Egg Exclusion Research Articles

Egg Consumption in the Context of Plant-Based Diets and Cardiometabolic Risk Factors in Adults at Risk of Type 2 Diabetes

BackgroundPlant-based diets (PBDs) are typically recommended to those at risk of type 2 diabetes mellitus (T2DM). ObjectivesWe examined how including eggs, compared with excluding them from PBDs, affected cardiometabolic risk factors in adults at risk of T2DM. MethodsThis was a randomized, controlled, single-blind, crossover trial of 35 adults (mean age: 60.7 y; 25 women, 10 men) at risk of T2DM assigned to 1 of 2 sequence permutations of 2 dietary treatments (plant-based plus eggs, and exclusively plant-based), with a 4-wk washout period. A dietitian counseled participants to exclude or include 2 eggs daily in the context of PBDs for a 6-wk interval. Our primary outcome measure was endothelial function (EF) measured as flow-mediated dilatation. Secondary outcome measures included lipid profile, blood pressure, insulin sensitivity, anthropometry, and dietary intake. Data were analyzed using generalized linear models. ResultsCompared with egg exclusion, egg inclusion in the context of PBDs did not adversely affect EF (−1.7% ± 6.5% compared with −1.8% ± 7.5%; P = 0.9805). Likewise, egg inclusion, compared with egg exclusion, did not adversely affect (P = 0.1096–0.9781) lipid profile, blood pressure, insulin sensitivity, or anthropometry. Egg inclusion, compared with egg exclusion, improved reported intakes of selenium (23.1 ± 30.3 μg/d compared with 2.3 ± 34.9 μg/d; P = 0.0124) and choline (172.0 ± 96.0 mg/d compared with −3.4 ± 68.1 mg/d; P < 0.0001). ConclusionsConsuming 2 eggs daily in the context of PBDs does not adversely affect cardiometabolic risk factors among adults at risk of T2DM. Eggs could be used as an adjuvant to enhance PBDs that are typically recommended for those at risk of T2DM.This trial was registered at clinicaltrials.gov as NCT04316429.

Egg Consumption in the Context of Plant-Based Diets and Diet Quality in Adults at Risk for Type 2 Diabetes: A Randomized Single Blind Cross-over Controlled Trial

Background: Lifestyle changes that emphasis on plant-based diets (PBD) are typically recommended for those at risk for type 2 diabetes mellitus (T2DM) to mitigate their cardo-metabolic risk. We examined the impact of the inclusion of eggs compared with their exclusion from PBD on diet quality among adults at risk for T2DM. Methods: This was a randomized, controlled, single-blind, crossover trial of 35 adults (mean age 60.7 years; 25 women, 10 men; 34 Caucasians, 1 African-American) at risk for T2DM (i.e., pre- diabetes or metabolic syndrome) assigned to one of two possible sequence permutations of two treatments (PBD with eggs and exclusively PBD), with a 4-week washout period. Participants received dietary counseling from a dietitian to exclude or to include 2 eggs daily in the context of PBD for a 6-week period. Diet quality was assessed using the Healthy Eating Index 2015 (HEI-2015) at baseline and 6 weeks. Results: Compared with the exclusion of eggs, the inclusion of eggs in the context of PBD improved the diet quality score for intake of total protein foods (1.0 ± 1.1 vs. −0.4 ± 1.0; p <.0001); seafood and plant proteins (0.2 ± 1.2 vs. −0.4 ± 1.1; p = 0.0338); and fatty acids (0.8 ± 2.5 vs. −0.7 ± 2.7; p = 0.0260). Overall diet quality score depreciated with the adoption of exclusively PBD without eggs (−3.1 ± 8.3; p = 0.0411), while it was unaffected with the adoption of a PBD with the inclusion of eggs (−0.6 ± 7.9; p = 0.6892). Conclusions: Eggs could be used as an adjuvant to enhance the diet quality among those at risk for T2DM who adopt plant-based dietary patterns.

Which foods are displaced in the diets of adults with type 2 diabetes with the inclusion of eggs in their diets? A randomized, controlled, crossover trial

BackgroundThe inclusion or exclusion of specific foods from the overall diet inevitably affects other food choices, and this matter is routinely neglected in dietary guidance and nutritional epidemiology. We examined...

Egg ingestion in adults with type 2 diabetes: effects on glycemic control, anthropometry, and diet quality—a randomized, controlled, crossover trial

BackgroundThe inclusion of eggs as part of a healthful diet for adults with diabetes is controversial. We examined the effects of including eggs in the diet of adults with type...

Effects of Egg Ingestion on Endothelial Function in Adults with Coronary Artery Disease: A Randomized, Controlled, Crossover Trial

ObjectiveTo determine effects of daily egg consumption on endothelial function, biomarkers, and anthropometric measures in individuals with coronary disease (CHD).MethodsThis was a randomized, controlled, single‐blind, crossover trial. Thirty‐two participants (mean age 67 years; 6 women and 26 men) with CHD were randomly assigned to one of 6 possible sequence permutations of 3 different treatments (breakfast with 2 eggs, ½ cup Egg Beaters, or a high‐carbohydrate breakfast as part of an ad libitum diet) for 6 weeks. The primary outcome measure was endothelial function measured as flow mediated dilatation (FMD).ResultsAs compared to the control breakfast, daily consumption of eggs showed no adverse effects on FMD (7.2 ± 2.9% vs. 7.5 ± 2.9%; p=0.33), lipids (total cholesterol: 158.3 ± 28.6 mg/dL vs. 156.2 ± 27.4mg/dL; p=0.49), blood pressure (systolic BP: 132.8 ± 14.1 mmHg or vs. 135.5 ± 14.9mmHg; p=0.52, diastolic BP: 77.2 ± 6.1 mmHg vs. 76.7 ± 6.9 mmHg; p=0.86) or body weight (90.8 ± 17.5 kg vs. 91.8 ± 17.1 kg; p= 0.92). Outcomes did not differ between eggs and Egg Beaters.ConclusionsOur findings, and the overall weight of evidence, argue against the exclusion of eggs from heart‐healthy diets, even among those with actual coronary disease.The source of research support:the Egg Nutrition Center/America Egg Board and Centers for Disease Control and Prevention.

Modified Egg as a Nutritional Supplement During Peak Brain Development: A New Target for Fortification

Though eggs have the unique capacity, like breastmilk, to concentrate essential nutrients required for early growth and brain development of offspring - i.e. n-3 PUFA, increasingly deficient and sources contaminated - cholesterol and allergy concerns often exclude them from perinatal recommendations. Egg's potential contribution of key nutrients required for peak brain development are re-evaluated vis-à-vis fortification, accessibility, and risks. Contributions of standard (USDA) and fortified (selected market-available) egg compositions to perinatal requirements for critical brain-supporting nutrients were compared to human and cow milks, and risks and recommendations evaluated. Standard egg has already higher concentrations/kcal of iron, selenium, zinc, choline, vitamins B12 and E, and essential amino acids (plus taurine) than human milk. Fortified egg could further yield significant n-3 PUFA % recommendations for pregnancy-lactation (total n-3 69.6-75.0% [DRI=1400-1300 mg/day]), including DHA (120.1-129.3%, mostly approximately 80% [calculated DRI=140-130 mg/day]), plus antioxidant vitamins A (9.0-15.2%) and E (51.6-65.3%), and minerals iodine (33.6-44.5%) and selenium (33.7-39.3%); % recommendations for children (1-3 y) even more. Cholesterol, important for nerve membranes and learning, may not be generally contraindicated in childbearing-aged women (approximately 10.5% hypercholesterolemia), and early-life egg exposure may increase tolerance. Egg-inclusive perinatal nutrition programs have shown significant contributions. Eggs, especially target-fortified, may provide a unique nutritional supplement for peak brain development continously during pregnancy, nursing, and infancy (from 6 months), especially vs. insufficiencies. Missing nutritional opportunities by egg exclusion vs. concerns of hypercholesterolemia or allergy could be addressed individually, rather than as general recommendations, warranting further research and targeted egg design.

Exposure of the fetus and infant to hens' egg ovalbumin via the placenta and breast milk in relation to maternal intake of dietary egg

Maternally derived allergens may be transferred to the developing infant during pregnancy and lactation. However, it is not known how manipulation of environmental allergen levels might impact on this early-life exposure. To measure dietary egg allergen (ovalbumin (OVA)) in gestation-associated environments, in relation to maternal dietary egg intake. OVA was measured by allergen-specific ELISA in maternal blood collected throughout pregnancy, infant blood at birth (umbilical cord) and in breast milk at 3 months post-partum. Samples derived from pregnant women undergoing diagnostic amniocentesis at 16-18 weeks gestation who were not subject to any dietary intervention, and from pregnant women, with personal or partner atopy, randomized to complete dietary egg exclusion or an unmodified healthy diet before 20 weeks gestation as a primary allergy prevention strategy. Maternal dietary egg intake was monitored closely throughout the study period by diary record and serial measurement of OVA-specific immunoglobulin G concentration. Circulating OVA was detected throughout pregnancy in 20% of women and correlated with both presence (P<0.001) and concentration (r=0.754, P<0.001) of infant OVA at birth (umbilical cord). At 3 months post-partum OVA was detected in breast milk samples of 35% women, in higher concentrations than measured in blood. Blood and breast milk OVA were not related to maternal dietary intake or atopic pre-disposition. Rigorous dietary egg exclusion does not eliminate trans-placental and breast milk egg allergen passage. This early-life exposure could modulate developing immune responses.

Serum ovalbumin‐specific immunoglobulin G responses during pregnancy reflect maternal intake of dietary egg and relate to the development of allergy in early infancy

The value of allergen elimination diets during pregnancy for primary prevention of infant allergy has been questioned. However, dietary compliance may influence effectiveness. To monitor egg intake during a randomized controlled trial of egg avoidance throughout pregnancy and lactation by serial measurements of serum ovalbumin (OVA) IgG concentration in conjunction with dietary diary record and also, to analyse specific IgG concentrations at birth in relation to infant allergic outcome. Pregnant women, with personal or partner atopy, were randomized to complete dietary egg exclusion or an unmodified healthy diet before 20 weeks gestation. The infants were evaluated for atopy at 6 months of age. Serum food-specific IgG concentrations were determined by ELISA in maternal samples collected at study recruitment and during labour, and in infant samples at birth (umbilical cord). Serum-specific IgG to OVA, but not the unrelated allergen, cow's milk beta-lactoglobulin, decreased over pregnancy in egg-avoiding women only (P<0.001). Cord OVA IgG concentration correlated with maternal IgG at delivery (r=0.944; P<0.001), and for infants born to atopic women, cord concentration was higher than that of their mother's (P<0.001). Infants with the lowest and highest cord IgG concentrations were the least likely, and those with mid-range concentrations were the most likely, to be atopic by 6 months of age (P=0.008). Serum OVA IgG concentration reflects egg consumption, thereby indicating dietary allergen doses to which the developing immune system might be exposed. Trans-placental maternal IgG must be considered among early life factors that regulate infant atopic programming.

Randomized Controlled Trial of Advice on an Egg Exclusion Diet inYoung Children with Atopic Eczema and Sensitivity to Eggs

Lever R, MacDonald C, Waugh P, Aitchison TPediatr Allergy Immunol.919981319The role of exclusion diets in the management of atopic dermatitis (AD) in young children remains controversial. The aim of this randomized, controlled trial was to evaluate the effect of excluding egg from the diet in young children with AD and sensitivity to eggs.Fifty-five children with AD and egg sensitivity were randomized either to a 4-week egg exclusion diet (diet group, n = 28) or no diet (control, n = 27). The mothers of all children were given advice on the general care of eczema. Randomization for the dietary phase took place only after optimal control of the eczema was achieved and the child was stable on maintenance treatment (mean = 3.5 months). Disease activity was assessed by estimates of the surface area affected by eczema and by an arbitrary severity score. Possible egg sensitivity was identified by radioallergosorbent test (RAST) before randomization and after the trial by double-blind, placebo-controlled egg challenge.Overall, two thirds of the children with positive RAST results to egg experienced a positive reaction during double-blind challenge. After the dietary period, the dietary group experienced a significantly greater mean reduction in surface area affected by eczema than the control group (P = .02); from 19.6% to 10.9% area affected in dietary group compared with the 21.9% to 18.9% reduction in the control group. A significant improvement also was seen in the severity score (P = .04); from 33.9 to 24.0 units for the dietary group compared with a decrease from 36.7 to 33.5 in the control group. Egg-sensitive patients in the control group were then placed on a 4-week egg exclusion diet and also showed significant improvement in their severity scores.The authors concluded that advice on the dietary exclusion of eggs is useful as part of the overall management of young children with atopic eczema and sensitivity to eggs.Allergists and dermatologists continue to disagree over the role of allergic inflammation in children with AD. A recent study demonstrated that almost 40% of children presenting to a university dermatology clinic with moderate to severe AD have food hypersensitivity (see below). This study by Dr Lever and her dermatology colleagues demonstrates that removal of a food allergen from the diet of a food allergic patient leads to improvement in eczematous symptoms. In fact, it is somewhat remarkable that significant differences were observed in this relatively small number of patients, in such a short period of time, with the exclusion of a single food after an intensive topical steroid regimen. It would have been interesting to see whether a more complete dietary assessment and longer follow-up would have produced even more striking results, and information on whether a significant reduction in medication requirements occurred in the dietary group.

Randomized Controlled Trial of Advice on an Egg Exclusion Diet inYoung Children with Atopic Eczema and Sensitivity to Eggs

1. Lever R, 2. MacDonald C, 3. Waugh P, 4. Aitchison T (1998) Pediatr Allergy Immunol. 9:13–19. [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] #### Purpose of the Study The role of exclusion diets in the management of atopic dermatitis (AD) in young children remains controversial. The aim of this randomized, controlled trial was to evaluate the effect of excluding egg from the diet in young children with AD and sensitivity to eggs. ##### Methods Fifty-five children with AD and egg sensitivity were randomized either to a 4-week egg exclusion diet (diet group, n = 28) or no diet (control, n = 27). The mothers of all children were given advice on the general care of eczema. Randomization for the dietary … [1]: {openurl}?query=rft.jtitle%253DPediatric%2Ballergy%2Band%2Bimmunology%2B%253A%2B%2Bofficial%2Bpublication%2Bof%2Bthe%2BEuropean%2BSociety%2Bof%2BPediatric%2BAllergy%2Band%2BImmunology%26rft.stitle%253DPediatr%2BAllergy%2BImmunol%26rft.aulast%253DLever%26rft.auinit1%253DR.%26rft.volume%253D9%26rft.issue%253D1%26rft.spage%253D13%26rft.epage%253D19%26rft.atitle%253DRandomised%2Bcontrolled%2Btrial%2Bof%2Badvice%2Bon%2Ban%2Begg%2Bexclusion%2Bdiet%2Bin%2Byoung%2Bchildren%2Bwith%2Batopic%2Beczema%2Band%2Bsensitivity%2Bto%2Beggs.%26rft_id%253Dinfo%253Adoi%252F10.1111%252Fj.1399-3038.1998.tb00294.x%26rft_id%253Dinfo%253Apmid%252F9560837%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1111/j.1399-3038.1998.tb00294.x&link_type=DOI [3]: /lookup/external-ref?access_num=9560837&link_type=MED&atom=%2Fpediatrics%2F104%2FSupplement_2%2F362.2.atom [4]: /lookup/external-ref?access_num=000072680800005&link_type=ISI

Dietary manipulation in childhood atopic dermatitis.

The dietary habits of 73 children seen consecutively in a dermatology out-patient department were studied to ascertain the nature and frequency of dietary manipulation and to assess any potential hazards. Although most children had only mild flexural dermatitis, 71% had had significant alterations made to their diet before attendance at hospital. Almost all diets were unsupervised and only six children had seen a dietitian. Over half had been started on diets before any professional advice had been sought. Information on diet had come from media, books or magazines (51%), friends (32%), general practitioners (27%) and district nurses or health visitors (18%). The major dietary alterations included the exclusion of eggs, dairy products and food additives, and the use of soya and goat's milk. Under 10% of patients claimed benefit from these largely unsupervised diets. Harmful practices included the frequent use of unboiled, unpasteurized goat's milk, unmodified goat's milk in a baby of 4 months and the use of severely restricted diets. Three children (6%) in the diet group had been on diets which were considered by a hospital dietitian to be particularly dangerous. However, there was no evidence of growth retardation, failure to thrive or specific deficiency syndromes in the group we studied. Uncontrolled, unsupervised and often prolonged dietary alterations are commonplace in children with atopic dermatitis. This is a potentially serious health problem.

Food allergy in atopic eczema I. The effect of maternal diet on breast-fed babies with eczema

Eczema in infants solely breast fed may be caused by food proteins transmitted through mother's milk (Warner, 1980). By radioimmunoassay we identified traces of cow's milk and egg proteins in human milk 2–4 h after oral challenge. Sixty-nine exclusively breast-fed infants with eczema and 36 controls were then studied. The infants' rashes were classified as ‘definite atopic eczema’ (DAE), ‘possible atopic eczema’ (PAE) and ‘atopic eczema unlikely’ (AEU). All were skin prick-tested against 12 common antigens including six foods. Thirty-five mothers who were breast feeding eczematous infants then completed controlled trials of cows' milk and egg exclusion diets. Sixty-nine per cent of infants with DAE, 37% with PAE, 25% with AEU and 8% of controls gave positive skin tests to food antigens, in all but three cases to egg and cows' milk. Thirty of 35 (86%) infants did not benefit from a maternal cow's milk and egg exclusion diet. In five, however, exclusion appeared to be effective and double-blind challenge provoked eczema in all five and diarrhoea and colitis in one. Although half of exclusively breast-fed infants with eczema (DAE and PAE) show cutaneous hypersensitivity to cows' milk or egg protein, only a minority improve if mothers avoid these foods.