OUP accepted manuscript

[Translated article] Multicenter, Prospective, Case-Control Study of Exposome in Melanoma

UV radiation is the main etiological agent of skin cancer. Other factors such as pollution, diet and lifestyle are also contributing factors. Our aim was to investigate the association between melanoma and exposome factors in the Spanish population with a prospective multicenter case-control study. Case group included patients with melanoma while the control group included people who attended the consultations as companions without a past medical history of skin cancer. A total of 73 melanoma patients and 126 controls were included. The former group included more outdoor workers, a history of skin cancer, drug use (acetylsalicylic acid, antidepressants and ACE inhibitors, p<0.05), more sun exposure (p<0.001) and more sunburns (p=0.04). Controls used shade (p=0.04) or clothing (p<0.001) and the sun protection factor (SPF) used 15 years earlier was higher (p=0.04). Melanoma-related exposome factors are associated with sun exposure, drug intake and food. Prevention strategies should target specific populations, such as outdoor workers by promoting sun-safe behaviors and healthy lifestyle habits since childhood.

Multicenter, Prospective, Case-control Study of Exposome in Melanoma

UV radiation is the main etiological agent of skin cancer. Other factors such as pollution, diet and lifestyle are also contributing factors. Our aim was to investigate the association between melanoma and exposome factors in the Spanish population with a prospective multicenter case-control study. Case group included patients with melanoma while the control group included people who attended the consultations as companions without a past medical history of skin cancer. A total of 73 melanoma patients and 126 controls were included. The former group included more outdoor workers, a history of skin cancer, drug use (acetylsalicylic acid, antidepressants and ACE inhibitors, p<0.05), more sun exposure (p<0.001) and more sunburns (p=0.04). Controls used shade (p=0.04) or clothing (p<0.001) and the sun protection factor (SPF) used 15 years earlier was higher (p=0.04). Melanoma-related exposome factors are associated with sun exposure, drug intake and food. Prevention strategies should target specific populations, such as outdoor workers by promoting sun-safe behaviors and healthy lifestyle habits since childhood.

Effect of egg consumption on health outcomes: An updated umbrella review of systematic reviews and meta-analysis of observational and intervention studies

AIMS

To evaluate the effect of egg consumption on health outcomes.

DATA SYNTHESIS

A systematic search in PubMed, Scopus, Lilacs, and Web of Science was developed using terms ("egg consumption" or "egg intake") and ("health" or "chronic diseases" or "diabetes" or "cancer" or "cholesterol" or "dyslipidemia"), and meta-analyses of observational or interventional studies published since January 2020 were included. The studies' quality was evaluated through AMSTAR-2 and NutriGrade, and the strength of evidence according to sample size, heterogeneity, and quality of articles. Fourteen meta-analyses were included (10 observational, 4 interventional studies). The wide range of outcomes, with substantial variability and high heterogeneity, indicated a lack of robust evidence. The overall quality of studies was critically low. The level of evidence was very weak for all the significant associations: risk of heart failure (RR 1.15; 95%CI: 1.02-1.30), cancer mortality (RR 1.13; 95%CI 1.06-1.20), higher levels of LDL cholesterol (WMD 7.39; 95%CI 5.82-8.95), total cholesterol (WMD 9.12; 95%CI 7.35-10.89), and apolipoprotein B-100 (WMD 0.06; 95%CI 0.03-0.08). Conversely, egg intake has been weakly associated with improvements in HDL cholesterol (WMD 1.37; 95%CI 0.49-2.25), apolipoprotein A1 (WMD 0.03; 95%CI 0.01-0.05), and growth parameters in children (WMD 0.47; 95%CI 0.13-0.80). No evidence of association was found among all cardiovascular outcomes and all-cause mortality risk between high vs. low egg consumption.

CONCLUSION

Due to the critically low strength of studies, insufficient evidence is available to discourage egg consumption, suggesting eggs can be part of a healthy diet.

Umbrella Review of Systematic Reviews and Meta-analyses on Consumption of Different Food Groups and Risk of All-cause Mortality

Consumption of different food groups is linked to a range of health outcomes. It is essential to integrate the most reliable evidence regarding intake of different food groups and risk of mortality to optimize dietary guidance. Our aim is to systematically and comprehensively assess the associations between the consumption of various food groups and all-cause mortality. The food groups under consideration include edible grains (refined and whole grains), fruits, vegetables, nuts, legumes, fish and fish products, eggs, dairy products/milk, meat and meat products (including processed meat, unprocessed red and white meat), sugar-sweetened beverages, and added sugars. We present these associations with high compared with low consumption and per serving comparisons. We comprehensively and systematically reviewed a search in Medline, Embase, Web of Science, and Epistemonikos (PROSPERO: CRD42024498035), identifying 41 meta-analyses involving over a million participants, many of which showed significant heterogeneity. Of the 41 studies, 18 were rated high quality, 8 moderate quality, 5 low quality, and 10 critically low quality according to AMSTAR-2 assessments. Our findings revealed that higher consumption of nuts, whole grains, fruits, vegetables, and fish was associated with lower mortality rates, both in high compared with low comparisons and per serving analyses. Similarly, we observed favorable outcomes for legumes and white meat in high compared with low comparisons. Conversely, high intakes of red and processed meats, as well as sugar-sweetened beverages, were linked to higher all-cause mortality. Dairy products and refined grains did not show clear associations with mortality, whereas there was a tendency in all-cause mortality for high intakes of added sugars and eggs.

Egg Consumption and Mortality: A Prospective Cohort Study of Australian Community-Dwelling Older Adults

BACKGROUND/OBJECTIVES

Egg consumption in adults has been linked with a modestly increased risk of all-cause and CVD mortality. However, evidence on adults aged 65 y+ is limited. The objective of this study was to investigate the association between egg intake and mortality in community-dwelling older adults.

METHODS

In this prospective cohort study, 8756 adults aged 70+ years, participants in the ASPirin in Reducing Events in the Elderly (ASPREE) Longitudinal Study of Older Persons, self-reported the frequency of their total egg intake: never/infrequently (rarely/never, 1-2 times/month), weekly (1-6 times/week), and daily (daily/several times per day). All-cause and cause-specific (cardiovascular disease [CVD] and cancer) mortality was established from at least two sources: medical records, death notices, next of kin, or death registry linkage. The association between egg intake and mortality was assessed using Cox proportional hazards regression analysis, adjusted for socio-demographic, health-related, and clinical factors and overall dietary quality.

RESULTS

Over the median 5.9-year follow-up period, a total of 1034 all-cause deaths (11.8%) were documented. A 29% lower risk of CVD mortality (HR (95% CI): 0.71 [0.54-0.92]) and a 17% (HR (95% CI): 0.83 [0.71-0.96]) lower risk of all-cause mortality were observed among those who consumed eggs weekly, compared to those who consumed eggs never/infrequently; no statistically significant association was observed for weekly consumption and cancer mortality. In contrast, compared to those that never or infrequently consumed eggs, daily consumption had slightly higher odds of mortality, though these results did not reach statistical significance.

CONCLUSIONS

The consumption of eggs 1-6 times per week was associated with a lower risk of all-cause mortality and CVD mortality in community-dwelling adults aged 70 years and over. These findings may be important to inform the development of evidence-based guidelines for egg consumption.

Eggs: Healthy or Risky? A Review of Evidence from High Quality Studies on Hen's Eggs

Hen's eggs (from Gallus gallus domesticus) provide choline, folate, vitamin D, iodine, B vitamins and high-quality protein and are no longer viewed by national bodies as a risk factor for hypercholesterolaemia and cardiovascular disease (CVD). Yet, questions remain about the benefits and risks of eating eggs regularly. This review evaluates recent high-quality evidence from randomised controlled trials (RCT) and meta-analyses of observational studies and considers new areas of interest, such as weight management, protein metabolism, allergy risk and sustainability. In several RCT, eggs increased muscle protein synthesis and lowered fat mass, which could support optimal body composition. Eggs within a meal improved satiety, which could translate into lower energy intakes, although more RCT are needed. In observational studies, higher egg consumption was associated with a null effect or a modest reduced risk of CVD. For type 2 diabetes (T2D) incidence and risk of CVD in people with T2D, there were inconsistencies between observational and RCT data, with the former noting positive associations and the latter seeing no effect of higher egg intake on markers of T2D and CVD. Sustainability metrics suggest that eggs have the lowest planetary impact amongst animal proteins. To lower allergy risk, earlier introduction of eggs into weaning diets is warranted. In conclusion, the balance of evidence points to eggs being a nutritious food suggesting there are broad health benefits from including eggs in the diet at intakes higher than that currently consumed by European populations.

Comparing Lifestyle Modifications and the Magnitude of Their Associated Benefit on Cancer Mortality

Many cancers are associated with poor diet, lack of physical activity, and excess weight. Improving any of these three lifestyle factors would likely reduce cancer deaths. However, modifications to each of these-better nutrition, enhanced activity and fitness, and loss of extra body fat-have different effect sizes on cancer mortality. This review will highlight the relative benefit that each lifestyle change, enacted prior to a diagnosis of cancer, might impart on cancer-related deaths, as well as attempt to quantify the changes required to derive such a benefit. The review relies primarily on epidemiological data, with meta-analyses serving as the backbone for comparisons across interventions and individual studies within the larger meta-analyses providing the data necessary to form more quantitative conclusions. The reader can then use this information to better understand, recommend, and implement behaviors that might ultimately reduce cancer mortality. Of all the interventions, it seems clear that exercise, specifically improving cardiorespiratory fitness, is the best way to decrease the risk of dying from cancer.

The Global Association between Egg Intake and the Incidence and Mortality of Ischemic Heart Disease-An Ecological Study

The relationship between egg consumption and ischemic heart disease (IHD) remains controversial as there is still no clear answer regarding the relationship, with research limited to a few geographical regions. In the current study, we conducted a longitudinal analysis of the association between egg intake and IHD incidence (IHDi) and mortality (IHDd) using 28 years of international data from 1990 to 2018. Egg intake (g/day/capita) by country was obtained from the Global Dietary Database. Age-standard IHDi and IHDd rates per 100,000 subjects in each country were obtained from the 2019 Global Burden of Disease database. The analysis included a total of 142 countries with populations of at least one million, for which all data were available from 1990 to 2018. Eggs are consumed worldwide, and regional differences in consumption are also shown. Utilizing IHDi and IHDd as objective variables and egg intake as an explanatory variable, the analysis was conducted using linear mixed models, which controlled for inter- and intra-country variation from year to year. The results showed a significant negative association between egg intake, and IHDi (-0.253 ± 0.117, p < 0.05) and IHDd (-0.359 ± 0.137, p < 0.05). The analysis was carried out using R 4.0.5. The results suggest that adequate egg intake might suppress IHDi and IHDd on a global scale.

Frequency of Egg Intake Associated with Mortality in Chinese Adults: An 8-Year Nationwide Cohort Study

Whether egg consumption plays a beneficial/detrimental role in affecting human health and longevity has been debated for decades. Large-scale cohort evidence from low- and middle-income populations are scarce. In this study, we aimed to assess the association of egg consumption with mortality in Chinese adults. A nationwide cohort of 30,835 participants ages 16-110 years were enrolled from 25 provincial regions in China's mainland. Dietary intake (e.g., egg, meat, vegetable) was assessed by a food-frequency questionnaire. Cox proportional hazards models were used to examine associations between egg consumption and mortality, adjusting for demographic characteristics, dietary factors and health status. Dose-response relationships were investigated using the smoothing function of restricted cubic splines. Several subgroup analyses were performed. A total of 1651 all-cause deaths occurred during a median follow-up of 8.1 years. Egg consumption was associated with lower risks of mortality, with the lowest risk occurring in the group of moderate egg intake (3-6 times/week). Compared with non-consumers, the hazard ratios (95% confidence intervals) for mortality were 0.84 (0.72-0.97) for 3-6 times/week and 0.82 (0.69-0.98) for ≥7 times/week, whereas no significant associations were observed among the lower egg intake group (1-2/week). An approximately inverted J-shaped association was observed in three models, while restricting our analysis in the multivariable model (model 3) did not identify a significant violation for the linear relationship (p for nonlinear = 0.122). There were no statistically significant effect modifications in the subgroup analyses. Egg consumption may be associated with lower risks of mortality in Chinese adults. Our findings found moderate-to-high egg consumption might be beneficial for improving long-term health and longevity.