Q How many children are affected by egg allergy?
Recent Australian data indicates that the prevalence of raw egg allergy in 12 month old infants is approximately 8.9%1. Of these, 80.3% of infants have been found to tolerate baked egg. It is also important to note that the majority of children grow out of egg allergy eventually with egg tolerance often developing between the ages of 2 and 4 years.
Q What are the symptoms of egg allergy?
In those with egg allergy, Immediate reactions to egg ingestion are characterised by urticaria, angioedema, vomiting, diarrhoea and wheeze. Symptoms usually occur within 30 minutes or less of egg contact but may be delayed for 1-2 hours in a minority of cases. Severe life-threatening events and fatal anaphylaxis to egg in children are less common than to peanut and milk.
Q Are most children allergic to the egg-white or the yolk?
Egg white is considered to be the most frequent source of allergens and most children with an allergy react to the proteins in the egg whites, though in some rare occassions reactions to egg yolk have been reported.
Q Should patients avoid allergens during pregnancy and breastfeeding?
The Australian Society of Clinical Immunology and Allergy (ASCIA) does not recommend restricting the mother's diet during pregnancy in order to eliminate allergenic foods as research does not support this as a strategy for reducing the development of allergenic diseases. Eggs can therefore be included in the diet of pregnant women as long as they are tolerated by the mother. Avoidance, by breastfeeding women, of cow's milk, egg and fish does not protect against infant food allergy.
Q When should eggs be introduced to an infant's diet?
In Australia, dietary guidelines recommend the introduction of solid foods at the age of approximately 6 months, beginning with the introduction of iron-enriched infant cereals. Vegetables, fruits, meats, poultry and fish are to be added gradually. Egg yolks are suggested as an example of a food that infants of age 8-12 months can consume. There are no specific recommendations for the introduction of egg whites to the diet however it is generally recommended from 9-12 months of age.
Q What is the ENC's postion in regards to eggs and the risk of Cardio Vascular Disease?
Scientific evidence shows little association between egg intake and risk of CVD. The ENC therefore concludes the following:
- In a healthy western population, there is insufficient evidence to excessively restrict egg intake as part of a healthy diet. Eggs should be considered in a similar way as other protein rich foods and selected as part of a varied diet that is low in saturated fat and contains a variety of cardio-protective foods such as fish, wholegrains, fruit, vegetables, legumes and nuts.
- Research supports the inclusion of six eggs per week as part of a healthy diet which is in line with the National Heart Foundation of Australia’s recommendations.
- In individuals at high risk, such as people with diabetes and those with hyperlipidaemia, there is little data to guide recommendations for egg consumption. However, prudent advice is that the inclusion of eggs in the context of a diet low in saturated fat and containing known cardio-protective foods is not associated with increased risk.
Q Should eggs be included in a child's diet?
Eggs are an ideal food for inclusion in children’s diets as they are nutritious and provide useful amounts of folate, vitamin A, iron, zinc, iodine and omega-3s in particular. Eggs are also a good source of protein for children to support growth and the immune system during this vital time of development.
Q Does dietary cholesterol impact on serum cholesterol?
Dietary cholesterol causes a small increase in total cholesterol and LDL cholesterol, but substantially less than saturated fat and trans fat. This increase is seen predominantly in approximately 25% of the population who have been dubbed ‘hyper-responders’. It is important to note however, that dietary cholesterol has been shown to increase HDL cholesterol which maintains the LDL:HDL ratio, is a key predictor of heart disease risk. Dietary cholesterol ingestion has also been shown to increase the size of both LDL and HDL particles making LDL cholesterol less likely to build up in arteries and cause heart disease and making HDL particles more effective at removing cholesterol from the arteries.
Q Can hyper-responders eat eggs?
Hyper-responders can still enjoy up to 6 eggs per week as part of a diet low in saturated fat without increasing their risk of heart disease8. While there is limited specific evidence regarding egg intake and hyper-responders to dietary cholesterol, since the LDL:HDL cholesterol ratio is maintained in this group of individuals9 there is no reason to restrict intake . Eggs provide a range of essential nutrients and antioxidants important for health and wellbeing, therefore unnecessary restriction of egg intake should be avoided.
Q What should I tell my patients that are at risk of high cholesterol in regards to egg consumption?
All Australians, (including those at risk of high cholesterol) may consume up to 6 eggs per week within a cardioprotective eating pattern (reduced saturated fat) without increasing their risk of heart disease. Dietary cholesterol intake has a small impact on cholesterol levels but this increase includes raising HDL (good) cholesterol levels which means overall heart disease risk does not increase. Patients at risk of high cholesterol levels are advised to prioritise a reduction in saturated fat intake and replacing saturated fat with unsaturated fats, rather than being overly concerned about dietary cholesterol intake.
Q How many people in Australia have diabetes?
Approximately one million Australians have been diagnosed with diabetes, including an estimated 130,000 people with type 1 diabetes. It is estimated a further 500,000 Australians have diabetes but are currently undiagnosed.
Q Can people with diabetes consume eggs?
Yes. The National Heart Foundation supports the consumption of up to six eggs per week for all Australians while acknowledging there is some evidence suggesting consumption of more than six eggs per weeks may increase heart disease risk in people with type two diabetes. However this evidence is weak and further research is required to confirm the effect of eggs on the risk of heart disease in people with type 2 diabetes.
Q What is nutrient density?
Nutrient dense foods have been defined as foods with a high proportion of vitamins and minerals for the amount of energy (kilojoules) they provide. Therefore foods that are relatively low in kilojoules but high in vitamins and minerals are classified as 'nutrient dense'.
Q Why are eggs nutrient dense?
A serve of eggs provides the same amount of kilojoules as two small apples (7% of a person’s daily energy needs) however provides significantly more than 7% of the recommended dietary intake (RDI) for at least 11 different vitamins and minerals. Eggs provide 59% of the RDI for selenium, 49% RDI for folate, 42% RDI for pantothenic acid, 40% RDI for vitamin B12, 32% RDI for vitamin A, 29% RDI for iodine and riboflavin, 24% RDI for vitamin E and 21% RDI for phosphorus. Other nutrients for which eggs contribute more than 10% of the RDI include iron (14%) and thiamin (11%). Eggs are also rich in long-chain omega-3 fatty acids, providing 71% of the adequate intake (AI) for men and 127% AI for women.
Q Who should eat nutrient dense foods?
For general good health, most people will benefit from eating nutrient dense foods. However, the following groups may particularly benefit:
- Those on weight loss diets: People on weight loss diets often cut out or reduce their intake of foods from the core food groups as a strategy to lower their kilojoule intake. By choosing nutrient dense foods, people on weight loss diets can improve their nutrition status and eat less food but still meet their nutrient needs.
- Pregnant Women: Significant increases in vitamin and mineral needs, with only minor increases in kilojoule requirements during pregnancy, can be met by increasing the intake of nutrient rich foods.
- Children: Children have a small stomach capacity and fussy eaters in particular may benefit from nutrient dense foods. Toddlers and preschoolers need to be encouraged to try a wide a range of nutrient dense foods to assist them meet their needs.
- Teenagers: Nutritional requirements during adolescence are high to fuel rapid growth and development, however adolescents often have irregular eating patterns, with a tendency to skip breakfast, graze constantly, have a high intake of snacks, confectionery and soft drinks, experiment with different diets, and make poor food choices. Due to the wide range of nutrients found in eggs, they are a particularly useful inclusion in the diet of teenagers who may be following special diets.
- Elderly: Elderly people often have higher nutrient requirements, coupled with lower energy needs, therefore it is particularly important they have a high quality, nutrient rich diet. Low nutrient intakes have been reported in older Australians, which researchers attribute to diets of low nutrient density along with an insufficient quantity of food eaten.
Q What are antioxidants?
The term antioxidants covers a large number of substances (including some vitamins and minerals) which protect the body’s cells from the harmful effects of oxidation.
Q What type of vitamins, minerals and antioxidants are in eggs and how does this impact on eye health?
Eggs contain a range of vitamins and minerals including vitamin A, vitamin E and selenium which all act as antioxidants. Antioxidants help protect the retina of the eye from progressive oxidative damage that occurs with ageing. Eggs also contain the carotenoids, lutein and zeaxanthin which are the two primary carotenoids found in the macular region of the retina as well as the amino acids tyrosine and tryptophan –which also act as antioxidants. In relation to eye health, the main evidence of benefit from egg nutrients is in relation to lutein and zeaxanthin, as well as long chain omega-3 fatty acids.
Q Does overall lifestyle and diet have an impact on eye health?
Yes. One example in which this is evidenced is that uncontrolled diabetes can lead to eye disease. While specific evidence linking diet to eye health is relatively limited, it is known that the lens and retina of the eye suffer from oxidative damage with age and the antioxidant vitamins vitamin A, C and E have been implicated as being protective. Furthermore a body of evidence links diet, including intakes of lutein and zeaxanthin with incidence of age-related macular degeneration (the leading cause of vision loss and blindness) and it is also known that omega 3 DHA accumulates in the retina, playing a role in maintaining eye health.
Q My patient has diabetes/ high cholesterol, can I still suggest eggs as a good source of antioxidants for eye health?
Eggs contain the antioxidants lutein and zeaxanthin which have been linked with maintenance of eye health. Eye health is of particular importance for patients with diabetes as they are at increased risk of eye disease if their diabetes is not well controlled. As per the National Heart Foundation’s recommendations, all Australians can enjoy up to six eggs per week which will provide a range of nutrients including lutein and zeaxanthin for eye health.
Q Can eggs aid in weight management or weight loss eating plans?
Few studies have looked specifically at the effect of eggs on weight loss however new evidence supports the inclusion of eggs in an energy restricted diet with one study suggesting eggs may even enhance weight loss. A study involving 152 overweight and obese adults found that those consuming two eggs for breakfast on at least 5 days of the week lost 65% more weight and 34% more from their waist circumference than those eating a bagel breakfast . Similarly another study found that weight loss was achievable when two eggs were included in the daily menus of those following an energy-restricted diet with no adverse effects on blood cholesterol. Men eating 3 eggs per day as part of a carbohydrate-restricted weight loss diet have also been shown to experience similar changes in weight, waist circumference and LDL cholesterol to a group not eating eggs. In this particular study however the egg group had a more favourable effect on HDL cholesterol and inflammatory markers, two risk factors for heart disease.
Eggs may assist with weight loss by improving satiety. This has been shown in two studies where eggs were either provided for breakfast or lunch and resulted in less variation in plasma glucose and insulin, a suppressed ghrelin response, and reduced energy intake as well as increased feelings of fullness when compared to either a bagel breakfast or a jacket potato.
Q Does a high protein/ lower carb diet have a positive impact on body weight and BMI?
A growing body of evidence has demonstrated moderately higher protein, lower carbohydrate kilojoule controlled diets can provide an effective weight loss strategy. These diets may be particularly useful for individuals who have trouble with compliance on low fat, high carbohydrate diets due to hunger, or individuals with insulin resistance or diabetes. Studies have also found that the style of eating recommended in a moderate protein, moderate carbohydrate eating plan, is easy to maintain, satisfying, and meets the needs of dieters.
Following a moderate protein, moderate carbohydrate diet relies on the inclusion of regular serves of a wide range of high quality protein rich foods. Low saturated fat meals incorporating eggs provide such protein and contribute to the variety of foods that are encouraged in this type of eating plan.
Q How many adults are overweight or obese in Australia?
Initial results from the 2011-2013 Australian Health Survey, the largest and most comprehensive health survey ever conducted in Australia, show Australian adults continue to gain weight, and increase their girth. The initial findings, released by the Australian Bureau of Statistics in October 2012, show men gained an average of 3.9kg and women 4.1kg between 1995 and 2011/2012. Prevalence of overweight and obesity increased to 63.4% in 2011-12, up from 61.2% in 2007-08 and 56.3% in 1995.
Q Are there many overweight or obese children in Australia?
The latest research shows 17% of Australian children aged 2-16 years are considered overweight and 6% obese. The 2010 NSW School Physical Activity and Nutrition Survey (SPANS) showed the prevalence of overweight in NSW children may be as high as 27.4% for some age groups. However according the initial results from the 2011-2013 Australian Health Survey, prevalence of overweight and obesity in children aged 5-17 years has remained stable between 2007-08 and 2001-12.
Q What are the most common nutritional issues in older adults?
The National Nutrition Survey shows those aged 65 years and over eat less than the recommended minimum number of serves from each of the core food groups, and have lower than ideal intakes of many vitamins and minerals. Self-reported consumption data of fruit and vegetables from the most recent National Health Survey showed that only 10% of adults in this age group consume the recommended five serves of vegetables and 2 serves of fruit each day. This, combined with the fact that many older adults have increased nutrient requirements and decreased food intake means nutrients that are commonly low in the diet of older Australians include fibre, calcium, vitamins A, E, B6, B12, folate, vitamin C, iron, magnesium and zinc .
Achieving optimal intakes of protein can also be a nutrition issue for older Australians. The protein RDI for adults aged 70 years and over (81 grams of protein per day for older men and 57 grams for older women) is around 25% higher than the protein needs of younger adults due to increased protein requirements with age. Inadequate protein intakes contribute to increased skin fragility, decreased immune function, poor wound healing and longer recovery times, highlighting the importance of maintaining adequate protein intake in older adults.
Q How can eggs contribute to a healthy diet for older adults?
Eggs are a good source of protein for older adults, providing 16-22% RDI for people aged 70+ years which helps maintain muscle and bone strength with ageing. They also contain the antioxidants lutein and zeaxanthin which have been associated with a reduced risk of age-related macular degeneration. Due to the variety of nutrients found in eggs, they are an ideal food to include the diets of older adults. They are also economical, easily prepared and soft in texture which makes them appropriate for people of this age group. Eggs are recommended as part of a healthy eating pattern that also includes adequate amounts of wholegrain breads and cereals, fruits, vegetables, low fat dairy foods, lean meat, fish and poultry and unsaturated fats.
Q Should I worry about cholesterol or diabetes risk in my older patients?
Eggs are a nutritious food that can be included in a healthy, well-balanced diet for all people. While some older adults may unnecessarily be avoiding eggs because of their perceived fat and cholesterol content, research shows that egg consumption has little association with plasma cholesterol levels and heart disease risk. For further details, refer to ENC’s Eggs and Obesity, Risk of Cardiovascular Disease, Plasma Cholesterol and Lipoproteins and Diabetes statements
Q Why are omega-3s so important?
The health effects of omega 3s have been relatively well established with evidence linking them with protection from heart disease, some inflammatory conditions and certain autoimmune disorders including rheumatoid arthritis. Omega 3s are important for infant growth and development and long chain DHA (a type of omega 3) is heavily concentrated in the brain and retina of the eye.
Q What types of omega-3s do egg contain?
Eggs provide both long chain and short chain omega-3 fatty acids. They contain an average of 180mg total omega-3 per serve representing 12% of the omega-3 adequate intake (AI) recommendation for men and 20% for women. Of this, 114mg is long chain omega-3 fatty acids (mainly DHA), representing 71-127% of the long chain omega-3 AI. The rest of the omega 3 in eggs is mainly the shorter chain alpha-linolenic acid (ALA). Eggs are therefore a particularly useful source of long chain omega-3 fatty acids for ovo-vegetarians and others who do not eat fish regularly.
Q Do most Australians meet the recommendations for omega-3s intake?
Research indicates that many Australians are meeting the Adequate Intake (AI) recommendations for levels of omega-3 fatty acids however are failing to meet the optimal intake for disease prevention. Data from the Blue Mountains Eye Study shows a mean long chain omega-3 intake of 260mg in Australians aged 55 years and over which is higher than the population mean intake, however still lower than the optimal intake for disease prevention. Younger Australians are also failing to meet dietary targets with just 6% of children aged 5-16 years meeting the suggested dietary target for long chain omega 3 fatty acids per day. Eggs can therefore play a useful role in the diet to assist in boosting omega-3 intakes.
Q Is it safe to recommend eggs during pregnancy?
Eggs are a nutrient dense food meaning they can play an important role in contributing to nutrient intakes during pregnancy. There are some recommendations, however, when it comes to consuming eggs safely at this time. Eggs should be cooked thoroughly and avoid using cracked or dirty eggs. It is also important to avoid any products containing raw eggs such as home-made mayonnaise, chocolate mousse or aioli.
Q What type of vitamins and minerals do eggs provide during pregnancy?
During pregnancy, a woman’s nutritional requirements for key nutrients such as energy, protein, omega 3 fatty acids and most vitamins and minerals increase. Eggs are a nutrient dense food meaning they can help pregnant women meet their increased nutrient requirements for the following nutrients in particular: protein, iron, zinc, vitamin A, folate, vitamin B12, vitamin D, iodine, choline and omega-3 fatty acids. Of particular note, eggs are one of the few food sources of choline and provide more choline per kilojoule than most foods. Choline is of particular importance in the diet of pregnant women as it is required for the normal development of brain tissue in infants and plays an important role in maternal nerve and brain functioning.
Q Can patients with gestational diabetes still eat eggs?
Patients with gestational diabetes can still eat eggs and it is recommended they follow the guidelines for all Australians to consume up to 6 eggs per week in the context of a diet low in saturated fat8. It is relevant to be aware that an analysis of 2 studies has suggested that higher intakes (more than 7 eggs per week) increases the risk of gestational diabetes although this evidence is relatively weak and further research is required to confirm the role of eggs in the diet of women with gestational diabetes.
Q What is the RDI for protein?
The RDI for protein varies depending on age and gender. Below is an indication of the recommended protein intake for various age groups:
- Children 1 to 3 years: 14 grams
- Children 4 to 8 years: 20 gramds
- Boys 9 to 13 years: 40 grams
- Girls 9 to 13 years: 35 grams
- Boys 14 - 18 Years: 65 grams
- Girls 14 to 18 years: 45 grams
- Men 19 to 70 years: 64 grams
- Women 19 to 70 years: 46 grams
- Men 70+ years: 81 grams
- Women 70+ years: 57 grams
Q Vegetarian patients - should I recommended them to eat eggs?
Due to the smaller variety of protein containing foods eaten by ovo-vegetarians, these people may have a limited intake of essential amino acids if they do not follow a balanced eating pattern. Additionally, the protein digestibility and lower biological protein value of many plant proteins may result in deficient dietary intakes of essential amino acids in ovo-vegetarian diets. The total protein content of a vegetarian diet is significantly lower than an omnivore diet. Due to their high protein quality and high digestibility, eggs may therefore be particularly useful in the diets of ovo-vegetarians.
Q Do most teenagers meet their RDIs?
Sufficient energy and nutrient intakes are essential for children and teenagers to achieve normal growth and development7. Adolescents have higher requirements for calcium than adults and need additional kilojoules to support the adolescent growth spurt, however research has shown that many teenagers have micronutrient intakes below the estimated average requirement (EAR). Key nutrients of concern in adolescents’ diets are calcium, magnesium, vitamin A, folate, iodine, zinc (males only), and iron and phosphorus (females in particular). Intakes of vitamins D and E were also below the recommended levels.
Q Do most teenagers eat breakfast? And could eggs play a role there?
Research from the 2010 NSW SPANS study indicates that between 30-40% of secondary school students skip breakfast38. This is a concern as research shows breakfast eaters are more able to control their weight, have better nutrient intakes, have better concentration levels and are better able to perform mental tasks throughout the morning. Eggs have been shown to have a greater satiety index than ready-to-eat breakfast cereals or white bread, and when eaten for breakfast, eggs can reduce the amount of energy (kilojoules) consumed at lunch by 29%. Research has also shown that eating a variety of foods at breakfast is associated with better mental performance in adolescence61. As eggs provide a wide range of different nutrients including protein and at least 11 different vitamins and minerals, they can make a significant contribution to teenagers’ diets.
Q Could eggs assist in combating overweight/obesity issues in the teenage population of Australia?
The level of overweight and obesity in Australian adolescents remains high, due to declining levels of physical activity, more screen time and the need for dietary change62. Current figures suggest just under 1 in 4 adolescents are overweight or obese with 18% falling into the overweight category and 5% being obese. Eggs are a highly nutritious food and are relatively low in kilojoules, with one serve* providing 581 kilojoules. As eggs are rich in protein, they may also increase satiety therefore contributing to a greater ability to manage total food intake over the day. For further details on eggs and obesity, refer to ENC’s Eggs and Obesity statement
Q Do eggs have a positive impact on skin health or the occurence of acne?
Some evidence suggests higher protein, low glycaemic load diets can improve symptoms of acne that is common in teenagers. As a protein-rich food, eggs lower the glycaemic load of the diet and could therefore play a role in the treatment and prevention of acne although this requires confirmation with additional research.
Q How many eggs can I tell my patients to eat?
How many eggs is it safe to consume for:
- People with high cholesterol: Individuals with high cholesterol may consume up to six eggs per week as part of a low saturated fat diet. Saturated fat intake has a significantly greater impact on cholesterol levels compared to dietary cholesterol intake.
- People with diabetes: Individuals with diabetes may consume up to six eggs per week, as part of a low saturated fat diet. There is some evidence that consumption of higher amounts of eggs may increase the risk of heart disease in this population group however further research is required in this area before specific recommendations can be made.
- People at risk of CVD: Individuals at risk of CVD, can consume up to six eggs per week in the context of a diet low in saturated fat, without adversely affecting outcomes. While there has been calls from some researchers for this group to limit egg intake, the current best available evidence does not suggest this is necessary.
- People with metabolic syndrome: Individuals with metabolic syndrome can follow the same guidelines as the rest of population and consume up to six eggs per week8. There is some recent research in this group of individuals suggesting higher intakes of eggs helps improve carotenoid status through increasing HDL cholesterol as well as lipid levels and insulin sensitivity.
- Pregnant women: Pregnant women can enjoy up to six eggs per week to help contribute protein and valuable micronutrients to the diet.
- Children: Since most studies assessing the role of eggs in health are conducted in adults, it is difficult to quantify a particular level of egg intake for children. It is recommended that children follow the healthy eating recommendations set out in the Australian Dietary Guidelines, which recommend including eggs as part of the lean meat, fish, poultry and alternatives group. The Australian Guide to Healthy Eating recommends children aged 4-7years consume ½-1 serve from this food group each day and children aged 8-11 years consume 1-1 ½ serves. A serve of eggs is defined as 2 small eggs.
Q Why should I encourage my patients to include eggs in a healthy diet?
Eggs are a nutrient rich food being a natural source of at least 11 different vitamins and minerals as well as high quality protein, omega-3s and antioxidants. Due to the variety of nutrients found in eggs, they can make a significant contribution to increasing population daily nutrient intakes. Research supports this assertion with a US study showing egg consumers have higher intakes of vitamins A, E, B12 and folate compared to non-egg consumers.
Q What are the nutrients in eggs?
Eggs provide protein, fat (two thirds of which is unsaturated fat), omega-3s, potassium, sodium, magnesium, phosphorus, iron, selenium, zinc, iodine, thiamine, riboflavin, vitamin B5, B6, B12, folate and vitamins A, D and E.
Q I heard eggs are high in fat, but they do contain a lot of good nutrients, what is more important?
One egg contains around 5grams of fat (1 tsp) and of this, 2.6g is monounsaturated and 0.8g is polyunsaturated. The high level of nutrients in eggs means eating eggs will contribute positively to meeting daily nutritional needs.
Q Are there particular groups in the Australian population that may particularly benefit from including eggs in their diet?
There are some groups in the population who may particularly benefit from the inclusion of eggs in their diet. These include the following:
- Ovo-vegetarians – one serve of eggs contains useful amounts of selenium (59% RDI), vitamin B12 (40% RDI) and iron (14% RDI), all nutrients that can be lacking in a vegetarian diet .
- Pregnancy – eggs are an excellent way for pregnant women to meet their increased nutritional requirements, containing useful amounts of protein, iron, iodine, vitamin B12, vitamin A and omega-3 fats.
- Children and adolescents – eggs provide useful amounts of nutrients such as riboflavin, zinc, folate, vitamin A , iron and iodine that can be low in many children’s diets.
- Sports people – eggs provide a valuable source of nutrients required by sports people including iron, folate and vitamin B12. Eggs are also a source of protein which can help meet the higher protein requirements of sports people and the antioxidants in eggs may assist recovery from exercise by reducing muscle and cell damage.
- Elderly – due to their soft texture, eggs may be a particularly suitable food in the diets of frail elderly. As well as providing omega-3 for heart health benefits, eggs provide the vitamins A and E and the antioxidants lutein and zeaxanthin which have been associated with lower rates of age-related macular degeneration (AMD).