ABC | Volume 110, Nº6, June 2018

Viewpoint Santos Impact of consumption of whole eggs on lipids Arq Bras Cardiol. 2018; 110(6):585-587 whole chicken eggs (n = 214) per week did not increase the incidence of cardiovascular disease compared to individuals with a consumption habit of less than two eggs per week (n = 2509). It is noteworthy that this study is of the renowned group PREDIMED (PREvención con DIeta MEDiterránea), in which the individuals followed a Mediterranean food style, therefore, with habitual consumption of olive oil and oilseeds. In this way, the increase in egg consumption was accompanied by a good dietary style, which was confirmed by the control of macronutrients and type of ingested lipids, as a relevant percentage of monounsaturated fats (~20% of total caloric value) and moderate in saturated fats (~10% of the total caloric value). 5 Despite the study by the PREDIMED group, 5 in a study with a considerable sample (n = 1231) it is stated that the higher the consumption of whole chicken eggs, the greater the area of the atheroma plaque in the carotid (weekly consumption between one and five eggs exhibited larger area of the plaque compared to half egg weekly). However, in the study lack physical exercise control, waist circumference and mainly, dietary habits. Nevertheless, the increase in plaque area was related to an older age and history of smoking. 10 Another recent study showed that the daily intake of two to three whole chicken eggs increased the functionality of HDL and plasma carotenoids, which are anti-inflammatory and antioxidant factors. Thirty-eight healthy participants participated in a study in which initially they stayed a period of 2 weeks without eating egg, and later consumed an entire egg of chicken for 4 weeks, and progressively two and three whole eggs daily every 4 weeks; the intervention lasted 14 weeks. Compared with the time of deprivation of egg ingestion, consumption of one to three eggs/day resulted in increased concentrations of large LDL (21‑37%), large HDL (6-13%) and apolipoprotein AI (9‑15%) whereas ingestion of two to three eggs/day promoted an increase in apolipoprotein AII by 11% and lutein and plasma zeaxanthin by 20-31%, whereas the ingestion of three eggs/day resulted in an increase of 9-16% in serum paraoxonase-1 activity compared to the intake of one to two eggs/day. Intake of one egg/day was sufficient to increase HDL function and particle concentration of large LDL. In general, the daily intake of less than three eggs/day favored a better LDL particle profile, improved the function of HDL and increased plasma antioxidants in healthy young adults. 6 This recent intervention adds to the literature a more biologically detailed impact as a function of the consumption of whole chicken eggs, since it goes beyond classic lipid profile markers in clinical practice, analyzing lipoprotein precursors and antioxidant character. 6 The increase of paraoxonase-1 and apolipoprotein AI levels as a function of egg ingestion are beneficial, since they are precursors of HDL formation, providing greater functionality. 11,12 In reference to the increase of large LDL, it does not mean a bad factor, but a beneficial modulation of the molecule, because the higher the volume, the lower is the propensity for endothelial penetration in the arteries, unlike LDL of lower volume (ie, sdLDL, small dense low-density lipoprotein particles). 13 Positioning of guidelines regarding cholesterol consumption The V Brazilian Guideline on Dyslipidemias and Prevention of Atherosclerosis encourages the ingestion of cholesterol < 300 mg/d for patients in general, and for dyslipidemics the incentive is < 200 mg/d. 14 In agreement with the most recent recommendations in the medical literature, a new consensus from the American Heart Association, 15 based mainly on the dietary guidelines of the Dietary Guidelines for Americans, 16 in the period from 2015 to 2020, cholesterol consumption is still limited to that advocated by the V Brazilian Guideline on Dyslipidemias and Prevention of Atherosclerosis. 14 However, such recommendations do not specify where dietary cholesterol comes from, for example, whether it is primarily from a Western-style diet rich in fritters as a whole, or from a type of nutrient-rich diet rich in functional substances. The American Heart Association's recent positioning encourages Mediterranean feeding, citing the PREDIMED group, which, in parallel, can be based on a considerable weekly frequency of intakes of whole eggs. 15,16 Discussion Analyzing a food in isolation requires detailed adjustments, and the egg is a food that undoubtedly remains controversial. There are two strands, one more cautious and another one that overestimates the potential of the egg as food. Following the traditional recommendations of cholesterol intake is of some importance; however, one should consider the whole lifestyle. Probably, in individuals who exercise and have good dietary control, the routine intake of whole eggs will not cause harm to the lipid profile, since, presumably, the body is in a good redox balance, being a protective factor for cardiovascular outcomes. 17 Even in elderly individuals, the daily consumption of eggs, at least non-abusively, may be insignificant in altering the lipid profile. 18 In a cross-over study of 33 elderly (mean age 79 years), the daily consumption of a whole chicken egg for five weeks did not change any traditional lipid profile marker compared to the same period without the ingestion of eggs, and serum antioxidant markers (+26% lutein and + 38% zeaxanthin). 19 Given the importance of redox balance as a protector to the cardiovascular side, perhaps the consumption of whole eggs is also not of concern for patients with dyslipidemias, because as was quoted, its consumption exhibits beneficial antioxidant modulation to lipoproteins. The PREDIMED study is a good baseline, encompassing middle-aged and large sample patients. Regarding whole eggs intake in the style of Mediterranean food, two to four eggs per week are consumed on average, whereas less than two servings of sweetmeats and red meat and less than a portion of processed meat are consumed. The white meat intake is two servings and the portions of vegetables, fish or shellfish are two or more per week. 19 Thus, like the PREDIMED study, if the individual has good eating habits as a whole, the intake of whole eggs with considerable weekly frequency seems to be safe. Above all, the prescription of eggs in clinical practice is a very individual factor, mainly depending on lipid and protein adjustments. 586