High versus low egg consumption and LDL cholesterol in adults with dyslipidemia: a randomized crossover trial

Purpose This paper aims to evaluate the effect of consuming 3 eggs/day versus 3 eggs/week on LDL-C levels in adults with stable dyslipidemia receiving lipid-lowering therapy. Design/methodology/approach A randomized controlled crossover trial was conducted in adults with stable dyslipidemia. Following a 2-week washout, participants consumed either 3 eggs/day or 3 eggs/week for 6 weeks, then crossed over after a 6-week washout. The primary outcome, LDL-C, alongside secondary lipid profiles, was evaluated using a linear mixed model. Findings Among 50 randomized participants (43 in the primary analysis), the mean LDL-C was 126 mg/dL during the 3 eggs/day intervention and 121 mg/dL during the 3 eggs/week intervention. The estimated difference was 5.0 mg/dL (95% CI, −3.7–13.8; p = 0.25). Furthermore, no statistically significant treatment effects were observed for total cholesterol, HDL-C or triglycerides. Research limitations/implications This short-term randomized crossover trial included adults with stable, well-controlled dyslipidemia receiving lipid-lowering therapy; therefore, the findings may not generalize to individuals with uncontrolled dyslipidemia or established cardiovascular disease. Attrition, limited statistical power, an imprecise confidence interval, dilution of the intended dietary cholesterol contrast, self-reported dietary intake, and incomplete quantitative adherence assessment may have affected the estimates. The findings do not establish equivalence or safety. Larger, adequately powered, longer-term trials with broader populations and structured adherence monitoring are needed. Practical implications In this study, the authors did not detect a statistically significant difference in LDL-C between consumption of 3 eggs/day and 3 eggs/week over six weeks. However, the confidence interval was wide and did not exclude a clinically meaningful increase in LDL-C, and the study was not adequately powered to rule out such a difference. Therefore, these findings should not be interpreted as evidence of equivalence or safety. Dietary counseling should remain individualized according to overall dietary quality and the patient’s cardiovascular risk profile. Social implications The findings highlight the importance of avoiding overly restrictive, one-size-fits-all dietary advice for individuals with dyslipidemia. Egg-consumption recommendations should consider overall dietary quality, food substitutions, lipid response, treatment status and cardiovascular risk rather than focusing on a single food in isolation. However, the study does not establish that high egg intake is safe or has no effect on LDL-C. Clear communication of this uncertainty may support informed, individualized dietary decisions while reducing both unnecessary food restriction and inappropriate reassurance. Originality/value This study provides randomized clinical trial evidence on the short-term difference in serum lipid levels between higher and lower egg consumption among patients receiving lipid-lowering therapy.