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Meta-Analysis
.2020 Sep 1;112(3):619-630.
doi: 10.1093/ajcn/nqaa115.

Egg consumption and risk of type 2 diabetes: findings from 3 large US cohort studies of men and women and a systematic review and meta-analysis of prospective cohort studies

Affiliations
Meta-Analysis

Egg consumption and risk of type 2 diabetes: findings from 3 large US cohort studies of men and women and a systematic review and meta-analysis of prospective cohort studies

Jean-Philippe Drouin-Chartier et al. Am J Clin Nutr..

Abstract

Background: Whether egg consumption is associated with the risk of type 2 diabetes (T2D) remains unsettled.

Objectives: We evaluated the association between egg consumption and T2D risk in 3 large US prospective cohorts, and performed a systematic review and meta-analysis of prospective cohort studies.

Methods: We followed 82,750 women from the Nurses' Health Study (NHS; 1980-2012), 89,636 women from the NHS II (1991-2017), and 41,412 men from the Health Professionals Follow-up Study (HPFS; 1986-2016) who were free of T2D, cardiovascular disease, and cancer at baseline. Egg consumption was assessed every 2-4 y using a validated FFQ. We used Cox proportional hazard models to estimate HRs and 95% CIs.

Results: During a total of 5,529,959 person-years of follow-up, we documented 20,514 incident cases of T2D in the NHS, NHS II, and HPFS. In the pooled multivariable model adjusted for updated BMI, lifestyle, and dietary confounders, a 1-egg/d increase was associated with a 14% (95% CI: 7%, 20%) higher T2D risk. In random-effects meta-analysis of 16 prospective cohort studies (589,559 participants; 41,248 incident T2D cases), for each 1 egg/d, the pooled RR of T2D was 1.07 (95% CI: 0.99, 1.15; I2 = 69.8%). There were, however, significant differences by geographic region (P for interaction = 0.01). Each 1 egg/d was associated with higher T2D risk among US studies (RR: 1.18; 95% CI: 1.10, 1.27; I2 = 51.3%), but not among European (RR: 0.99; 95% CI: 0.85, 1.15; I2 = 73.5%) or Asian (RR: 0.82; 95% CI: 0.62, 1.09; I2 = 59.1%) studies.

Conclusions: Results from the updated meta-analysis show no overall association between moderate egg consumption and risk of T2D. Whether the heterogeneity of the associations among US, European, and Asian cohorts reflects differences in egg consumption habits warrants further investigation.This systematic review was registered at www.crd.york.ac.uk/prospero as CRD42019127860.

Keywords: egg; meta-analysis; prospective cohort study; systematic review; type 2 diabetes.

Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.

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Figures

FIGURE 1
FIGURE 1
Statistical model–based HRs and 95% CIs for incident T2D associated with replacing 1 egg/d with 1 serving/d of other foods in the NHS, the NHS II, and the HPFS (pooled analysis,n = 213,798). In the substitution analyses, Cox proportional hazards regression models were stratified by calendar time (in 2-y intervals) and cohort, and adjusted for age (mo), race (Caucasian/other), family history of diabetes (yes/no), baseline history of hypercholesterolemia (yes/no), baseline history of hypertension (yes/no), smoking status (never, former, current), BMI (in kg/m2: <21.0, 21.0–22.9, 23.0–24.9, 25.0–26.9, 27.0–29.9, 30.0–34.9, ≥35.0), physical activity (MET-h/wk: <3.0, 3.0–8.9, 9.0–17.9, 18.0–26.9, ≥27.0), oral contraceptive use (never, former, current; in the NHS II only), postmenopausal hormone use (premenopausal, never, former, current; in the NHS and NHS II only), statin use (yes/no), cumulative average alcohol intake (g/d; quintiles), multivitamin use (yes/no), and physical examination during the 2-y cycle (yes/no). The model also included updated cumulative average of daily intake of total calories (kcal/d; in quintiles), bacon (servings/d; in categories), unprocessed red meat (servings/d; in categories), other processed red meats (servings/d; in categories), refined grains (servings/d; in categories), fruits (servings/d; in categories), vegetables (servings/d; in categories), potatoes (servings/d; in categories), full-fat milk (servings/d; in categories), coffee (servings/d; in categories), fruit juices (servings/d; in categories), and sugar-sweetened beverages (servings/d; in categories). All covariates (except race, family history of diabetes, baseline hypercholesterolemia, and basline hypertension) were updated every 2 y. HPFS, Health Professionals’ Follow-up Study; NHS, Nurses’ Health Study; T2D, type 2 diabetes.
FIGURE 2
FIGURE 2
Association of egg consumption with T2D risk, for a 1-egg/d increase, stratified by geographic region and using random-effects meta-analysis (589,559 participants; 41,248 incident T2D cases). Weights of each of the studies are represented by the size of the square. Black diamonds represent the individual study effects and black lines represent the 95% CIs. The overall effect estimate and 95% CI are represented by the dotted line and white diamonds respectively.P value for interaction between geographic regions, tested using meta-regression = 0.01. ES, effect size; HPFS, Health Professionals’ Follow-up Study; NHS, Nurses’ Health Study; T2D, type 2 diabetes.
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