5 Steps to prevent Heart Disease

Monday, September 28, 2015

NLA Part 2 advises less than 200 mg cholesterol a day for cardioprotection

NLA Part 2 cited this meta-analysis on eating eggs

This was the NLA's spin on the trial?
"A more recent systematic review and meta-analysis of 40 studies (17 cohort studies with 19 publications and 19 trials with 21 publications) was published by Berger et al.67
In the review of17 of the 19 trials, dietary cholesterol (intervention cholesterol intake was 501 to 1415 mg/dayand 0 to 415 mg/day in the control conditions) significantly increased both serum total-C (11.2mg/dL) and LDL-C (6.7 mg/dL). When the intervention intake levels were greater than 900mg/day, there were no longer statistically significant increases in LDL-C. In this review, dietary
cholesterol also increased HDL-C (3.2 mg/dL). Similar to the Hopkins results,61the increases intotal-C and LDL-C were greatest when the baseline dietary cholesterol intake was the lowest."
This is the trial author's conclusion:


Reviewed studies were heterogeneous and lacked the methodologic rigor to draw any conclusions regarding the effects of dietary cholesterol on CVD risk. Carefully adjusted and well-conducted cohort studies would be useful to identify the relative effects of dietary cholesterol on CVD risk.

67. Berger S, Raman G, Vishwanathan R, Jacques PF, Johnson EJ.
Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis.
Am J Clin Nutr. 2015 Jun 24

"Results from well-controlled RCTs indicate that dietary cholesterol has modest effects to raise levels of total-C, LDL-C, and HDL-C. 
 The increase in HDL-C associated with increased dietary
cholesterol is of uncertain clinical importance.
 Hyper- and hypo-responders to dietary cholesterol exist, with some individuals showing little or no increases in atherogenic cholesterol levels in response to greater intake of dietary cholesterol and others showing responses wellabove the average. The biological determinants of inter-individual variability are understudied, and presently no inexpensive and widely available methods are available for identifying thosewho are likely to be hyper- or hypo-responders. 
 In controlled feeding RCTs, each 100 mg/day of dietary cholesterol raises LDL-C by an average of ~1.9 mg/dL.  
Observational data have consistently reported no association between dietary cholesterol or egg consumption (a large
contributor to dietary cholesterol intake) and ASCVD risk in the general population, but suggest that there may be increased ASCVD risk associated with greater cholesterol and egg
consumption in those with diabetes mellitus. 
 The NLA Expert Panel recommendations are,
therefore, based mainly on results from controlled-feeding RCTs showing modest effects of dietary cholesterol to raise total-C and LDL-C, while recognizing that other dietary factors(saturated fatty acids, trans fatty acids, MUFA and PUFA) more reliably and predictably influence levels of atherogenic cholesterol."
NLA Part 2 advises:
The cardioprotective eating pattern should limit cholesterol intake to  less than 200 mg day 
to lower levels of atherogenic
cholesterol (LDL-C and non-HDL-C).

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