Cohort studyindependent cross-checkabstract only checked★ key study I-EGG-02 in-depth review
Eggs, cholesterol and heart disease in 50 countries
Association of egg intake with blood lipids, cardiovascular disease, and mortality in 177,000 people in 50 countries.
Overview
Dehghan M et al.. Am J Clin Nutr 2020 · PMID 31965140 · DOI 10.1093/ajcn/nqz348
Eating an egg a day was not linked to cholesterol levels, heart disease or death.
Does the study support the specific claim? No · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Is egg intake associated with blood lipids, CVD and mortality across income levels?
- How was the study done?
Prospective cohort analyses of PURE and of patients in ONTARGET/TRANSCEND trials
- How many people, animals or samples were studied?
146,011 (PURE) + 31,544 (trials); PURE general population (21 countries) and patients with vascular disease (ONTARGET/TRANSCEND)
- What was actually found?
PURE >=7 vs <1 egg/week: composite HR 0.96 (0.89-1.04); mortality 1.04 (0.94-1.15); major CVD 0.92 (0.83-1.01); no association with lipids. ONTARGET/TRANSCEND similar (composite 0.97, 0.76-1.25).
- How large was the observed effect?
Cox frailty models
- What do the results mean in everyday life?
Moderate egg intake appears neutral worldwide.
- What are the study's limitations?
Single FFQ; Few very high consumers
- What does it say about Elawady's specific claim?
Contradicts.
- Do the results apply to Germany and Europe?
Includes European countries.
- What can explicitly not be concluded from this study?
Cannot exclude small effects.
Scientific in-depth review
1. Full reference
- Authors
- Dehghan M et al.
- Journal
- Am J Clin Nutr
- Year
- 2020
- Identifier
- PMID 31965140 DOI 10.1093/ajcn/nqz348
- Verification
- verified – PubMed efetch 2026-10-25 (PubMed lists publication type "Randomized Controlled Trial" because ONTARGET/TRANSCEND trial cohorts were used; analysis is observational)
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
None stated in record
2. Research question
Is egg intake associated with blood lipids, CVD and mortality across income levels?
3. Study design and population
- Study design
- Cohort study – Prospective cohort analyses of PURE and of patients in ONTARGET/TRANSCEND trials
- Population
PURE general population (21 countries) and patients with vascular disease (ONTARGET/TRANSCEND)
- Country
50 countries on 6 continents
- Period
Not stated in abstract
- Sample size
146,011 (PURE) + 31,544 (trials)
- Inclusion and exclusion criteria
Excluding history of CVD for main PURE analysis
4. Methods and endpoints
- Exposure / intervention
Egg intake (validated country-specific FFQ)
- Comparator
<1 egg/week
- Endpoints
Blood lipids, composite outcome, total mortality, major CVD
- Statistical methods
Cox frailty models
5. Actual results
- Results
PURE >=7 vs <1 egg/week: composite HR 0.96 (0.89-1.04); mortality 1.04 (0.94-1.15); major CVD 0.92 (0.83-1.01); no association with lipids. ONTARGET/TRANSCEND similar (composite 0.97, 0.76-1.25).
- Absolute risks
not reported
- Authors' conclusion
No significant associations between egg intake and blood lipids, mortality or major CVD.
6. Strengths
- Includes low- and middle-income countries
- Large size
7. Weaknesses
- Single FFQ
- Few very high consumers
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Confounding possible.
9. Assessment of the statistical interpretation
Null with reasonably narrow CIs.
10. Relevance to the specific claim
C-EGG-04; relevant to Egypt-like middle-income settings.
11. Independent contrary findings
12. Transferability to Germany and Europe
Includes European countries.
13. Overall methodological judgement
Strong null evidence, global.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | some concerns |
| Precision of results | high |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Egypt-specific data.
15. Linked fact checks
- All eggs (chicken, quail, pigeon, ostrich, etc.) are harmful because an egg is an embryo / contains the 'full components of a living organism'. – Studies contradicting or limiting the claim
- Higher egg (and dietary cholesterol) intake increases the risk of cardiovascular disease and all-cause mortality (each additional half egg per day: +6% CVD, +8% mortality). – Studies contradicting or limiting the claim
- Egg-yolk phosphatidylcholine is converted by gut bacteria into TMAO, and therefore eggs raise the risk of major cardiovascular events (about 2.5-fold). – Studies contradicting or limiting the claim
- Eggs should be completely avoided (all kinds, all cooking methods). – Studies contradicting or limiting the claim