ABSTRACT
For over 40 years there has been continuous debate regarding the relationship between dietary cholesterol intake and its impact on blood cholesterol levels and coronary heart disease (CHD) risk. The 1968 American Heart Association recommendation that dietary cholesterol be limited to not more
9.1 Introduction .......................................................................................................................... 179 9.2 Basis of the Dietary Cholesterol: Heart Disease Hypothesis ............................................... 180 9.3 The Dietary Cholesterol-Heart Disease Risk Relationship: Epidemiological Evidence ..... 181 9.4 Eggs and Heart Disease Risk................................................................................................ 182 9.5 The Dietary Cholesterol-Heart Disease Risk Relationship: Clinical Evidence................... 183 9.6 A Failed Hypothesis ............................................................................................................. 185 9.7 Contribution of Eggs to Health Promotion and Disease Prevention .................................... 185 9.8 Protein and Health ................................................................................................................ 186
9.8.1 Sarcopenia ................................................................................................................ 186 9.8.2 Weight Control .......................................................................................................... 186
9.9 Choline and Health ............................................................................................................... 186 9.9.1 Choline and Fetal Brain Development ..................................................................... 187 9.9.2 Choline and NTD Risk ............................................................................................. 188 9.9.3 Choline and Alzheimer’s Disease ............................................................................. 188 9.9.4 Choline and In—ammation ........................................................................................ 188 9.9.5 Choline and Breast Cancer Risk ............................................................................... 189 9.9.6 Inadequate Choline Intake ........................................................................................ 189
9.10 Xanthophylls and Health ...................................................................................................... 190 9.11 The “Functional” Egg ........................................................................................................... 191 9.12 International Perspectives ..................................................................................................... 191
9.12.1 Canada ...................................................................................................................... 191 9.12.2 Australia and New Zealand ...................................................................................... 191 9.12.3 Great Britain ............................................................................................................. 191 9.12.4 Ireland ....................................................................................................................... 192
9.13 Primum Non-Nocere ............................................................................................................ 192 9.14 The Cost of Egg Restrictions ................................................................................................ 192 9.15 Summary .............................................................................................................................. 192 References ...................................................................................................................................... 193
than 300 mg/day, and that egg intake be limited to not more than 3 egg yolks/week, initiated a scienti c debate that continues to this day. When this recommendation was originally proposed there was a limited understanding of endogenous cholesterol metabolism and its regulation, and of the impact of dietary factors on blood cholesterol levels and CHD risk. From a purely logical perspective it does seem reasonable to assume that dietary cholesterol would affect blood cholesterol levels and there was epidemiological evidence suggesting a relationship between blood cholesterol levels and CHD risk. Forty years later it is clear that, while this assumed relationship may have been logical in 1968, it has not withstood the test of time.
