Y no es lejano hasta la infinidad:)
Sobre nosotros
Group social work what does degree bs stand for how to take off mascara with eyelash extensions how dose response gradient definition is heel balm what does myth mean in old english ox power bank 20000mah price in bangladesh life goes on lyrics quotes full form of cnf in export i love you to the moon and back meaning in punjabi what pokemon cards are the best to buy black seeds arabic translation.
Cardiovascular disease CVD is a leading cause of mortality globally and is strongly influenced by dietary risk factors. Two independent reviewers screened and extracted the data through standardized methods. Size effects were calculated as summary relative risks SRRs in a dose response gradient definition fashion through random-effects meta-analyses. Thirty-nine studies including nearly 2 million individuals and 85, CHD, 25, stroke, heart failure, andCVD cases were included.
No associations were retrieved with risk of stroke. After considering GRADE criteria for strength of the evidence, it was rated low for all outcomes but stroke, for which it dose response gradient definition moderate yet referring to no risk. There is no conclusive evidence on the role of egg in CVD risk, despite the fact that higher quality studies are warranted to dose response gradient definition stronger evidence for a possible protection of CVD associated with moderate weekly egg consumption compared to no intake; equally, future studies may strengthen the evidence for increased heart failure risk associated with high regular egg consumption.
Cardiovascular disease CVD represents the leading cause of mortality globally, responsible for a total of about 18 million deaths inwhile increasing from Nutritional risk factors have been considered of paramount importance to prevent the global burden of CVD [ 23 ]. Among the many factors widely studied over the last decades, dietary cholesterol has been the focus of major attention due to the relationship between blood cholesterol and increased risk of CVD firstly observed in the Framingham Heart Study nearly half century ago and ever since considered as risk factor [ 4 ].
However, current evidence on the association between dietary cholesterol and CVD risk is not consistent [ 6 ]. In the American Heart Association advised consumption of up to one egg per day [ 7 ] and nearly 10 years later the US Dietary Guidelines Advisory Committee eliminated cholesterol restrictions dose response gradient definition the latest US dietary guidelines [ 8 ].
Nonetheless, the general opinion on egg consumption might be misled and food advertising and media campaigns sponsoring and claiming cholesterol-free products as healthier sometimes supplemented with added sugars are common. As specifically for egg consumption, a comprehensive summary of evidence reported repeatedly null dose response gradient definition contrasting findings, suggesting that meta-analytic studies need to better investigate potential confounding effects of relevant variables i.
However, more prospective cohort dose response gradient definition have been published so far: specifically, a later study involving 6 US cohorts showed that egg consumption was associated with increased risk of CVD and that the detrimental cardiovascular effect of egg consumption was mainly driven by dietary cholesterol, once more dose response gradient definition the need to limit eggs consumption. In light of such dose response gradient definition, the aim of this study was to update current evidence on the association between egg consumption and CVD risk while assessing whether confounding factors may play a role in such relation.
Studies were selected if they met the following inclusion criteria: i they were conducted on general population of human adults i. Reference lists of studies of interest were also examined for any additional study not previously identified. If more than one study was conducted on the same cohort, only the dataset including the larger number of individuals, the longest follow-up, or the most comprehensive data i.
We did not exclude studies based on language or publication date. All references were evaluated by two independent reviewers J. Data were abstracted by the two independent reviewers from each identified study using a standardized extraction form. The tool consists of the following seven domains: 1 confounding, 2 selection of participants, 3 measurement of the exposure, 4 misclassification of exposure during follow-up, 5 missing data, 6 measurement of outcomes and 7 selective reporting. Two researchers J.
Any disagreements were resolved by consensus or by consultation of a third researcher. Outcomes evaluated in the analyses included total CVD, CHD, and stroke including dose response gradient definition hemorrhagic and ischemic stroke incidence and mortality. Also risk of heart failure incidence was assessed. When egg consumption was reported by ranges of intake, the midpoint of the range was used. When the highest what is the definition of composition in photography was open-ended, we dose response gradient definition the width of the category to be the same as the adjacent category.
When the lowest category was open-ended, we set the lower boundary to zero. Two-stage random-effects dose—response meta-analysis was performed to examine linear and non-linear relationship between egg consumption and CVD outcomes. In the first stage the method reported by Dose response gradient definition and Orsini generalized least-squares, GLS was used to calculate study-specific coefficients on the basis of results across categories of egg consumption taking into account the correlation within each set of retrieved HRs [ 1213 ].
We combined the coefficients that had been estimated within each study by performing random-effects meta-analysis. In linear dose—response meta-analysis the method of DerSimonian and Laird was used and in non-linear dose—response meta-analysis the multivariate extension of the method of moments was used to estimate summary relative risks SRRs. We calculated an overall P value by testing that the two regression coefficients were simultaneously equal to zero. We then calculated a P value for non-linearity by testing that the coefficient of the second spline was equal to zero.
A subgroup analysis was conducted for those studies providing risk measures by diabetic status. A number of connecting external hard drive home network analyses were conducted to test stability of results, including i exclusion of one study at the time, ii exclusion of studies that did not report number of cases and person-years for each category of exposure, and iii stratifying studies by variables of interest such as sex, geographical localization of the cohort, level of adjustment for body mass index [BMI], diabetic status, and other dietary factors, and study quality.
All analyses were performed with R software version 3. Included observational studies started at low-certainty of evidence by default and then were downgraded or upgraded based on pre-specified criteria. Out of initial references identified, a total of 39 studies [ 161718192021222324what are the components of blood class 7262728 what is the correlation coefficient of the linear regression, 293031323334353637383940 dose response gradient definition, 414243444546474849dose response gradient definition51525354 ] were selected based on 38 cohorts providing data on CHD 1, individuals and 85, casesstrokeindividuals and 25, casesheart failureindividuals and casesand CVD 1, individuals andcases outcomes Fig.
A detailed description of the studies included is presented in Table 1. From the 38 individual cohorts, 16 were from North America, 9 from Europe, 9 from Asia and one from Iran, and 3 multinational cohorts. One of dose response gradient definition studies from North America included a pooled analysis of 6 US cohorts pooled data was used in this meta-analysis.
All studies had adequate follow-up to assess occurrence of the outcomes investigated ranging from 3 to 32 years of mean follow-up. All studies scored moderate or serious risk of bias; a detailed description of judgment of potential risk of bias is given in the online supplementary materials ESM Table 2. Subgroup analyses were conducted through sex- and diabetic-specific groups, including nine studies provided separate risk estimates for male and female participants, and eight studies for diabetic participants.
The love through good and bad quotes analyses for egg consumption and cardiovascular outcomes are showed in Fig. The analysis restricted to CVD mortality showed wide confidence intervals while a decreased risk of CVD incidence was observed for consumption of up to 1 egg per day Table 2. Graphical representation of dose—response association between egg intake and CVD, CHD, stroke and heart failure risk in prospective cohort studies.
Distinction between studies on CHD incidence or mortality showed that the associated reduced risk was referring to the former, yet with evidence of heterogeneity Table 2. The summary analysis for stroke including 22 datasets from 16 studies showed no related risks associated with any dose of egg consumption compared to no consumption, with lower SRRs for stroke mortality, though with large CIs Table 2.
Also, the analyses conducted on sub-types of stroke, despite investigated in a lower number of studies eight studies on hemorrhagic and nine studies on ischemic strokeshowed null associations with egg consumption, yet with evidence of heterogeneity Table 2. In the sensitivity analyses by excluding one study at the time, results were substantially unchanged data not shown.
Also in the sensitivity analyses excluding studies with no complete data on number of individuals and cases risk estimates associated to egg consumption were unchanged for CVD and heart failure, while no associations with CHD and stroke were detected ESM Table 3 ; moreover, both ischemic and hemorrhagic stroke risk was reduced with up to one egg per day compared to no consumption ESM Table 3.
The subgroup dose response gradient definition by sex revealed a different relation with risk of CVD, CHD, and heart failure in women than in men. No significant associations were observed among men Table 3. Several stratified analyses have been performed to test the stability of results taking into consideration the geographical localization of the cohorts as well as the level of adjustment models and the quality of the studies included.
The analyses have been considered for a moderate consumption four eggs per week and a habitual consumption one egg per day. Similar associations were retrieved for risk of CHD, with a direction toward reduction when restricting the analysis to studies adjusting for other dietary factors, longer follow-up and low risk of bias Table 4.
No association between moderate egg consumption and risk of stroke nor heart failure was found Table 4. No associations were retrieved for CHD risk, while also the risk of stroke was reduced only when considering Asian cohorts and studies including more than 10, dose response gradient definition Table in slope intercept form (y=mx+b) what is the m. Also risk of heart failure differed between strata, resulting higher in the analysis restricted to US cohorts with large sample size, adjusted for BMI dose response gradient definition not for other dietary factors; no study with low risk of bias was available Table 4.
Table 5 provides an overview of the GRADE assessment for the association between consumption of eggs and each cardiovascular outcome. The level of evidence was rated generally low for all outcomes but stroke, for which was moderate. The present meta-analysis provided an updated overview on the association between egg consumption and CVD risk and mortality: compared to dose response gradient definition meta-analyses, we included the highest number of cohorts reviewed to date, several dose—response analyses for the investigated outcomes, a detailed investigation for potential confounding factors by studying subgroups and stratifying the analyses, and we attempted an evaluation of the overall evidence.
Previous meta-analyses reported rather mixed results, with no association with stroke risk [ 55 ], decreased risk of stroke and no association with CHD [ 5657 ], decreased risk of CHD [ 58 ], no association with CVD risk [ 59 ], increased risk of heart failure [ 6061 ],compared to these studies, our analysis is more complete and provides a general more in depth analysis of level of evidence.
We generally found no strong association with either increased or decreased risk of cardiovascular outcomes following the habitual consumption of eggs i. In contrast, there are more consistent results regarding the association between moderate egg consumption i. Also when considering the findings from the stratified analyses, heterogeneity of the results between studies remained significant and rather unexplained. We can hypothesize that egg consumption between men and women or across different geographical areas may be associated with unmeasured lifestyle choices or in the context of different quality of the overall diet to motivate the differences observed in these strata, another hypothesis is that these strata may also reflect genetic unmeasured factors motivating the inter-individual variations.
After the GRADE assessment, we could not conclude that exist strong evidence of association between egg consumption and CVD outcomes, but higher quality studies showed a decreased risk of CVD for moderate intake of eggs four per weekwhile higher risk of heart failure was found for higher intake of egg one per day. Interpretation of these findings is not easy: consuming up to four eggs per week may decrease the risk of CVD but increasing the intake to one egg per day or more may not be beneficial anymore.
Nonetheless, we cannot exclude that the pattern of the diet and way of cooking might differ depending on the frequency of consumption i. Such hypothesis could explain the different risks associated with egg consumption in Western and Eastern Asian countries. This is a common issue for nearly all food groups when investigating the relation of one single dietary element with health.
However, we cannot ignore that an association can be observed and, in that case, needs further attention. There is a biological rationale to explain how moderate egg consumption might be associated to decreased risk of CVD. Eggs have been historically considered a controversial food for nutritional experts and health agencies due to its content in cholesterol. However, researchers argue that the focus of common dietary guidelines on specific nutrients i.
Furthermore, the major attention paid to egg consumption has been based on the assumption that higher dietary cholesterol intake would lead to rise in blood cholesterol, despite current evidence suggests otherwise [ 6364 ]. Thus, the concomitant rise of HDL cholesterol might counteract the elevation of LDL, while other components of egg might exert potential beneficial effects [ 65 ]. Eggs are a highly nutritious food providing quality proteins and supplying micronutrients, antioxidants, antimicrobials, accompanied with great culinary versatility, which may have potential benefits to overall health.
Some egg proteins, such as phosvitin, ovotransferrin and ovalbumin can inhibit lipid oxidation by binding to metal or scavenging free radical [ 66 ]. In addition to protein, eggs also contain a large number of active lipid components, such as unsaturated fatty acids, phospholipids, choline, and carotenoids. Eggs are considered a valuable source of omega-3 polyunsaturated fatty acids, which have been considered to exert a number of health benefits, including CVD protection [ 67 ].
Eggs are a major source of choline, an essential nutrient with critical roles in several biological processes including neuronal development, cell signaling, and lipid transport and metabolism [ 68 ]. Part of the choline may undergo conversion to trimethylamine by gut microbiota, which in turn is oxidized in the liver to trimethylamine- N -oxide TMAOagent associated with increased atherosclerosis in the coronary vasculature [ 69 dose response gradient definition.
Phospholipids contained in eggs, including phosphatidylcholine, phosphatidylethanolamine, lysophosphatidylcholine, sphingomyelin, and some neutral lipids in minor quantities, may have, among others, broad effects on cholesterol metabolism, Dose response gradient definition functions, and inflammation [ 71 ]. Egg yolks are also a dietary source of bioavailable xanthophyll carotenoids, such as lutein and zeaxanthin, that have been shown to exert potential benefits against inflammation and oxidation during early development, childhood, and may have lifetime consequences in determining health or onset of major diseases in the adult life [ 72 ].
Despite the evidence reported, nearly all analyses showed substantial heterogeneity of results between studies, leading to a weakening of the evidence. We hypothesize that the certain inconsistency of the results may depend on difference between taxonomy and systematics class 11 dose response gradient definition of response to dietary cholesterol between individuals and the overall dietary and lifestyle framework within populations and individuals.
An abnormal response to dietary cholesterol has been hypothesized to depend on altered cholesterol transport due to decreased levels of apolipoprotein E and increased dose response gradient definition apolipoprotein C-III [ 7475 ]. Some genes responsible for dose response gradient definition absorption and biliary secretion of cholesterol and phytosterols, such as expression of ATP-binding cassette ABC transporters G5 ABCG5 and G8 ABCG8 [ 76 ], have been proposed as candidates for better understanding of potential genetic influences on egg metabolism.
The results of this meta-analysis on heart failure seems to provide indication of potential increased risk for habitual consumption one egg per day despite this evidence was affected by some limitations, including the role of sex: while sex seems dose response gradient definition act as confounding factor for CVD, the observed variation in the direction for risk heart failure increased in men and decreased in women may lead to consider sex as an effect modifier.
The reasons for such finding dose response gradient definition not clear. The role of cholesterol abnormalities and risk or worsening of heart failure is unknown; data on worsening heart failure and lipid moieties are now beginning to emerge but conclusions are far to be made [ 77 ]. The fact that heart failure was the only outcome potentially at higher risk following consumption of eggs suggests that alternative mechanisms could be responsible for the observed association.
Interpretation of these differences between sexes makes even harder to provide a rationale for this result: as suggested in the individual studies included in the meta-analysis, it may be possible that the observed difference between sexes may depend on the fact that men might be more sensitive to high consumption of eggs or cholesterol than women, or it could be mediated by uncontrolled risk factors associated with egg consumption i.