Dietary Choline Intake Research Articles

One-year longitudinal association between changes in dietary choline or betaine intake and cardiometabolic variables in the PREvención con DIeta MEDiterránea-Plus (PREDIMED-Plus) trial

Choline and betaine intakes have been related to cardiovascular health. We aimed to explore the relation between 1-y changes in dietary intake of choline or betaine and 1-y changes in cardiometabolic and renal function traits within the frame of the PREDIMED (PREvención con DIeta MEDiterránea)-Plus trial. We used baseline and 1-y follow-up data from 5613 participants (48.2% female and 51.8% male; mean±SD age: 65.01±4.91 y) to assess cardiometabolic traits, and 3367 participants to assess renal function, of the Spanish PREDIMED-Plus trial. Participants met ≥3 criteria of metabolic syndrome and had overweight or obesity [BMI (in kg/m2) ≥27 and ≤40]. These criteria were similar to those of the PREDIMED parent study. Dietary intakes of choline and betaine were estimated from the FFQ. The greatest 1-y increase in dietary choline or betaine intake (quartile 4) was associated with improved serum glucose concentrations (-3.39 and -2.72mg/dL for choline and betaine, respectively) and HbA1c levels (-0.10% for quartile 4 of either choline or betaine intake increase). Other significant changes associated with the greatest increase in choline or betaine intake were reduced body weight (-2.93 and -2.78kg, respectively), BMI (-1.05 and -0.99, respectively), waist circumference (-3.37 and -3.26cm, respectively), total cholesterol (-4.74 and -4.52mg/dL, respectively), and LDL cholesterol (-4.30 and -4.16mg/dL, respectively). Urine creatinine was reduced in quartile 4 of 1-y increase in choline or betaine intake (-5.42 and -5.74mg/dL, respectively). Increases in dietary choline or betaine intakes were longitudinally related to improvements in cardiometabolic parameters. Markers of renal function were also slightly improved, and they require further investigation.This trial was registered at https://www.isrctn.com/ as ISRCTN89898870.

Is dietary choline intake related to dementia and Alzheimer’s disease risks? Results from the Framingham Heart Study

The positive association of choline for cognition has been reported in both animal and human studies, yet the associations of choline with the risks of incident dementia or Alzheimer's disease (AD) in humans is unclear. Our objective was to test the hypothesis that lower or higher dietary choline intake is associated with increased or decreased, respectively, risks of incident dementia and AD. Data from the Framingham Heart Study Offspring Cohort exam 5 to exam 9 were used. Participants were free of dementia and stroke, with a valid self-reported 126-item Harvard FFQ at exam 5. The intakes of total choline, its contributing compounds, and betaine were estimated based on a published nutrient database. The intakes were updated at each exam to represent the cumulative average intake across the 5 exams. The associations between dietary choline intakes and incident dementia and AD were examined in mixed-effect Cox proportional hazard models, adjusting for covariates. A total of 3224 participants (53.8% female; mean ± SD age, 54.5 ± 9.7 y) were followed up for a mean ± SD of 16.1 ± 5.1 y (1991-2011). There were 247 incident dementia cases, of which 177 were AD. Dietary choline intake showed nonlinear relationships with incident dementia and AD. After adjusting for covariates, low choline intake (defined as ≤ 219 and ≤ 215 mg/d for dementia and AD, respectively) was significantly associated with incident dementia and incident AD. Low choline intake was associated with increased risks of incident dementia and AD.

Association between dietary intake of one-carbon metabolism nutrients and hyperglycemia in coal-burning fluorosis areas of Guizhou, China.

Background and aimsThere are limited studies describing the association between dietary intake of one-carbon metabolism nutrients and hyperglycemia. The present study aimed to investigate the association of habitual dietary intake of one-carbon metabolism nutrients with hyperglycemia in a fluorosis area in China, and explored the interaction between these nutrients and fluorosis related to hyperglycemia.MethodIn a cross-sectional study, we recruited 901 villagers, ages ranging from 18–75, in Guizhou Province. Dietary data and other covariate data were obtained through an interviewer-administered questionnaire. We collected venous blood samples from participants who had fasted for one night to obtain fasting blood glucose levels and we categorized dietary intake of betaine, total choline, methionine, folate, vitamins B6 and B12, and choline subclasses into quartiles (Q1–Q4). The lowest quartile (Q1) served as the reference group. An unconditional logistic regression model was used to evaluate the protective effects of a dietary intake of one-carbon nutrients against hyperglycemia. We calculated Odds Ratios (ORs) with 95% confidence intervals (CIs). A presence or absence of fluorosis subgroup analysis was performed to determine the potential effect of fluorosis on hyperglycemia.ResultAfter adjusting for potential confounding factors, we found that a greater intake of dietary vitamin B6, total choline and methyl-donor index was inversely associated with the occurrence of hyperglycemia (P-trend <0.05). However, there were no significant associations between hyperglycemia and the dietary intake of folate, vitamin B12, methionine, and betaine. As for the choline subgroups, it showed that the dietary intake of free choline, phosphatidylcholine, and glycerol phosphatidylcholine was negatively correlated with the occurrence of hyperglycemia (P < 0.05). In contrast, there was no statistical association between dietary phosphatidylcholine and sphingomyelin and hyperglycemia (all P > 0.05). The results of subgroup analysis showed that dietary intake of folate, vitamin B6, total choline, free choline, glycerol phosphorylcholine, and phosphocholine had a protective effect against the occurrence of hyperglycemia in the non-fluorosis subgroup, although no effects were observed in the fluorosis subgroup. There were significant interactions between these nutrients and fluorosis (P = 0.010–0.048).ConclusionThe study demonstrated that higher dietary intake of vitamin B6, total choline, methyl-donor index, free choline, glycerol phosphorylcholine, and phosphocholine in choline compounds were associated with a lower incidence of hyperglycemia. Moreover, the associations were modified by the presence or absence of fluorosis. Further investigation is needed to test the association in large-scale follow-up studies.

Estimated Choline Intakes and Dietary Sources of Choline in Pregnant Australian Women.

(1) Background: Despite the postulated importance of choline during pregnancy, little is known about the choline intake of Australians during pregnancy. In this study, we estimated dietary intakes of choline in early and late pregnancy, compared those intakes to recommendations, and investigated food sources of choline in a group of pregnant women in Australia. (2) Methods: 103 pregnant women enrolled in a randomized controlled trial. In early pregnancy (12–16 weeks gestation) and late pregnancy (36 weeks gestation), women completed a food frequency questionnaire designed to assess dietary intake over the previous month. (3) Results: Choline intakes and sources were similar in early and late pregnancy. Median choline intake in early pregnancy was 362 mg/day. Of the women, 39% and 25% had choline intakes above the Australian National Health and Medical Research Council (NHMRC) adequate intake (AI) of >440 mg/day and the European Food Safety Authority (EFSA) AI of >480 mg/day for choline in pregnancy, respectively. Eggs, red meat, nuts, legumes, and dairy accounted for 50% of choline intake, with eggs being the most significant contributor at 17%. (4) Conclusions: Few pregnant women in our study met the AI recommended by the NHMRC and EFSA. In Australia, choline intake in pregnancy may need to be improved, but further work to define choline requirements in pregnancy is required.

The Associations Between Maternal Dietary Choline Intake and Infant Growth Outcomes

The Associations Between Maternal Dietary Choline Intake and Infant Growth Outcomes

Dietary choline increases plasma concentration of gut-derived uremic toxins and metabolites associated with chronic kidney disease progression in apoE-knockout mice with elevated HDL

Background and Aims : Experimental and observational studies have highlighted a positive correlation between increased plasma concentration of choline-derived trimethylamine-N-oxide (TMAO) and adverse cardiovascular events. This study was aimed at investigating how the plasma metabolome of mice prone to atherosclerosis development was modulated by HDL levels and the dietary intake of choline.

Gestational weight gain and dietary energy, iron, and choline intake predict severity of fetal alcohol growth restriction in a prospective birth cohort

Animal models have demonstrated that maternal nutrition can alter fetal vulnerability to prenatal alcohol exposure (PAE). Few human studies have examined the role of nutrition in fetal alcohol spectrum disorders (FASD). Our objectives were to examine whether fetal vulnerability to PAE-related growth restriction is modified by: 1) rate of gestational weight gain; or prenatal dietary intakes of 2) energy, 3) iron, or 4) choline. In a prospective longitudinal birth cohort in Cape Town, South Africa, 118 heavy-drinking and 71 abstaining/light-drinking pregnant women were weighed and interviewed regarding demographics, alcohol, cigarette/other drug use, and diet at prenatal visits. Infant length, weight, and head circumference were measured at 2 wk and 12 mo postpartum. Heavy-drinking mothers reported a binge pattern of drinking [Mean = 129mL (∼7.2 drinks)/occasion on 1.3 d/wk). Rate of gestational weight gain and average daily dietary energy, iron, and choline intakes were similar between heavy-drinking women and controls. In regression models adjusting for maternal age, socioeconomic status, cigarette use, and weeks gestation at delivery, PAE [ounces (30mL) absolute alcohol per day] was related to smaller 2-wk length and head circumference and 12-mo length, weight, and head circumference z-scores (β = -0.43 to -0.67; all P values<0.05). In stratified analyses for each maternal nutritional measure (inadequate compared with adequate weight gain; tertiles for dietary energy, iron, and choline intakes), PAE-related growth restriction was more severe in women with poorer nutrition, with effect modification seen by weight gain, energy, iron, and/or choline for several anthropometric outcomes. Gestational weight gain and dietary intakes of energy, choline, and iron appeared to modify fetal vulnerability to PAE-related growth restriction. These findings suggest a need for screening programs for pregnant women at higher risk of having a child with FASD to identify alcohol-using women who could benefit from nutritional interventions.

Dietary choline supplementation increases the plasma concentration of several amino acids during atherosclerosis development

Background and Aims : Increased dietary intake of choline worsens the development of atherosclerosis in ApoE-KO mice. Gut microbial metabolism of choline results in the production of trimethylamine, which, upon intestinal absorption is converted into the pro-atherogenic molecule trimethylamine-N-oxide (TMAO) in the liver. In this study we investigated if additional endogenous plasma metabolites were modulated by increased choline intake.

Choline Intake and Sensory Processing Symptoms in Children With Autism Spectrum Disorder

ObjectivesSensory processing differences are frequently experienced by both children and adults diagnosed with autism spectrum disorder (ASD) and can greatly influence quality of life. Evidence exists to suggest a potential relationship of one carbon metabolism (OCM) nutrients with core diagnostic aspects of autism, but little is known about OCM nutrients in relation to sensory processing symptoms in autism. This study sought to observe associations between OCM nutrient intake and sensory assessment scores in school-age children with ASD.MethodsFamilies with a child aged 6–10 with ASD were recruited, and a parent completed all questionnaires on their child's behalf (n = 28). The Harvard Youth and Adolescent food frequency questionnaire (FFQ) was used to assess nutrient intake, and the Child Sensory Profile 2 (SP2) was used to assess sensory processing across 13 sensory domains. Linear regression models were developed for all sensory domains with respect to intake of each individual OCM micronutrient (categorized as lower or higher than the median intake, to account for skewing). The following nutrients were included: choline, vitamins B1, B2, B6, B12, folate, and zinc. Models were adjusted for age and use of attention deficit hyperactivity disorder medication.ResultsIntake exceeded the DRI values for the OCM nutrients, with 26 of 28 the children's intake meeting the DRI for each nutrient except choline (11 of 28). Regression analysis showed that dietary choline intake was positively associated with SP2 scores in the avoider, visual, and touch domains (p < 0.05), and was approaching significance in the seeker, auditory, and conduct domains (p < 0.10). Regression analysis of the other OCM nutrients did not produce significant associations with any SP2 score.ConclusionsInitial results from this small observational study suggest that nutritional intake of choline may be associated with sensory processing symptoms in children with ASD, which identifies choline as a potential nutritional support in future studies. Additional research is first needed to confirm these findings in a larger sample, and to explore directionality of potential relationships.Funding SourcesAmerican Egg Board/Egg Nutrition Center.

Relationship Between PEMT Gene rs7946 Polymorphism and Nutritional Choline Status in Association With Nonalcoholic Fatty Liver Risk

ObjectivesPhosphatidylethanolamine N-methyltransferase (PEMT) rs7946 genetic polymorphism and nutritional choline status on nonalcoholic fatty liver (NAFL) risk have not been well elucidated. The aims of the study were to investigate the choline-polymorphic relationship on NAFL risk.MethodsThe study recruited 253 patients with metabolic disorders from one regional hospital in 2020. By abdominal ultrasound diagnosis, 99 patients with hepatic steatosis (HS) and 99 age- and sex-matched controls without HS were included for the study. Habitual dietary choline intakes were assessed using validated quantitative FFQ by a face-to-face interview. PEMT rs7946 (V175M, G to A substitution) polymorphism, blood choline concentrations and metabolic disorders factors were analyzed for their interaction with HS risk.ResultsGenetic distribution of PEMT rs7946 polymorphism significantly differed in controls (GG: 48%, GA, 32%, AA, 20%) and in the HS cases (GG: 69%, GA: 26%, AA: 5%) (p = 0.003). Higher values of body mass index (BMI), serum triglycerides (TG), insulin resistance (HOMO-IR), alanine aminotransferase and lower levels of HDL were associated with HS cases. Plasma free choline levels were significantly higher in HS cases (median:12.4 μM, quartile range (9.9–14.8)) than in controls (median: 10.6 μM, quartile range (9.3–12.8)) (p = 0.001). The daily dietary intake of total choline and the choline derivatives did not differ between the two groups. After adjustment of age, gender, BMI, energy consumption, fiber intake, and blood metabolic markers (TG, LDL, HDL and HOMA-IR), odds ratios of HS were 7-fold increase (OR: 7.6, 95% CI: 2.3–24.4) for patients with PEMT rs7946 GG genotype of high plasma choline level (> median levels: 11.6 μM) as compared with GA/AA genotype of plasma choline level lower than 11.6 μM.ConclusionsThe PEMT rs7946 GG genotype in combination with high plasma choline levels was associated with increased risks of hepatic fat accumulation in patients with metabolic disorders.Funding SourcesThe Ministry of Health and Welfare-affiliated Taipei Hospital. The Ministration of Science and Technology, Taiwan, ROC.

Infant Temperament: Exploring The Potential Role of Maternal Dietary Choline and Folate Consumption During Pregnancy in a Michigan Pregnancy Cohort

ObjectivesCholine and folate are important nutrients involved in fetal brain development, but relationships between diet and infant temperament—an outcome potentially related to neurobehavioral development—have not been widely explored. Our objective was to examine associations between maternal dietary choline and folate intake during pregnancy and infant temperament assessed at 9 months.MethodsParticipants from the Michigan Archive for Research on Child Health (MARCH) prospective pregnancy cohort were included in this analysis (n = 89, mean age [SD] = 30.4 ± 5.5 y). Maternal dietary intake was assessed in mid-pregnancy with the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24). Infant temperament was assessed by parent report using the Infant Behavior Questionnaire-Revised Very Short Form (IBQ-VSF) at the infant 9-month visit (range 8–16 months; mean [SD] 287 ± 31 days after birth). Participants were included if they had data from at least one ASA24 and the IBQ-VSF assessment. Where applicable, the average of two ASA24s was used (n = 45). For twins, infant data was randomly selected to include only one twin (n = 2 mother-child pairs). Independent t-tests were used to assess mean differences in nutrient intake by maternal sociodemographic characteristics. Pearson correlations were used to examine relationships between maternal nutrient consumption and infant temperament scores.ResultsNeither folate nor choline intake differed significantly by maternal age, education, marital status, or income. Choline intake varied by work status (418.76 ± 197.01 mg [not working/part-time] vs. 337.70 ± 150.34 mg [full-time], p = 0.033). Maternal choline intake was related to infant Positive Affect/Surgency, r = 0.213, p = 0.045; when data were limited to the subset with two ASA24s (n = 45), the relationship was no longer significant r = 0.262, p = 0.083. No significant relationships between maternal folate intake and infant temperament were observed.ConclusionsPregnancy dietary folate was not associated with parent-reported temperament at 9 months, but we observed an association between pregnancy dietary choline and Positive Affect/Surgency in infants. In addition to replicating these findings, more research is needed to examine the plausibility of associations reported here.Funding SourcesFunded in part by a grant from the NIH ECHO program.

Choline and Betaine Intakes During Pregnancy in Relation to Risk of Gestational Diabetes Mellitus Among Chinese Women

ObjectivesCholine, an essential nutrient, and its metabolite betaine have been evidenced to exert beneficial effects on maternal lipid/glucose metabolism and fetal development via animal studies. However, whether choline and betaine intakes are associated with risk of Gestational Diabetes Mellitus (GDM) among pregnant women remains unknown. This study aims to investigate associations between dietary choline and betaine intakes during pregnancy and incident GDM among Chinese women.MethodsThis case-control study enrolled 168 hospital-based GDM pregnant women and 375 healthy controls during 24–28 gestational weeks when they underwent 75-g oral glucose tolerance test in Shanghai, China. GDM was diagnosed if one or more of the following glucose levels were met: ≥5.1 nmol/L at 0 h, ≥10.0 nmol/L at 1 h, or ≥ 8.5 nmol/L at 2 h. Choline and betaine intakes during pregnancy were assessed by a validated semi-quantitative food frequency questionnaire via face-to-face interviews. Unconditional logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CIs) for the association between intake of total choline or betaine and GDM risk.ResultsCompared with the healthy pregnant women, those who developed GDM tended to be older, have relatively higher pre-pregnancy BMI, more parities, higher triglycerides, and lower high-density lipoprotein-cholesterol. Generally, there was no significant association between intake of choline or betaine and risk of GDM [OR 0.77, 95% CI (0.41, 1.43) for choline; OR 0.80, 95% CI (0.42–1.52) for betaine] after adjustment for various covariates. However, there was a significant interaction between betaine intake and parity on incident GDM (P = 0.01). Among those with no parity history, the women in the highest quartile of betaine intake had significantly lower incident GDM than those in the lowest quartile [OR 0.25, 95% CI (0.06–0.81)] after adjusting for various covariates. This inverse association was not modified by serum folate status.ConclusionsCholine intake during pregnancy was not associated with risk of GDM among these Chinese women. However, there was an inverse correlation between betaine intake and incident GDM among those Chinese women with no parity history.Funding SourcesThis study was supported by Texas State University startup funds granted to Dr. Jie Zhu.

Pre-diagnosis Dietary One-Carbon Metabolism Micronutrients Consumption and Ovarian Cancer Survival: A Prospective Cohort Study.

Background and AimsEpidemiological evidence on the relation between one-carbon metabolism (OCM) micronutrients intake and ovarian cancer (OC) survival are limited and conflicting. We evaluated the aforementioned associations in a prospective cohort-the Ovarian Cancer Follow-Up Study.MethodsA total of 635 newly diagnosed OC patients aged 18–79 y were enrolled in the present study. Dietary intake related to one-carbon metabolism, including methionine, vitamins B2, B3, B6, B9, B12, choline, and betaine, was assessed using a validated 111-item food frequency questionnaire. Deaths were ascertained until March 31, 2021, via medical records and active follow-up. Cox proportional hazards regression model was used to evaluate the hazard ratios (HRs) and 95% confidence intervals (CIs) for these aforementioned associations.ResultsDuring a median follow-up of 37.2 months (interquartile: 24.7–50.2 months), 114 deaths were identified. We observed an improved survival with the highest compared with the lowest tertile of dietary vitamin B6 (HR = 0.52, 95%CI: 0.32–0.84, P-trend <0.05) and choline intake (HR = 0.50, 95%CI: 0.30–0.83, P-trend <0.05). No significant associations with OC survival were observed for dietary vitamins B2, B3, B9, B12, methionine, and betaine intake. We also observed a curvilinear association between vitamin B6 intake and OC survival (P non-linear <0.05).ConclusionOur study suggests that pre-diagnosis higher intake of vitamin B6 and choline may improve OC survival. Further clarification of these associations is warranted.

Assessment of Dietary Choline Intake, Contributing Food Items, and Associations with One-Carbon and Lipid Metabolites in Middle-Aged and Elderly Adults: The Hordaland Health Study

BackgroundCholine is an essential nutrient for humans and is involved in various physiologic functions. Through its metabolite betaine, it is closely connected to the one-carbon metabolism, and the fat-soluble choline form phosphatidylcholine is essential for VLDL synthesis and secretion in the liver connecting choline to the lipid metabolism. Dietary recommendations for choline are not available in the Nordic countries primarily due to data scarcity. ObjectivesThe aim of this study was to investigate the dietary intake of total choline and individual choline forms, dietary sources, and the association of total choline intake with circulating one-carbon metabolites and lipids. MethodsWe included 5746 participants in the Hordaland Health Study, a survey including community-dwelling adults born in 1925–1927 (mean age 72 y, 55% women) and 1950–1951 (mean age 48 y, 57% women). Dietary data were obtained using a 169-item FFQ, and choline content was calculated using the USDA Database for Choline Content of Common Foods, release 2. Metabolites of the one-carbon and lipid metabolism were measured in a nonfasting blood sample obtained at baseline, and the association with total choline intake was assessed using polynomial splines. ResultsThe geometric mean (95% prediction interval) energy-adjusted total choline intake was 260 (170, 389) mg/d, with phosphatidylcholine being the main form (44%). The major food items providing dietary choline were eggs, low-fat milk, potatoes, and leafy vegetables. Dietary total choline was inversely associated with circulating concentrations of total homocysteine, glycine, and serine and positively associated with choline, methionine, cystathionine, cysteine, trimethyllysine, trimethylamine-N-oxide, and dimethylglycine. A weak association was observed between choline intake and serum lipids. ConclusionsPhosphatidylcholine was the most consumed choline form in community-dwelling adults in Norway. Our findings suggest that choline intake is associated with the concentration of most metabolites involved in the one-carbon and lipid metabolism.

Dietary choline is inversely associated with depressive symptoms: A cross-sectional study of the National Health and Nutrition Examination Survey (NHANES) 2011 to 2018

BackgroundDietary choline has neuroprotective actions. However, the relationship between dietary choline and depression has been little studied. MethodsWe conducted a cross-sectional study to explore the association between dietary choline and depressive symptoms in US adults, using data from the 2011 to 2018 National Health and Nutrition Examination Survey (NHANES). 12,906 individuals age ≥20 who had valid information on dietary choline and depressive symptoms were chosen. Depressive symptoms were defined as the score ≥10 of the Patient Health Questionnaire-9 (PHQ-9). Multivariable logistic regression and the restricted cubic splines were used in analyses. ResultsIn three models, compared with the bottom quintile, each quintile of dietary choline was significantly associated with a lower risk of depressive symptoms. After adjusted all selected confounding factors and covariates, the odds ratio with the 95% confidence interval of depressive symptoms was 0.57 (95% CI:0.38–0.85) for the highest quintile versus the lowest quintile of dietary choline intake. Statistical significance was also maintained in gender and age stratification studies. In the study of the dose-response relationship, an L-shaped relationship between dietary choline and depressive symptoms was found. LimitationsCausality cannot be inferred in a cross-sectional study. ConclusionIn this analysis of US adults, dietary choline intake is inversely associated with the risk of depressive symptoms. An L-shape dose-response relationship between those two was found. Further studies are needed to confirm our results.

Association between dietary choline and betaine intake and 10.6-year cardiovascular disease in adults

BackgroundSeveral studies have assessed the association between dietary choline and betaine and cardiovascular disease (CVD), but their results are inconsistent. The present study aimed to determine the association between dietary intake of choline and betaine and the risk of CVD in the general population over a 10.6-year period of follow-up.MethodsThe present cohort study was conducted on participants in the third wave of the Tehran Lipid and Glucose Study (2006–2008) and was followed-up until March 2018. Dietary intake of choline and betaine was calculated using the United States Department of Agriculture (USDA) database. Patients’ medical records were used to collect data on CVD.ResultsIn this study, 2606 subjects with no previous CVD participated and were followed-up for a median of 10.6 years. During the follow-up periods, 187 incidences of CVD were detected. Results of the Cox proportional hazards regression indicated that neither energy-adjusted total choline nor betaine was associated with the incidence of CVD. Among individual choline forms, only higher intake of free choline (FC) was associated with a lower risk of CVD (HR: 0.64, 95% CI: 0.42–0.98). There was no significant association between each 10 mg/d increase in choline and betaine content of each food category and CVD.ConclusionOur investigation indicates no association between energy-adjusted total choline and betaine and a 10.6-year risk of CVD among adults. Besides, we found no relationship between individual choline forms (except FC) and CVD. We also found energy-adjusted choline and betaine obtained from food categories were not associated with the risk of CVD.

Relationship between different forms of dietary choline and ovarian cancer survival: findings from the ovarian cancer follow-up study, a prospective cohort study.

Background: Choline has important and diverse functions in both cellular maintenance and growth. However, the relationships between the prediagnosis of the different forms of dietary choline intake and ovarian cancer (OC) survival are relatively unknown. This study is the first to investigate this topic based on the Ovarian Cancer Follow-Up Study, a prospective cohort study conducted in China. Methods: In the present study, 635 new cases of ovarian cancer between the ages of 18 and 79 were enrolled. A valid and reliable 111-item food frequency questionnaire was used to assess dietary choline intake. Deaths were ascertained until March 31, 2021, via medical records and active follow-up. Multivariable-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: During a median follow-up of 37.2 months (interquartile: 24.7-50.2 months), 114 deaths were identified. Higher lipid-soluble choline intake was significantly associated with better overall survival for patients with OC (Tertile 3 vs. Tertile 1: HR = 0.56; 95% CI: 0.34, 0.92; P trend = 0.02) in the fully adjusted model. Similar associations were observed for phosphatidylcholine intake (Tertile 3 vs. Tertile 1: HR = 0.55; 95% CI: 0.33, 0.91; P trend = 0.02). However, no associations were found between total water-soluble choline (free choline, phosphocholine, and glycerophosphocholine), sphingomyelin, and betaine intake and OC survival. Significant additive interactions between higher fat-soluble choline intake and positive expression of estrogen receptor and Wilms tumor-1 as well as higher phosphatidylcholine intake and positive expression of estrogen receptor and Wilms tumor-1 on OC survival were detected. Conclusions: Our findings indicate that prediagnosis, total lipid-soluble choline and phosphatidylcholine intake were associated with improved overall survival among OC patients.

Low Intake of Choline Is Associated with Diminished Strength and Lean Mass Gains in Older Adults.

Choline is an essential micronutrient for many physiological processes related to exercise training including biosynthesis of acetylcholine. Though dietary choline intake has been studied in relation to endurance training and performance, none have studied it during resistance exercise training (RET) in older adults. The objective of the study was to examine the relationship between choline intake and muscle responses to RET in older adults. Forty-six, 60-69-year-old individuals (M=19, F=27) underwent 12 weeks of RET (3x/week, 3 sets, 8-12 reps, 75% of maximum strength [1RM], 8 exercises). Body composition (DEXA) and 1RM tests were performed before and after training. After analyzing 1,656 diet logs (3x/week, 46 participants, 12 weeks), participants' mean choline intakes were categorized into three groups: Low (2.9-5.5 mg/kg lean/d), Med-Low (5.6-8.0 mg/kg lean/d), or Adequate (8.1-10.6 mg/kg lean/d). These correspond to <50%, ~63%, and ~85% of Adequate Intake (AI) for choline, respectively. Gains in composite strength (leg press + chest press 1RM) were significantly lower in the Low group compared with the other groups (Low: 30.9 ± 15.1%, Med-Low: 70.3 ± 48.5%, Adequate: 81.9 ± 68.4%; p=0.004). ANCOVA with cholesterol, protein, or other nutrients did not alter this result. Reduced gains in lean mass were also observed in the Low group, compared with higher choline intake of 5.6-10.6 mg/kg lean/d (1.3 ± 0.6% vs. 3.2 ± 0.6%, p<0.05). These data suggest that this population of older adults does not consume adequate choline and lower choline intake is negatively and independently associated with muscle responses to RET.

Choline intake and its dietary reference values in Korea and other countries: a review.

Choline is a water-soluble organic compound that is important for the normal functioning of the body. It is an essential dietary component as de novo synthesis by the human body is insufficient. Since the United States set the Adequate Intakes (AIs) for total choline as dietary reference values in 1998, Australia, China, and the European Union have also established the choline AIs. Although choline is clearly essential to life, the 2020 Dietary Reference Intakes for Koreans (KDRIs) has not established the values because very few studies have been done on choline intake in Koreans. Since choline intake levels differ by race and country, human studies on Koreans are essential to set KDRIs. Therefore, the present study was undertaken to provide basic data for developing choline KDRIs in the future by analyzing data on choline intake in Koreans to date and reference values of choline intake and dietary choline intake status by country and race.

Choline Intake Correlates with Cognitive Performance among Elder Adults in the United States.

Objective This research attempted to explore the neuroprotective effect of choline and establish evidence for future dietary recommendations and nutritional interventions to maintain a proper cognitive function among elders aged >60 years in the US. Method This cross-sectional study retrieved data of 2,393 eligible elderly participants from the 2011-2014 National Health and Nutrition Examination Survey. Combining dietary and supplement choline intake, total choline intake was evaluated using the 24-hour dietary recall method and the dietary supplement questionnaire. Total choline intake was categorized into tertiles, which ranged at <187.60 mg/day (T1), 187.60-399.50 mg/day (T2), and >399.50 mg/day (T3). The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word Learning subtest, Animal Fluency (AF) test, and Digit Symbol Substitution test (DSST) was used to measure cognitive function. Participants who scored the lowest 25th percentile in each cognitive test were classified in the low cognitive function (LC) group. Logistic regression models were implemented to examine the association between total choline intake and the incidence of LC. Results In the CERAD test, the risk of LC was significantly lower in T2 than T1 (OR: 0.668, 95% CI: 0.493-0.904, and P = 0.006) when adjusted for age, gender, BMI, alcohol consumption, and hypertension. Similarly, T2 was associated with a significantly lower risk of LC when assessed by the AF test (OR: 0.606, 95% CI: 0.580-0.724, and P < 0.001) and DSST (0.584, 95% CI: 0.515-0.661, and P < 0.001). In all three cognitive measures, the T3 of the total choline intake was not associated with cognitive function compared to T1. Conclusion Total choline intake at 187.06-399.50 mg/day reduces the risk of LC by approximately 50% compared to intake at <187.6 mg/day. The findings of this research may be used to establish dietary recommendations and nutritional interventions to optimize the cognitive function among elders.