Dietary Cholesterol and the Lack of Evidence in Cardiovascular Disease

Abstract

Cardiovascular disease (CVD) is the leading cause of death in the United States. For years, dietary cholesterol was implicated in increasing blood cholesterol levels leading to the elevated risk of CVD. To date, extensive research did not show evidence to support a role of dietary cholesterol in the development of CVD. As a result, the 2015–2020 Dietary Guidelines for Americans removed the recommendations of restricting dietary cholesterol to 300 mg/day. This review summarizes the current literature regarding dietary cholesterol intake and CVD. It is worth noting that most foods that are rich in cholesterol are also high in saturated fatty acids and thus may increase the risk of CVD due to the saturated fatty acid content. The exceptions are eggs and shrimp. Considering that eggs are affordable and nutrient-dense food items, containing high-quality protein with minimal saturated fatty acids (1.56 gm/egg) and are rich in several micronutrients including vitamins and minerals, it would be worthwhile to include eggs in moderation as a part of a healthy eating pattern. This recommendation is particularly relevant when individual’s intakes of nutrients are suboptimal, or with limited income and food access, and to help ensure dietary intake of sufficient nutrients in growing children and older adults.

Correlation between dietary fat consumption with body mass index and body composition (a preliminary study in community based)

“…The fact that dietary cholesterol is common in foods that are high in saturated fatty acids might have contributed to the hypothesis that dietary cholesterol is atherogenic. 12 The limitation of this study did not calculate the physical activity, other food intakes like sugar consumption, and method in assessing fat consumption; semiquantitative food frequency questionnaire. Studies that measure relation between physical activity and body composition showed that, greater physical activity was associated with lower average body fat percentage (for a BMI of 22.5-24.99 kg/m 2 : 2.0 (95% CI 1.8 to 2.2), percentage points lower body fat in men and 1.8 (95% CI 1.6 to 2.0) percentage points lower body fat in women.…”

“…11 The study hypothesized that cholesterol consumption was atherogenic, and could increase cardiovascular disease risk. 12 However, there is an evidence that saturated fatty acids and trans-fats increase cardiovascular disease risk. The fact that dietary cholesterol is common in foods that are high in saturated fatty acids might have contributed to the hypothesis that dietary cholesterol is atherogenic.…”

Ghee: the much maligned cooking medium, now slowly reclaiming its therapeutic reputation

“…These findings were rapidly followed by the US agency FDA promptly withdrawing the strictures against cholesterol, and placing these against trans-fats. 3 The ancient ayurvedic texts describe the use of ghee, honey, and antitoxic drugs to protect the heart in cases of poisoning. 4 It is significant to note that the cardioprotective effects of intra-venous lipid emulsions is now established in cases of toxicity due to some drugs and local anaesthetic agents.…”

Threshold-Effect Association of Dietary Cholesterol Intake with Dyslipidemia in Chinese Adults: Results from the China Health and Nutrition Survey in 2015

“…And results from the controlled feeding studies showed changes in serum cholesterol ranging from 2.2 to 4.5 mg/dL per 100 mg/day of change in dietary cholesterol [8]. On the contrary, others have shown a null association [9,10], because investigators have reported that increased intake of dietary cholesterol (exogenous) was associated with the decreased synthesis of endogenous de novo cholesterol, possibly as a compensatory mechanism that keeps cholesterol homeostasis constant [11,12]. In China, one study using China Health and Nutrition Survey (CHNS) 2009 found that the adults with a high intake of dietary cholesterol (≥300.0 mg/day) had higher odds of hypercholesterolemia than the adults with intake of <300 mg/day [13].…”