Fruit juice and childhood obesity: a review of epidemiologic studies.

Childhood obesity is a national epidemic, and many efforts have been made to understand its risk factors. The purpose of this review was to provide an updated account of the observational studies evaluating the relationship between 100% fruit juice intake and obesity in children and adolescents, and to highlight the major risk factors that may impact this relationship. PubMed and Scopus were searched for terms related to fruit juice and childhood obesity, and studies assessing 100% fruit juice intake in participants ≤ 19 years old, with obesity-related outcomes (BMI or adiposity), and published before March 9, 2021 were included. There were 17 prospective cohort and 14 cross-sectional studies included in the analysis. Overall, the evidence does not support a relationship between 100% fruit juice intake and measures of obesity in most children. There is some evidence to suggest a minor positive association in some overweight or very young children, but due to fundamental differences and limitations in methodology, further investigation is required. Significant gaps in literature on this topic exist particularly in regards to randomized clinical trials in children, and in studies in racially diverse populations.

Associations of 25-Hydroxyvitamin D With the Blood Pressure Response to Maximal Exercise Among Healthy Adults.

Insufficient 25-hydroxyvitamin D [25(OH)D] levels are associated with high resting blood pressure (BP). However, the relationship between 25(OH)D and the peak systolic BP (SBP) response to exercise, a predictor of future hypertension, has yet to be investigated. We sought to examine the relationship among serum 25(OH)D and the peak SBP response to a graded exercise stress test (GEST) among a large sample (n = 417) of healthy men (49%) and women (51%) over a broad age range (20-76 years; mean age: 44.1 ± 0.8 years). We hypothesized that individuals with clinically insufficient 25(OH)D would have a greater peak SBP response to a GEST compared to individuals with sufficient 25(OH)D levels. Fasting serum 25(OH)D, anthropometrics, resting BP, and peak exercise SBP were obtained at the baseline visit of a larger clinical trial (STOMP; NCT01140308). Mean 25(OH)D levels were 36.1 ± 0.7 ng/ml, with ∼35% of individuals classified as insufficient (<30 ng/ml). Average resting BP was 119 ± 13 mmHg/75 ± 10 mmHg, with 52.3% considered to have normal BP, while 25.2% had elevated BP and 22.5% had established hypertension. The peak SBP response to a GEST was similar between individuals with sufficient (48 ± 19 mmHg) versus insufficient (48 ± 18 mmHg) 25(OH)D (p = 1.000). One unexpected finding emerged such that individuals with sufficient 25(OH)D had higher resting SBP (120 ± 14 mmHg vs. 117 ± 13 mmHg; p = .020) than individuals with insufficient 25(OH)D. In contrast to our hypothesis, 25(OH)D levels were not associated with the peak SBP response to a GEST. Baseline 25(OH)D levels were positively correlated with resting SBP; however, the magnitude of this effect is likely not clinically meaningful.

Standardizing Dietary Recall: A Necessity for the Expanded Food and Nutrition Education Program.

This report explores the 24-hour dietary recall (24HDR) form used for the Expanded Food and Nutrition Education Program (EFNEP). Dietary supplement use, amount of money spent on food, time being physically active, portion size consumed, foods reported by meals, and preparation of the meal were common components collected among 61 EFNEP programs. Components not included were instructions for the peer educator, use of food models/measuring cups, examples of foods/beverages, time food/beverages were consumed, color coding, and a prompt to review what was written. A standardized 24-hour dietary recall form with training protocols is recommended to uphold the integrity of data collection.

Food Resource Management and Healthy Eating Focus Associates with Diet Quality and Health Behaviors in Low-Income Adults.

Nutrition education and food resource management (FRM) can assist food-insecure individuals in acquiring healthy and affordable food. We aimed to assess the relationships between FRM skills and healthy eating focus with diet quality and health-related behaviors in low-income adults during the COVID-19 pandemic. This cross-sectional study was conducted using an online survey of 276 low-income adults living in a low-food-access community in Northeast Connecticut. Through analysis of covariance, adults who usually or always had a meal plan, considered reading nutrition labels important, made a grocery list, were concerned about their food healthiness, and rated their diet quality as very good/excellent reported higher diet quality (frequency-based and liking-based scores) (p < 0.05 for all). Individuals who considered reading food labels very important and reported having a good diet reported less frequent pandemic-related unhealthy behaviors (consumption of candy and snack chips, soda or sugary drinks, weight gain, smoking) (p < 0.001). Furthermore, higher-frequency-based diet quality was associated with lower risk of overweight or obesity (OR: 0.37; 95% CI: 0.18, 0.76; p-trend < 0.01). Thus, FRM skills and healthy eating focus were associated with higher diet quality and healthier self-reported changes in diet, weight, and smoking behaviors during the pandemic.

Conducting 24-Hour Dietary Recalls in Group Settings with Adults Having Low-Income: Perspectives of EFNEP Peer Educators.

The Expanded Food and Nutrition Education Program (EFNEP) is a federally funded program that teaches nutrition education to adults and youth with low-income. EFNEP is funded throughout the United States including federal territories. The purpose of EFNEP is to provide nutrition education. Evaluation for adult programs includes pre/post surveys and pre/post 24-h diet recalls (24HDR). A validated standard of dietary measures, 24HDR are useful when collected as designed: one-on-one by a trained professional. In EFNEP, 24HDR are collected in group settings by EFNEP peer educators who often have not received a college degree or any formal education in nutrition. The purpose of this study was to explore attitudes and behaviors of EFNEP peer educators regarding how they collect diet recalls in a group setting, their perceptions of how adult participants feel about the recalls, and the benefits and challenges of using recalls. Online interviews were conducted with EFNEP peer educators across the U.S. Peer educators recognized the importance of collecting the recall data but identified several challenges such as time, resources, and participant reluctance to complete the recall. Program evaluation through methods like the 24HDR is important to measure outcomes and inform program improvements but also needs to include how evaluation can benefit participants and minimize data collection burden. Future research needs to examine the validity of collecting recalls in a group setting compared to other measures of diet quality.

24-Hour Dietary Recall in the Expanded Food and Nutrition Education Program: Perspective of the Program Coordinator.

The purpose of this study was to determine how the 24-hour dietary recall (24HDR) is administered and how the Expanded Food and Nutrition Education Program (EFNEP) peer educators and other staff are trained on the data collection and entry process, from the EFNEP coordinators' perspectives. This cross-sectional, quantitative study utilized an online survey to collect information from EFNEP coordinators representing 61 of 76 EFNEP programs. While 56% of the programs collected the 24HDR data starting with the first thing eaten the previous day, 49% of them started collecting data at the time of class, going backwards. Most programs, i.e., 72%, reported using a multiple-pass method; however, only one-third of them reported using the standard five-pass method. Almost all programs, i.e., 97%, reported one peer educator collecting data from a group of 2-12 clients. All programs reported collecting the 24HDR data in a group setting, with about one-third of the programs also collecting data one-on-one. Most programs, i.e., 57%, reported spending ≤4 h on the initial training of staff in how to collect 24HDR data, and 54% of them reported that the peer educators entered the data themselves. This study found that the methods used to collect answers, train the staff, and enter the 24HDR data varied across EFNEP programs and that there is a need to standardize or revise the collection of 24HDR data.

Can Ordering Groceries Online Support Diet Quality in Adults Who Live in Low Food Access and Low-Income Environments?

During the COVID-19 pandemic, U.S. food assistance programs allowed the use of program benefits to order groceries online. We examined relationships between the food environment, food assistance, online grocery ordering, and diet quality among adults from one low-income, low food access community in Northeastern Connecticut during the pandemic. Via online survey, adults (n = 276) reported their perceived home and store food environments, food assistance participation, whether they ordered groceries online, and consumption frequency and liking of foods/beverages to calculate diet quality indices. Those who ordered groceries online (44.6%) were more likely to participate in food assistance programs and report greater diet quality. Perceived healthiness of store and home food environments was variable, with the ease of obtaining and selecting unhealthy foods in the neighborhood significantly greater than healthy foods. Healthier perceived home food environments were associated with significantly higher diet qualities, especially among individuals who participated in multiple food assistance programs. Ordering groceries online interacted with multiple measures of the food environment to influence diet quality. Generally, the poorest diet quality was observed among individuals who perceived their store and home food environments as least healthy and who did not order groceries online. Thus, ordering groceries online may support higher diet quality among adults who can use their food assistance for purchasing groceries online and who live in low-income, low-access food environments.

Increasing Access to Healthy Foods through Improving Food Environment: A Review of Mixed Methods Intervention Studies with Residents of Low-Income Communities.

Food insecurity is a broad and serious public health issue in the United States, where many people are reporting lack of access to healthy foods. The reduced availability of healthy, affordable foods has led to increased consumption of energy-dense and nutrient-poor foods, resulting in increasing the risk for many chronic diseases such as obesity, cardiovascular diseases, and type 2 diabetes mellitus. Thus, identifying promising approaches to increase access to healthy foods through improving the food environment is of importance. The purpose of this review article is to highlight how the food environment affects directly a person's food choices, and how to increase access to healthy foods through improving environmental approaches. The literature search was focused on finding different approaches to improve food security, primarily those with an impact on food environment. Overall, potential solutions were gathered through multilevel environmental approaches, including nutrition education and peer education, community-based participatory research, and policy changes in supplemental nutrition programs. A recommendation to reduce food insecurity is learning to create meals with a variety of seasonal fruits and vegetables purchased from affordable farmers' markets.

The Health Benefits of Egg Protein.

Once the general public accepts that dietary cholesterol is not a concern for cardiovascular disease risk, foods that have been labeled as high-cholesterol sources, including eggs, may be appreciated for their various other dietary components. One of the nutrients in eggs that deserves further discussion is egg protein. Egg protein has been recognized to be highly digestible and an excellent source of essential amino acids, with the highest attainable protein digestibility-corrected amino acid score. Egg protein has been shown to decrease malnutrition in underdeveloped countries, possibly increase height in children, and protect against kwashiorkor. Egg protein has been demonstrated to be important to skeletal muscle health and protective against sarcopenia. Egg protein also can decrease appetite, resulting in a reduction in the caloric intake from the next meal and weight reduction. Other protective effects of egg protein addressed in this review include protection against infection as well as hypotensive and anti-cancer effects.

The Association between Diet Quality and Health Status in Mobile Food Pantry Users in Northeastern Connecticut.

Low-income Americans tend to have poor diet quality and disease prevalence overall. Mobile food pantries aim to improve these outcomes, and have rarely been studied. This cross-sectional study aimed to evaluate the association between diet quality and health status in mobile food pantry users. Data were collected from two mobile food pantry sites in Northeastern Connecticut (n = 83). Sociodemographic food security and diet quality data were collected. Overall, diet quality was low among all participants with intakes of fruits, vegetables, and whole grains of concern. Participant adherence to the 2020−2025 US Dietary Guidelines were low, with no participants meeting recommendations for whole grains. Obesity, diabetes, and hypertension prevalence in this population exceeded national averages. After adjusting for covariates, hypertension was associated with higher dairy and added sugar intake, as well as a greater intake of added sugar from sugar-sweetened beverages (p < 0.05). Although results were not statistically significant, participants with obesity, diabetes, and hypertension showed a trend of having lower adherence to the guidelines than those without these chronic diseases. Questions assessing participant interest in changing their diets were also posed, indicating overall high interest in learning about current diet quality and weight improvement.

Dietary Influences on Gut Microbiota with a Focus on Metabolic Syndrome.

There is a clear correlation between gut microbiota, diet, and metabolic outcomes. A diet high in fiber has been shown to decrease inflammation, increase insulin sensitivity, and reduce dyslipidemias whereas a diet high in fat and sugar leads to dyslipidemia, insulin resistance, and low-grade inflammation. There is recent evidence suggesting that the human gut microbiota has a significant role in the development or the resolution of metabolic syndrome (MetS) and associated conditions. Leading a stressful, sedentary lifestyle with limited or no physical activity and consuming an unhealthy diet high in saturated fat, simple carbohydrates, and sodium and low in dietary fiber and in high-quality protein are some of the contributing factors. Unhealthy diets have been shown to induce alterations in the gut microbiota and contribute to the pathogenesis of MetS by altering microbiota composition and disrupting the intestinal barrier, which leads to low-grade systemic inflammation. In contrast, healthy diets can lead to changes in microbiota that increase gut barrier function and increase the production of anti-inflammatory biomarkers. This review aims at providing a more in-depth discussion of diet-induced dysbiosis of the gut microbiota and its effect on MetS. Here, we discuss the possible mechanisms involved in the development of the metabolic biomarkers that define MetS, with an emphasis on the role of sugar and dietary fiber in microbiome-mediated changes in low-grade systemic inflammation and metabolic dysfunction.

Eggs Improve Plasma Biomarkers in Patients with Metabolic Syndrome Following a Plant-Based Diet-A Randomized Crossover Study.

Plant-based (PB) diets are considered a healthy dietary pattern; however, eggs are not always included in this dietary regime. We hypothesized that the addition of two eggs per day would increase HDL cholesterol as well as plasma lutein, zeaxanthin and choline in individuals with metabolic syndrome (MetS). In this randomized controlled crossover intervention, we recruited 30 participants (49.3 ± 8 y) with MetS who followed a PB diet for 13 weeks. A registered dietitian advised all subjects on food selection and followed them through the intervention to ensure compliance. Participants underwent a 2-week washout with no eggs or spinach (a source of dietary lutein and zeaxanthin) and were randomly allocated to consume spinach (70 g) with either two eggs (EGG) or the equivalent amount of egg substitute (SUB) for breakfast for 4 weeks. After a 3-week washout, they were allocated the alternate breakfast. A total of 24 participants (13 women/11 men) finished the intervention. Plasma lipids, glucose, insulin, anthropometrics, plasma lutein, zeaxanthin, choline and trimethylamine oxide (TMAO) were assessed at baseline and the end of each intervention. When we compared individuals consuming the EGG versus the SUB breakfast, we observed a lower body weight (p < 0.02) and a higher HDL cholesterol (p < 0.025) after the EGG diet. There were no differences in plasma LDL cholesterol, triglycerides, glucose, insulin, or blood pressure. The number of large HDL particles measured by NMR was higher after EGG (p < 0.01) as compared to SUB. Plasma choline was higher in both treatments (p < 0.01) compared to baseline (8.3 ± 2.1 µmol/L). However, plasma choline values were higher in EGG (10.54 ± 2.8 µmol/L) compared to SUB (9.47 ± 2.7 µmol/L) p < 0.025. Both breakfasts increased plasma lutein compared to baseline (p < 0.01), while plasma zeaxanthin was only increased in the egg intervention (p < 0.01). These results indicate that consuming a plant-based diet in combination with whole eggs increases plasma HDL cholesterol, choline and zeaxanthin, important biomarkers in subjects with MetS.

A Feasibility and Pilot Study of a Personalized Nutrition Intervention in Mobile Food Pantry Users in Northeastern Connecticut.

OBJECTIVE: This pilot study assessed the effectiveness and acceptability of personalized nutrition intervention for mobile food pantry users. METHODS: The 8-week intervention recruited 25 participants in the control (n = 13) and in the treatment (n = 12) groups (60% obese). Personalized nutrition and health reports were generated based on baseline dietary intake and health status. The treatment group received weekly phone counseling and nutrition education, while the control group was only contacted to ensure compliance. The primary outcomes were 8-week changes in weight and diet quality score, assessed by the Healthy Eating Index. RESULTS: The acceptability of the intervention was assessed by the eligibility rate, recruitment rate (62.5%), and drop-out rate (36%). Following the intervention, there was a significant decrease in weight (mean ± standard deviation, -2.3% ± 2.4%) among all participants (p < 0.05). Diet-quality improved (4.54% in treatment vs. 0.18% in control), but was ultimately non-significant (p = 0.284). CONCLUSIONS AND IMPLICATIONS: A personalized nutrition education intervention in mobile food pantry users may be an acceptable and effective intervention to encourage weight loss through dietary improvements.

Diet Quality, Nutritional Adequacy, and Sociodemographic Characteristics of Mobile Food Pantry Users in Northeastern Connecticut.

Poor diet quality among low-income populations is a major contributing factor to their poor health and wellbeing, and thus is a focus of many government aid programs. Mobile food pantries are an increasingly popular method of emergency food assistance, targeting the communities most affected by food insecurity; however, little is known about the dietary characteristics of mobile food pantry users. This study aims to characterize the diet quality and nutrient adequacy level and examine its association with sociodemographic characteristics among mobile food pantry users in Windham County, Connecticut. Surveys to assess food insecurity, diet composition, and sociodemographic characteristics were administered to 83 adult food pantry users. Participants (n = 40) completed a three-day dietary record for analysis of diet quality, and were found to have inadequate intakes of fruits, vegetables, whole grains and dairy, as well as some related micronutrients. At least 30% of participants had intakes below the Estimated Average Requirement (EAR) for vitamins A, C, E, calcium, zinc, magnesium, and folate. Intakes of added sugar, sugar sweetened beverages, and saturated fat were also above recommendations according to the United States Dietary Guidelines. Certain sociodemographic factors affected diet quality among this sample. For example, being male was associated with increased sugar-sweetened beverage and added sugar intake. This characterization of mobile pantry users will serve as a reference for developing nutrition education and determining the effectiveness of future interventions.

Impact of increased adipose tissue mass on inflammation, insulin resistance, and dyslipidemia.

Obesity is associated with increased prevalence of metabolic disorders, such as inflammation, insulin resistance, and dyslipidemia, which can predispose an individual to develop diabetes and cardiovascular disease. Adipose tissue (AT) is now recognized as a metabolically active organ that controls plasma free fatty acid levels and contributes to systemic metabolic homeostasis by secreting adipokines. In obesity, the recruitment of immune cells, such as T cells and macrophages, to AT causes inflammation, which is thought to contribute to local insulin resistance. This loss of insulin sensitivity within AT can lead to uncontrolled release of fatty acids, secretion of inflammatory cytokines, and alterations in the balance of adipokines, which ultimately impact lipoprotein metabolism and insulin sensitivity systemically. Thus, AT itself plays an important role in the increased risk of diabetes and cardiovascular disease that is associated with obesity.

A-002 (Varespladib), a phospholipase A2 inhibitor, reduces atherosclerosis in guinea pigs.

BACKGROUND: The association of elevated serum levels of secretory phospholipase A2 (sPLA2) in patients with cardiovascular disease and their presence in atherosclerotic lesions suggest the participation of sPLA2 enzymes in this disease. The presence of more advanced atherosclerotic lesions in mice that overexpress sPLA2 enzymes suggest their involvement in the atherosclerotic process. Therefore, the sPLA2 family of enzymes could provide reasonable targets for the prevention and treatment of atherosclerosis. Thus, A-002 (varespladib), an inhibitor of sPLA2enzymes, is proposed to modulate the development of atherosclerosis. METHODS: Twenty-four guinea pigs were fed a high saturated fat, high cholesterol diet (0.25%) for twelve weeks. Animals were treated daily with A-002 (n = 12) or vehicle (10% aqueous acacia; n = 12) by oral gavage. After twelve weeks, animals were sacrificed and plasma, heart and aorta were collected. Plasma lipids were measured by enzymatic methods, lipoprotein particles size by nuclear magnetic resonance, aortic cytokines by a colorimetric method, and aortic sinus by histological analyses. RESULTS: Plasma total cholesterol, HDL cholesterol and triglycerides were not different among groups. However, the levels of inflammatory cytokines interleukin (IL)-10, IL-12 and granulocyte-macrophage colony-stimulating factor (GM-CSF) were significantly reduced in the treatment group. This group also had a significant 27% reduction in cholesterol accumulation in aorta compared with placebo group. Morphological analysis of aortic sinus revealed that the group treated with A-002 reduced atherosclerotic lesions by 24%. CONCLUSION: The use of A-002 may have a beneficial effect in preventing diet-induced atherosclerosis in guinea pigs.

Influences of a dietary supplement in combination with an exercise and diet regimen on adipocytokines and adiposity in women who are overweight.

The influence of a proprietary blend of modified cellulose and cetylated fatty acids (Trisynextrade mark, Imagenetix, Inc., San Diego, CA 92127, USA) on adipocytokine and regional body composition responses to a weight loss program was examined. Twenty-two women (Supplement group (S) (n = 11): age = 36.8 +/- 7.2 years; weight = 87.1 +/- 6.2 kg; % body fat = 43.4 +/- 4.1; Placebo group (P) (n = 11): age = 38.3 +/- 6.8 years; weight = 86.9 +/- 4.7 kg; % body fat = 44.3 +/- 2.0) completed an 8-week placebo-controlled, double-blind study consisting of a caloric restricted diet and cardiovascular exercise. Body composition and serum insulin, leptin, and adiponectin were assessed at pre-, mid-, and post-intervention. From pre- to post-intervention, significant decreases (P < 0.05) were observed for body weight (S: 87.1 +/- 6.2-77.9 +/- 5.1 kg; P: 86.9 +/- 4.7-82.7 +/- 3.8 kg) (P < 0.05 S vs. P), % body fat (S: 43.4 +/- 4.1-36.1 +/- 3.6; P: 44.3 +/- 2.0-40.6 +/- 1.2) (P < 0.05 S vs. P), leptin (S: 28.3 +/- 3.5-16.2 +/- 2.6 ng ml(-1); P: 29.4 +/- 3.2-19.9 +/- 1.1 ng ml(-1)) (P < 0.05 S vs. P), and insulin (S: 7.3 +/- 0.8-5.1 +/- 0.2 mU l(-1); P: 7.7 +/- 0.9-5.1 +/- 0.3 mU l(-1)). Serum adiponectin increased (P < 0.05) (S: 12.2 +/- 2.4-26.3 +/- 3.0 microg ml(-1): 12.6 +/- 2.0-21.8 +/- 3.1 microg ml(-1)) (P < 0.05 for S vs. P). Supplementation with a proprietary blend of modified cellulose and cetylated fatty acids during an 8-week weight loss program exhibited favorable effects on adipocytokines and regional body composition.

Feeding Infants and Toddlers: A Qualitative Study to Determine Parental Education Needs.

Background: Limited evidence-based guidance is available to parents regarding optimal child feeding practices to prevent early childhood obesity from birth to 24 months of age (B-24). The objective of this qualitative study was to determine current child feeding practices, barriers to implementation, and educational needs of parents of varying socioeconomic backgrounds as it relates to responsive feeding to prevent early obesity in children of ages B-24. Methods: One-on-one interviews were conducted with parents (n = 66) of children ages B-24 from both low-and non-low-income households. Interviews were audiorecorded, transcribed verbatim, and analyzed with NVivo using classical qualitative analysis. Results: Participants were primarily female (91%), married (53%), low-income (59%), and were not first-time parents (72%). The results revealed overarching themes, including parents' reported need for information on preparing child meals, optimal dietary intake, affordable healthy foods, promoting child self-feeding, and food and nutrition knowledge. Low-income parents more frequently requested guidance about identifying affordable healthy options and overfeeding while non-low-income parents requested information about food allergens, transitioning to solids, and creating structured mealtimes. Conclusions: Additional and focused outreach to parents of children ages B-24 regarding optimal feeding practices is needed especially on topics related to complementary feeding during the transition to solid food.

Modulation of C-reactive protein, tumor necrosis factor-alpha, and adiponectin by diet, exercise, and weight loss.

Chronic disease has been strongly correlated with inflammation resulting from the body's release of inflammatory cytokines as a result of injury or infection. Specific interventions promoting weight loss, exercise, or intake of antioxidants have been used by several investigators in an effort to decrease inflammatory cytokines. C-reactive protein (CRP) is produced by the liver and its role in the development of inflammation has been well established. However, the strong association between CRP and risk for heart disease is a more recent discovery. During the inflammation process, the transcriptional activity of nuclear factor kappaB leads to the increased production of inflammatory cytokines associated with atherosclerosis, including tumor necrosis factor-alpha (TNFalpha). Increased concentrations of TNFalpha have been reported in obese patients; thus, weight loss is considered a key intervention to reduce the concentrations of this cytokine. In contrast to CRP and TNFalpha, adiponectin increases during weight loss and insulin sensitivity. Additionally, lower concentrations of this cytokine have been reported in cardiovascular disease and type-2 diabetes. Recent epidemiological studies and clinical interventions have reported contradictory findings related to dietary or exercise interventions and the resulting alterations in plasma cytokines. Part of the discrepancies may be due to the population studied, the time of the treatment, and the lack of weight loss in some studies. Although it is clear from the literature that these cytokines play a major role in the development of chronic disease, the best strategy to favorably alter the inflammatory response is still debatable.

Dietary cholesterol from eggs increases plasma HDL cholesterol in overweight men consuming a carbohydrate-restricted diet.

Carbohydrate-restricted diets (CRD) significantly decrease body weight and independently improve plasma triglycerides (TG) and HDL cholesterol (HDL-C). Increasing intake of dietary cholesterol from eggs in the context of a low-fat diet maintains the LDL cholesterol (LDL-C)/HDL-C for both hyper- and hypo-responders to dietary cholesterol. In this study, 28 overweight/obese male subjects (BMI = 25-37 kg/m2) aged 40-70 y were recruited to evaluate the contribution of dietary cholesterol from eggs in a CRD. Subjects were counseled to consume a CRD (10-15% energy from carbohydrate) and they were randomly allocated to the EGG group [intake of 3 eggs per day (640 mg/d additional dietary cholesterol)] or SUB group [equivalent amount of egg substitute (0 dietary cholesterol) per day]. Energy intake decreased in both groups from 10,243 +/- 4040 to 7968 +/- 2401 kJ (P < 0.05) compared with baseline. All subjects irrespective of their assigned group had reduced body weight and waist circumference (P < 0.0001). Similarly, the plasma TG concentration was reduced from 1.34 +/- 0.66 to 0.83 +/- 0.30 mmol/L after 12 wk (P < 0.001) in all subjects. The plasma LDL-C concentration, as well as the LDL-C:HDL-C ratio, did not change during the intervention. In contrast, plasma HDL-C concentration increased in the EGG group from 1.23 +/- 0.39 to 1.47 +/- 0.38 mmol/L (P < 0.01), whereas HDL-C did not change in the SUB group. Plasma glucose concentrations in fasting subjects did not change. Eighteen subjects were classified as having the metabolic syndrome (MetS) at the beginning of the study, whereas 3 subjects had that classification at the end. These results suggest that including eggs in a CRD results in increased HDL-C while decreasing the risk factors associated with MetS.