective measure is to improve lifestyle, among which diet has the greatest impact on blood lipid levels, and a healthy diet is the key to lowering cholesterol. The incidence of cardiovascular diseases in my country is on the rise, and the number of people with dyslipidemia is also on the rise. From 2012 to 2014, the blood LDL-C level of the population has increased by nearly 50% compared with 2002. The severe situation facing my country suggests that it is necessary to strengthen the control of high-cholesterol diet intake. Income, can not follow the dietary guidelines in Europe and the United States to open restrictions on cholesterol.

It seems that the guide is still close to the people’s livelihood and based on the national conditions!


After all, we have not achieved “egg freedom

Although the dietary guidelines in my country and the United States have canceled the upper limit of cholesterol intake, this does not mean that Dietary cholesterol is no longer included in the consideration of healthy dietary structure. We should keep calm thinking about dietary cholesterol and health, put down eggs and live a healthy life.


[1] Chinese Medical Association Cardiovascular Branch, Chinese Association of Rehabilitation Medicine Cardiac Prevention and Rehabilitation Committee, Chinese Association of Gerontology and Geriatrics Cardiology Committee, et al. Guidelines for Primary Prevention of Cardiovascular Diseases in China[J]. Chinese Journal of Cardiovascular Diseases, 2020,48(12):1000-1038.

[2] Liu Dan, Zhao Wenhua. Review of recommendations for cholesterol intake in various guidelines[J]. Chinese Journal of Health Management, 2017, 11(01):29-33.

[3]Zhong VW, Van Horn L, Cornelis MC, et al. Associations of Dietary Cholesterol or Egg Consumption With Incident Cardiovascular Disease and Mortality[J]. JAMA, 2019, 321(11):1081-1095.