본 총설은 논란이 되고 있는 계란 콜레스테롤이 심장질환과 관련성이 없다는 것을 증명하기 위하여 지난 50여 년간의 연구 결과를 조사하였다. 그 결과, 식이로 섭취된 콜레스테롤은 혈액 콜레스테롤 농도에 큰 영향을 미치지 않는 것이 밝혀졌다. 더욱이 고콜레스테롤혈증이 있는 중년 남녀에게 1일 2개의 계란을 더 섭취한 실험에서도 혈액 콜레스테롤이 증가되지 않는 것으로 나타났다. 식이 콜레스테롤 섭취가 증가하면 LDL-콜레스테롤 뿐 아니라, HDL-콜레스테롤도 같이 증가하여 심장질환 위험의 중요 지표인 LDL : HDL 비율은 거의 변화가 없었다. 특히 노인에게서 더 좋은 지표로 밝혀진 HDL-콜레스테롤이 증가하므로, 콜레스테롤 섭취는 심장질환 예방에 좋은 것으로 나타났다. 따라서 계란의 섭취는 건강에 나쁘다고 알려진 인식은 사실이 아니며, 오히려 심장질환 예방에 효과적인 것으로 밝혀졌다. 또한, 계란 섭취량에 관한 공식적인 기준도 없는 것으로 나타났다. 따라서 이와 같은 증거들은 더 이상 계란에 대한 오해와 불신이 없기를 제안한다.
The objective of this literature review is to prove that egg cholesterol is not related with heart disease based upon research results of the past 50 years. As a result, it was reported that the dietary intake cholesterol did not affected cholesterol levels in blood. Moreover, it was reported that adding two eggs a day to a healthful diet did not significantly increase blood cholesterol levels in young or middle-aged men and women with normal or even moderately elevated blood cholesterol levels. Cholesterol feeding studies demonstrate that dietary cholesterol increases both LDL and HDL cholesterol with little change in the LDL : HDL ratio as an important risk indicator of heart disease. Especially a good indicator in the elderly from increased HDL-cholesterol, so cholesterol intake appeared to be good for the prevention of heart disease. Thus the consumption of eggs is bad for your health is not known as a fact, but rather was found to be effective in preventing heart disease. Also, all consumers may consume without worrying because there are no official standards regarding egg intake. Therefore, these evidences would clear up some misunderstanding and mistrust on egg cholesterol regarding the consumption of egg as well as give some desirable advice on how to maintain healthy life.
구미의 사망 원인을 보면 심장병, 특히 동맥 경화가 원인이 되어 나타나는 심근경색 등으로 사망자가 많은 것이 특징이다(National Vital Statistics Reports, 2010). 콜레스테롤 수치가 높아지면 심근경색 등의 위험률이 커지는 것은 의학적으로도 밝혀지고 있다. 한편, 일본에서는 암에 의한 사망자가 1위로, 심근경색과 뇌경색 사망자 수의 2배 이상에 달하고 있다.
계란의 크기는 작지만, 내용물은 우리 인체가 필요로 하는 각종 영양소를 고루 함유하고 있다. 주요 영양소로는 전란 기준으로 단백질(6 g), 지방(5 g)과 11종의 필수 비타민과 광물질이 있다(USDA, 2006). 계란은 가격까지 저렴하여 식탁에서 부담 없이 먹을 수 있는 식품이지만, 건강과 관련한 부정적인 소식이 매스컴을 통해 나올 때마다 많은 서러움을 받고 있는 식품이기도 하다.
American Heart Association 1973 Diet and Coronary Heart Disease. Dallas: American Heart Association.
Anitschkow NN, Chalatov S 1913 Ueber experimentelle choleserinsteatose und ihre bedeutung fur die entstehung einiger pathologischer Prozesse. Zentralbl Allg Pathol 24:1-9.
Anitschkow N 1913 Ueber die veranderungen der kaninchenaorta bei experimenteller cholesterinsteatose. Beitr Pathol Anat 56:379-404.
Appleby PN, Thorogood M, Mann JI, Key TJ 1999 The Oxford vegetarian study: an overview. Am J Clin Nutr 70: 525S-531S.
Ascherio A, Rimm EB, Giovannucci EL, Spiegelman D, Stampfer M, Willett WC 1996 Dietary fat and risk of coronary heart disease in men: cohort follow up study in the United States. Br Med J 313:84-90.
Ballesteros MN, Cabrera RM, Saucedo M, Del S, Fernandez ML 2004 Dietary cholesterol does not increase biomarkers for chronic disease in a pediatric population from northern Mexico. Am J Clin Nutr 80:855-861.
Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, Grundy SM, Kastelein JJP, Bittner V, Fruchart JC 2007 Treating to new targets investigators. HDL cholesterol, very low levels of LDL cholesterol and cardiovascular events. N Engl J Med 357:1301-1310.
Clarke R, Frost C, Collins R, Appleby P, Peto R 1997 Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies. Br Med J 314:112-117.
Clifton PM, Nestel PJ 1996 Effect of dietary cholesterol on postprandial lipoproteins in three phenotypic groups. Am J Clin Nutr 64:361-367.
Corti MC, Guralnik JM, Bilato C 1996 Coronary heart disease risk factors in older persons. Aging Clin Exp Res 8:75-89.
Dawber TR, Nickerson RJ, Brand FN, Pool J 1982 Eggs, serum cholesterol and coronary heart disease. J Am J Clin Nutr 36:617-625.
Detopoulou P, Panagiotakos DB, Antonopoulou S, Pitsavos C, Stefanadis C 2008 Dietary choline and betaine intakes in relation to concentrations of inflammatory markers in healthy adults: the ATTICA study. Am J Clin Nutr 87: 424-430.
Eckhardt ER, Wang DQ, Donovan JM, Carey MC 2002 Dietary sphingomyelin suppresses intestinal cholesterol absorption by decreasing thermodynamic activity of cholesterol monomers. Gastroen 122:948-956.
Esrey KL, Joseph L, Grover SA 1996 Relationship between dietary intake and coronary heart disease mortality: lipid research clinics prevalence follow-up study. J Clin Epidemiol 49:211-216.
Fernandez ML, Webb D 2008 The LDL to HDL cholesterol ratio as a valuable tool to evaluate coronary heart disease risk. J Am Coll Nutr 27:1-5.
Fraser GE 1999 Associations between diet and cancer, ischemic heart disease and all-cause mortality in non-Hispanic white California Seventh-day Adventists. Am J Clin Nutr 70:532S-538S.
Fraser GE, Sabate J, Beeson WL, Strahan TM 1992 A possible protective effect of nut consumption on risk of coronary heart disease. The Adventist Health Study. Arch Intern Med 152:1416-1424.
Ginsberg HN, Karmally W, Siddiqui M, Holleran S, Tall AR, Blaner WS, Ramakrishnan R 1995 Increases in dietary cholesterol are associated with modest increases in both LDL and HDL cholesterol in healthy young women. Arterioscl Throm Vas 15:169-178.
Ginsberg HN, Karmally W, Siddiqui M, Holleran S, Tall AR, Rumsey SC, Deckelbaum RJ, Blaner WS, Ramakrishnan R 1994 A dose-response study of the effects of dietary cholesterol on fasting and postprandial lipid and lipoprotein metabolism in healthy young men. Arterioscler Thromb 14:576-586.
Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR 1977 High density lipoprotein as a protective factor against coronary heart diseases: The Framingham study. Am J Med 62:707-714.
Gramenzi A, Gentile A, Fasoli M, Negri E, Parazzini F, Vecchia CL 1990 Association between certain foods and risk of acute myocardial infarction in women. Br Med J 300: 771-773.
Greene CM, Zern TL, Wood RJ, Shrestha S, Aggarwal D, Sharman MJ, Volek JS, Fernandez ML 2005 Maintenance of the LDL cholesterol: HDL cholesterol ratio in an elderly population given a dietary cholesterol challenge. J Nutr 135:2793-2798.
Gylling H, Kontula K, Koivisto UM, Miettinen HE, Miettinen TA 1997 Polymorphisms of the genes encoding apoproteins A-I, B, C-III, and E and LDL receptor and cholesterol and LDL metabolism during increased cholesterol intake. Common alleles of the apoprotein E gene show the greatest regulatory impact. Arterioscler Thromb Vasc Biol 17:38-44.
Herron KL, Lofgren IE, Sharman M, Volek JS, Fernandez ML 2004 High intake of cholesterol results in less atherogenic low-density lipoprotein particles in men and women independent of response classification. Metabolism 53:823-830.
Howell WH, McNamara DJ, Tosca MA, Smith BT, Gaines JA 1997 Plasma lipid and lipoprotein responses to dietary fat and cholesterol: a meta-analysis. Am J Clin Nutr 65: 1747-1764.
Hu FB, Stampfer MJ, Rimm EB, Manson JE, Ascherio A, Colditz GA, Rosner BA, Spiegelman D, Speizer FE, Sacks FM, Hennekens CH, Willett WC 1999 A prospective study of egg consumption and risk of cardiovascular disease in men and women. J Am Med Assoc 281:1387-1394.
Hu FB, Willett WC 2002 Optimal diets for prevention of coronary heart disease. J Am Med Assoc 288:2569-2578.
Inter-Society Commission for Heart Disease Resources 1970 Prevention of cardiovascular disease. Primary prevention of the atherosclerotic diseases. Circulation 42:A55-A95.
Jang A, Kim DW, Park JE, Choe JH, Kang GH, Han JS, Oh MH, Seol KH, Lee SG, Kim DH, Kim HW, Hwang KA, Hwang YJ, Kim HK 2011 Effect of hen egg supplementation on blood lipid profile and fecal bile acid of C57BL/6 mouse fed normal and high cholesterol diet. Korean J Food Sci An 31:250-256.
Jones PJ, Pappu AS, Hatcher L, Li ZC, Illingworth DR, Connor WE 1996 Dietary cholesterol feeding suppresses human cholesterol synthesis measured by deuterium incorporation and urinary mevalonic acid levels. Arterioscler Thromb Vasc Biol 16:1222-1228.
Katz DL, Evans MA, Nawaz H, Njike VY, Chan W, Comerford BP, Hoxley ML 2005 Egg consumption and endothelial function: a randomized controlled crossover trial. Int J Cardiol 99:65-70.
Kim SC, Lee MS, Choi JD, Kim KM 1979 Effect of egg intake on serum to Korea. Kor J Int Med 22:578-583.
Knekt P, Reunanen A, Jarvinen R, Seppanen R, Heliovaara M, Aromaa A 1994 Antioxidant vitamin intake and coronary mortality in a longitudinal population study. Am J Epidemiol 139:1180-1189
Knopp RH, Retzlaff BM, Walden CE, Dowdy AA, Tsunehara CH, Austin MA, Nguyen T 1997 A double-blind, randomized, controlled trial of the effects of two eggs per day in moderately hypercholesterolemic and combined hyperlipidemic subjects taught the NCEP step I diet. J Am Coll Nutr 16:551-561.
Kritchevsky SB, Kritchevsky D 2000 Egg consumption and coronary heart disease: an epidemiologic overview. J Am Coll Nutr 19:549S-555S.
Kromhout D, Coulander CL 1984 Diet, prevalence and 10-year mortality from coronary heart disease in 871 middle-aged men. The Zutphen Study. Am J Epidemiol 119:733-741.
Krumholz HM, Seeman TE, Merrill SS, Mendes de Leon CF, Vaccarino V, Silverman DI, Tsukahara R, Ostfeld AM, Berkman LF 1994 Lack of association between cholesterol and coronary heart disease mortality and morbidity and allcause mortality in persons older than 70 years. J Am Med Assoc 272:1335-1340.
Kronmal RA, Cain KC, Ye Z, Omenn GS 1993 Total serum cholesterol levels and mortality risk as a function of age. A report based on the Framingham data. Arch Intern Med 153:1065-1073.
Kushi LH, Lew RA, Stare FJ, Ellison CR, Lozy M, Bourke G, Daly L, Graham I, Hickey N, Mulcahy R, Kevaney J 1985 Diet and 20-year mortality from coronary heart disease. The Ireland-Boston Diet-Heart Study. New Engl J Med 312:811-818.
Lee A, Griffin B 2006 Dietary cholesterol, eggs and coronary heart disease risk in perspective. Nutr Bull 31:21-27.
Lehtimaki T, Moilanen T, Solakivi T, Laippala P, Ehnholm C 1992 Cholesterol-rich diet induced changes in plasma lipids in relation to apolipoprotein E phenotype in healthy students. Ann Med 24:61-66.
Mann JI, Appleby PN, Key TJA, Thorogood M 1997 Dietary determinants of ischaemic heart disease in health-conscious individuals. Heart 78:450-455.
Mayurasakorn K, Srisura W, Sitphahul P, Hongto PO 2008 High-density lipoprotein cholesterol changes after continuous egg consumption in healthy adults. J Med Assoc Thai 91:400-407.
McCombs RJ, Marcadis DE, Ellis J, Weinberg RB 1994 Attenuated hypercholesterolemic response to a high-cholesterol diet in subjects heterozygous for the apolipoprotein A-IV-2 allele. N Engl J Med 331:706-710.
McNamara DJ 1987 Effects of fat-modified diets on cholesterol and lipoprotein metabolism. Annu Rev Nutr 7:273-290.
McNamara DJ 2000 The impact of egg limitations on coronary heart disease risk: do the numbers add up? J Am Coll Nutr 19:540S-548S.
Mutungi G, Ratliff J, Puglisi M, Torres-Gonzalez M, Vaishnav U, Leite JO, Quann E, Volek JS, Fernandez ML 2008 Dietary cholesterol from eggs increases plasma HDL cholesterol in overweight men consuming a carbohydrate-restricted diet. J Nutr 138: 272-276.
Nagaoka S, Masaoka M, Zhang Q, Hasegawa M, Watanabe K 2002 Egg ovomucin attenuates hypercholesterolemia in rats and inhibits cholesterol absorption in Caco-2 cells. Lipids 37:267-272.
Nakamura Y, Okamura T, Tamaki S, Kadowaki T, Hayakawa T, Kita Y, Okayama A, Ueshima H 2004 NIPPON DATA- 80 Research Group. Egg consumption, serum cholesterol, and cause-specific and all-cause mortality: the national integrated project for prospective observation of non-communicable disease and its trends in the aged, 1980 (NIPPON DATA80). Am J Clin Nutr 80:58-63.
Nakamura Y, Iso H, Kita Y, Ueshima H, Okada K, Konishi M, Inoue M, Tsugane S 2006 Egg consumption, serum total cholesterol concentrations and coronary heart disease incidence: Japan Public Health Center-based Prospective Study. Br J Nutr 96:921-928.
National Vital Statistics Reports 2010 Deaths: final data for 2007. Nat Vital Stat Rep 58:1-136.
Okayama A, Ueshima H, Marmot MG, Nakamura M, Kita Y, Yamakawa M 1993 Changes in total serum cholesterol and other risk factors for cardiovascular disease in Japan 1980-1989. Int J Epidemiol 22:1038-1047.
Posner BM, Cobb JL, Belanger AJ, Cupples LA, D'Agostino RB, Stokes J 1991 Dietary lipid predictors of coronary heart disease in men. The Framingham Study. Arch Intern Med 151:1181-1187.
Qureshi AI, Suri FK, Ahmed S, Nasar A, Divani AA, Kirmani JF 2007 Regular egg consumption does not increase the risk of stroke and cardiovascular diseases. Med Sci Monit 13:CR1-8.
Reaven GM, Abbasi F, Bernhart S, Coulston A, Darnell B, Dashti N, Kim H, Kulkarni K, Lamendola C, McLaughlin T, Osterlund L, Schaff P, Segrest J 2001 Insulin resistance, dietary cholesterol and cholesterol concentration in postmenopausal women. Metabolism 50:594-597.
Rodrigueza WV, Klimuk SK, Pritchard PH, Hope MJ 1998 Cholesterol mobilization and regression of atheroma in cholesterol-fed rabbits induced by large unilamellar vesicles. Biochim Biophys Acta 368:306-320.
Sarkkinen E, Korhonen M, Erkkila A, Ebeling T, Uusitupa M 1998 Effect of apolipoprotein E polymorphism on serum lipid response to the separate modification of dietary fat and dietary cholesterol. Am J Clin Nutr 68:1215-1222.
Sasazuki S 2001 Case-control study of nonfatal myocardial infarction in relation to selected foods in Japanese men and women. Jpn Circ J 65:200-206.
Sauvaget C, Nagano J, Allen N, Grant EJ, Beral V 2003 Intake of animal products and stroke mortality in the Hiro shima/Nagasaki Life Span Study. Int J Epidemiol 32:536-543.
Shekelle RB, Shryock AM, Paul O, Lepper M, Stamler J, Liu S, Raynor WJ 1981 Diet, serum cholesterol and death from coronary heart disease. The Western Electric study. New Engl J Med 304:65-70.
Stamler J, Shekelle R 1988 Dietary cholesterol and human coronary heart disease: the epidemiologic evidence. Arch Pathol Lab Med 112:1032-1040.
The Statistics Korea 2010 Statistics of death cause of Korea in 2009. Statistics Korea. p. 7.
Uemura K, Pisa Z 1988 Trends in cardiovascular disease mortality in industrialized countries since 1950. World Health Stat Q 41:155-178.
USDA 2006 National Nutrient Database for standard reference, Release 19.
Vorster HH, Beynen AC, Berger GM, Venter CS 1995 Dietary cholesterol-the role of eggs in the prudent diet. S Afr Med J 85:253-156.
Vuoristo M, Miettinen TA 1994 Absorption, metabolism and serum concentrations of cholesterol in vegetarians: Effects of cholesterol feeding. Am J Clin Nutr 59:1325-1331.
Weggemans RM, Zock PL, Katan MB 2001 Dietary cholesterol from eggs increases the ratio of total cholesterol to high-density lipoprotein cholesterol in humans: a metaanalysis. Am J Clin Nutr 73:885-891.
Willett W 1998 Nutritional Epidemiology, 2nd ed. New York: Oxford University Press, pp. 414-466.
Windaus A 1910 Uber den Gehalt nirmaler und atheromatoser aroten an cholsterin und cholesterinestern. Hoppe-Seyler Z Physiol Chemie 67:174-176.
Yang SU, Hong S, Sung MK, Kang MH, Kim MK 2007 Effect of lecithin intake on lipid metabolism and antioxidative capacity in rats fed high fat diet. Kor J Nutr 40: 312-319.
Yu EJ, Lim HS 1988 Effect of egg yolk supplementation to Korean diet on human serum cholesterol. Kor J Nutr 21: 260-267.