Egg consumption and risk of all-cause and cause-specific mortality in an Italian adult population
Emilia Ruggiero, Augusto Di Castelnuovo, Simona Costanzo, Mariarosaria Persichillo, Amalia De Curtis, Chiara Cerletti, Maria Benedetta Donati, Giovanni de Gaetano, Licia Iacoviello, Marialaura Bonaccio, the Moli-sani Study Investigators, Licia Iacoviello, Giovanni de Gaetano, Maria Benedetta Donati, Marialaura Bonaccio, Americo Bonanni, Chiara Cerletti, Simona Costanzo, Amalia De Curtis, Augusto Di Castelnuovo, Francesco Gianfagna, Mariarosaria Persichillo, Teresa Di Prospero, Jos Vermylen, Ignacio De Paula Carrasco, Antonio Spagnuolo, Deodato Assanelli, Vincenzo Centritto, Simona Costanzo, Marco Olivieri, Teresa Panzera, Augusto Di Castelnuovo, Simona Costanz Esposito Marialaura Bonaccio, Alessandro Gialluisi, Francesco Gianfagna, Emilia Ruggiero, Amalia De Curtis, Sara Magnacca, Benedetta Izzi, Annalisa Marotta, Fabrizia Noro, Roberta Parisi, Alfonsina Tirozzi, Mariarosaria Persichillo, Francesca Bracone, Francesca De Lucia, Cristiana Mignogna, Teresa Panzera, Livia Rago, Americo Bonanni
Abstract
PURPOSE: Dietary guidelines recommend to limit egg consumption to 4 servings per week but the relation between egg intake and health outcomes is still controversial. To evaluate the association of egg consumption and mortality risk in Italian adults and to investigate nutritional factors and serum lipids as potentially explaining such associations. METHODS: Longitudinal analysis on 20,562 men and women aged ≥ 35y, free from cardiovascular disease (CVD) and cancer belonging to the Moli-sani Study cohort (enrolled 2005-2010) followed up for a median of 8.2 years. RESULTS: In multivariable-adjusted analysis as compared to low intake (> 0 ≤ 1 egg/week), eating > 4 eggs/week led to an increased risk of all-cause (Hazard ratio [HR] = 1.50; 95%CI 1.13-1.99), CVD (HR = 1.75; 1.07-2.87) and cancer mortality (HR = 1.52; 0.99-2.33). Similarly, an intake of 2-4 eggs/week was associated with higher all-cause (HR = 1.22; 1.01-1.46) and CVD mortality risk (HR = 1.43; 1.03-1.97). An increase of 1 egg per week was associated with higher mortality risk among high-risk individuals, such as those with hypertension and hyperlipidaemia. Dietary cholesterol explained about 43.0% and 39.3% (p values < 0.0001) of the association of eggs with all-cause and CVD mortality, respectively, while serum lipids (e.g., total cholesterol) accounted for a small proportion of egg-mortality relation. CONCLUSIONS: Among Italian adults, high egg consumption leads to an increased risk of all-cause and CVD mortality, with the risk being evident even at the recommended intake of 2-4 eggs per week. A substantial part of this association was likely due to the egg contribution to dietary cholesterol. Our findings suggest limiting the consumption of eggs in the diet and these results should be considered in the development of dietary guidelines and updates.