Dietary cholesterol

AHA - American Heart Association

CVD - Cardiovascular disease

"Dietary cholesterol" refers to cholesterol found in foods

Lipid parameters - LDL, HDL, total cholesterol, triglycerides

One whole egg = approximately 200 mg of cholesterol with only a very small amount of fatty acids

USDA - United States Dept of Agriculture

Cholesterol is used by the body to make steroid hormones, bile acids, and cell membranes
The body is capable of synthesizing all the cholesterol that it needs, therefore there is no minimum dietary requirement for cholesterol
Cholesterol is only found in animal products - eggs, dairy products, meat and fish [1]

In 2015, the USDA removed its recommendation that that people limit dietary cholesterol intake to less than 300 mg a day
No limitation is currently recommended [9]

In 2019, the AHA released a science advisory about dietary cholesterol and CVD risk

To achieve healthy dietary patterns, consumers are advised to eat a dietary pattern characterized by fruits, vegetables, whole grains, low-fat or fat-free dairy products, lean protein sources, nuts, seeds, and vegetable oils, consistent with those recommended in the 2015 to 2020 Dietary Guidelines Advisory Committee. These patterns have a relatively high ratio of polyunsaturated fatty acid to saturated fatty acid and are low in cholesterol, achieved by minimizing the intake of major sources of saturated fat intake (animal fats) and including liquid nontropical vegetable oils. Choosing plant-based protein sources will limit cholesterol intake.
Given the relatively high content of cholesterol in egg yolks, it remains advisable to limit intake to current levels. Healthy individuals can include up to a whole egg or equivalent daily
Patients with dyslipidemia, particularly those with diabetes mellitus or at risk for heart failure, should be cautious in consuming foods rich in cholesterol
For older patients with normal cholesterol, given the nutritional benefits and convenience of eggs, consumption of up to 2 eggs per day is acceptable within the context of a heart-healthy dietary pattern [10]

In the 1960s and 70s, the link between high blood cholesterol levels and the development of heart disease was established
Based on this link, a number of medical and health entities made the recommendation that individuals lower their intake of dietary cholesterol
This recommendation was based largely on the assumption that lowering cholesterol in the diet equated to lowering cholesterol in the blood and therefore lowering risk of heart disease
Since eggs contain a relatively large amount of cholesterol and are widely consumed, many of the recommendations focused on limiting their consumption [5,6]

A number of studies have evaluated the effect of dietary cholesterol on blood cholesterol levels

Results from studies have shown that dietary cholesterol has the following effect on blood cholesterol:

Total cholesterol - increases by 2.2 mg/dl on average for every 100 mg increase in daily dietary cholesterol
LDL cholesterol (bad) - increases by 2 mg/dl on average for every 100 mg increase in daily dietary cholesterol
HDL cholesterol (good) - increases by 0.4 mg/dl on average for every 100 mg increase in daily dietary cholesterol [1,2,3,5,7]

Most studies that have evaluated the relationship between heart disease and dietary cholesterol have used egg consumption as a measure of dietary cholesterol intake
Eggs lend themselves well to these studies because unlike other foods that are high in cholesterol, they are high in cholesterol and low in fatty acids which can also affect heart disease

In general, there is no conclusive evidence that dietary cholesterol increases heart disease risk
There is no conclusive evidence that egg consumption at any level increases heart disease risk
Egg consumption of one or more a day in diabetics may increase heart disease risk, but this is not conclusive [4,5,6,8]

Cholesterol is found in any food that comes from an animal which includes meat, dairy products, and eggs
The table below gives the cholesterol content of some common animal products

USDA food composition database - extensive nutritional information about numerous foods including restaurant foods
myfitnesspal - commercial website that has extensive database of food calorie content
Lose it! - commercial website that has extensive database of food calorie content

1 - IOM Dietary Reference Intake 2005
2 - USDA 2010 dietary recs for chol
3 - PMID: 11333841
4 - PMID: 10217054
5 - PMID: 11023005
6 - PMID: 15640512
7 - PMID: 12074253
8 - PMID: 11023006
9 - Scientific Report of the 2015 Dietary Guidelines Advisory Committee
10 - PMID 31838890 - Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association, Circulation (2019)

DIETARY CHOLESTEROL