Associations of Dietary Cholesterol, Serum Cholesterol, and Egg Consumption With Overall and Cause-Specific Mortality, and Systematic Review and Updated Meta-Analysis - 赵斌课题组-免疫代谢

Background: Despite substantial attention underscoring the importance of exogenous dietary and endogenous serum cholesterol to human health, thorough evaluation of the associations is lacking. Our study objective was to examine overall and cause-specific mortality in relation to dietary and serum cholesterol, as well as egg consumption, and conduct an updated meta-regression analysis of cohort studies. Methods: We conducted a prospective analysis of 27,078 men in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study. Multivariable-controlled cause-specific Cox proportional hazards regression models calculated hazard ratios (HR) and 31-year absolute mortality risk differences (ARD). A systematic review and meta-analysis of cohort studies was also performed (PROSPERO: CRD42021272756). Results: Based on 482,316 person-years of follow-up, we identified 22,035 deaths, including 9,110 deaths from cardiovascular disease (CVD). Greater dietary cholesterol and egg consumption were associated with increased risk of overall and CVD mortality. HRs for each additional 300 mg cholesterol intake per day were 1.10 and 1.13 for overall and CVD mortality (respectively), and for each additional 50 g egg consumed daily HRs were 1.06 and 1.09, respectively, for overall and CVD mortality (all P-values<0.0001). After multivariable adjustment, higher serum total cholesterol concentrations were associated with increased risk of CVD mortality (HRs per 1-SD increment: 1.14; P-value<0.0001). The observed associations were generally similar across cohort subgroups. The updated meta-analysis of cohort studies based on 49 risk estimates, 3,601,401 participants, and 255,479 events) showed consumption of one additional 50 g egg daily was associated with significantly increased CVD risk: pooled RR=1.04 (95% CI: 1.00, 1.08); I 2 =80.1%). In the subgroup analysis of geographical regions (P-value-for-interaction=0.02), an increase of 50 g egg consumed daily was associated with a higher risk of CVD among US cohorts (pooled-RR=1.08, 95% CI: 1.02, 1.14), appeared related to a higher CVD risk in European cohorts with a borderline significance (pooled-RR=1.05), but was not associated with CVD risk in Asian cohorts. Conclusions: In this prospective cohort study and updated meta-analysis, greater dietary cholesterol and egg consumption were associated with increased risk of overall and CVD mortality. Our findings support restricted consumption of dietary cholesterol as a means to improve long-term health and longevity.