Egg and egg-sourced cholesterol consumption in relation to mortality: Findings from population-based nationwide cohort

Abstract

Background & aims: Evidence linking egg and dietary cholesterol consumption with human health and longevity is highly debated. Data from non-Western populations are sparse. We aim to prospectively assess the egg and cholesterol consumption in relation to mortality in a nationwide Chinese cohort.

Methods: We followed 18,914 adults aged ≥20 y from China Health and Nutrition Survey (CHNS) between 1991 and 2015. In each survey year, 3-day 24-hr dietary records were used to collect dietary data. Cumulative averages of egg and cholesterol intakes were calculated. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox proportional hazards model.

Results: Overall 1,429 deaths were reported after a median follow-up of 15 years. Egg consumption was significantly associated with lower total mortality (P-trend<0.001). Multivariable-adjusted HRs (95% CIs) were 0.69 (0.59-0.81) for 1-3 eggs/wk, 0.68 (0.59-0.79) for 3-7 eggs/wk, 0.78 (0.66-0.93) for 1-2 eggs/d, and 0.64 (0.52-0.78) for ≥2 eggs/d compared with ≤1 egg/wk. Although total dietary cholesterol was not related to mortality, intake of cholesterol from eggs was inversely associated with total mortality (P-trend = 0.001) while intake of cholesterol from non-egg sources was positively related to total mortality (P-trend = 0.01). Substituting 50 g/d egg for equivalent amounts of dairy products, nuts/legumes, or red meat was associated with 9%, 7%, or 8% lower total mortality, respectively.

Conclusions: Egg consumption is associated with lower total mortality among the Chinese population. Consuming cholesterol from non-egg sources may be detrimental to longevity. Habitual consumption of eggs should continue to be recommended in the Chinese dietary guidelines while excess intake of cholesterol from non-egg sources may be discouraged.

Clinical trial registry: This trial was registered at clinicaltrials.gov (NCT04104308).

Keywords: China Health and Nutrition Survey; Dietary cholesterol; Eggs; Mortality.