Effect of Daily Incorporation of Eggs in a Heart-Healthy Diet for 8 Weeks Compared with Their Exclusion on Cardio-Metabolic Risk Factors in Adults with Hyperlipidemia: A Randomized, Controlled, Crossover Trial.

Background: Despite dietary cholesterol not being considered a nutrient of concern, dietary guidelines still recommend that people with elevated LDL cholesterol limit their intake of egg yolks.

Objective: We examined the effects of the daily consumption of eggs in the context of the Dietary Approach to Stop Hypertension (DASH) diet for 8 weeks on cardio-metabolic risk factors in adults with hyperlipidemia.

Methods: The study was a randomized, controlled, single-blind, crossover trial involving 45 adults (mean age 59.5 years; 35 females, 10 males; 42 Caucasian, two African American, one Asian) with hyperlipidemia. Participants were randomly allocated to one of the two possible sequence permutations of two treatments: the DASH diet with eggs (I) and the DASH without eggs (C). There was a 4-week run-in phase before treatments and an 8-week washout period between treatments. Participants received menus and guidance from the study dietitian on adhering to the DASH diet. They also received advice to exclude or include two whole eggs daily for 8 weeks in their DASH diet while displacing other foods based on instructions to maintain an isocaloric intake. Primary outcome measures were LDL cholesterol and endothelial function assessed as flow-mediated dilation. Secondary outcome measures included insulin sensitivity, other lipids, blood pressure, C-reactive protein, and dietary intake. Data were analyzed using repeated measures ANOVA.

Results: Daily addition of eggs to the DASH (Δ_I) compared with DASH without eggs (Δ_C) did not negatively affect endothelial function (Δ_I: 2.7 ± 10.8% versus Δ_C: 3.7 ± 19.9% versus Δ_I - Δ_C = -1.1, p = 0.767) or LDL cholesterol (Δ_I: 13.0 ± 23.5 mg/dL versus Δ_C: 8.9 ± 19.6 mg/dL; Δ_I - Δ_C = 4.2, p = 0.317). The DASH diet with eggs compared with the DASH without eggs relatively increased the consumption of choline (Δ_I: -29.6 ± 136.8 mg/d versus Δ_C: -148.2 ± 146.3 mg/d; Δ_I - Δ_C = 118.6, p = 0.002) while the intake of carbohydrates decreased (Δ_I: -26.4 ± 327.3 kcal/d versus Δ_C: 147.7 ± 282.3 kcal/d; Δ_I - Δ_C = -174.1, p = 0.032). Compared with DASH diet without eggs, the addition of 2 eggs per day in the DASH did not impact other cardio-metabolic risk factors (blood pressure, other lipid profiles, CRP, and glycemic control).

Conclusions: In adults with hyperlipidemia, daily egg consumption as part of a heart-healthy diet did not compromise cardio-metabolic health indicators.

Clinical trial registration number: https://clinicaltrials.gov/study/NCT05807334.