Population-based Cohort Study Research Articles

Intrapartum antibiotic exposure and infectious diseases in childhood – a population-based cohort study

Intrapartum antibiotics are used to prevent group B streptococcus disease in newborn infants. We hypothesised that intrapartum antibiotic exposure is associated with the occurrence of childhood infectious diseases because it influences the development of the gut microbiome. The cohort for this population-based study comprised vaginally delivered children born in Northern Finland in 2007-2018. We used structured electronic medical records linked to comprehensive national registers. Primary outcome was the number of infectious disease episodes leading to an emergency room visit, outpatient hospital visit, or hospitalisation from birth until five years of age. Analyses were performed on 9733 children (48.8% girls) exposed to intrapartum antibiotics and on 35,842 unexposed children (49.9% girls). Exposure to intrapartum antibiotics was associated with increased risk of any infectious disease episode at the ages 7-28 days (adjusted incidence rate ratio [aIRR] 1.30, 95% CI 1.10-1.54) and 1-2 years (aIRR 1.10, 95% CI 1.02-1.18). The occurrence of urinary tract infections was associated with the exposure to intrapartum antibiotics whereas the occurrence of severe infections caused by pathogens susceptible to penicillin was reversely associated with the exposure to intrapartum antibiotics. Maternal intrapartum antibiotics were associated with the occurrence of infectious diseases in the offspring. The observed associations appeared to depend on bacterial pathogens and their antimicrobial susceptibility to penicillin. Pediatric Research Foundation, Alma och K.A. Snellman Foundation, Orion Research Foundation, Päivikki and Sakari Sohlberg Foundation, Finnish Medical Foundation, Academy of Finland, Finland.

Trajectories of functional limitations, health-related quality of life and societal costs in individuals with long COVID: a population-based longitudinal cohort study

ObjectivesTo examine trajectories of functional limitations, fatigue, health-related quality of life (HRQL) and societal costs of patients referred to long COVID clinics.DesignA population-based longitudinal cohort study using real-time user data.Setting35...

Human papillomavirus infection is associated with increased risk of new-onset hidradenitis suppurativa: a population-based cohort study

BackgroundThe exact cause of hidradenitis suppurativa (HS) remains unclear, though emerging research suggests a link between infectious agents and inflammatory skin diseases. The association between human papillomavirus (HPV) infection and HS development, however, has not been studied. ObjectiveTo evaluate the risk of incident HS in HPV infection patients. MethodsUsing the TriNetX research network, we conducted a retrospective cohort study of patients diagnosed with HPV and matched controls. Propensity score matching adjusted for variables like age, sex, race, BMI, comorbidities, and lifestyle factors. The primary outcome was new-onset HS, analyzed across demographic and clinical factors. Hazard ratios with 95% confidence intervals (95% CI) were calculated to assess risk. ResultsAfter matching, both the HPV and control cohorts included 582,007 patients. HPV-infected individuals had a significantly higher risk of developing HS (HR: 1.356, 95% CI: 1.290-1.427). This increased risk was consistent across various demographic and clinical groups. Sensitivity analyses confirmed the robustness of these findings. LimitationsRetrospective cohort design. ConclusionsHPV infection is linked to a higher risk of HS, suggesting a potential association. Further research is required to validate these results and assess their impact in different populations and clinical settings but could also elucidate a potential impact of other infections involved in the pathogenesis of HS.

Determinants of Between-Person Variation in Shoulder Pain in Individuals With Spinal Cord Injury: A Population-Based Cohort Study.

The aim of the study was to evaluate determinants of between-person variation in shoulder pain ("yes"/"no") in individuals with spinal cord injury living in Switzerland. This longitudinal study used data from the Swiss Spinal Cord Injury Cohort community surveys 2012, 2017, and 2022. Logistic regression analyses were used to identify determinants of between-person variability in shoulder pain while controlling for within-person variability. The prevalence of shoulder pain was 34.4% (95% CI = 33.0-35.9) when studying 4393 completed questionnaires. Significant determinants for between-subject variability revealed higher likelihoods for shoulder pain in females as compared with males (odds ratio: 1.57; 95% CI = 1.21-2.05), and when spasticity (1.49; 1.14-1.95), contractures (2.77; 2.21-3.48), and depression (1.39; 1.02-3.48) were present. In addition, shoulder pain presented highest likelihoods in individuals with incomplete tetraplegia (1.81; 1.32-2.48) versus incomplete paraplegia, in individuals over 26 yrs since injury (1.65; 1.15-2.37) versus up to 5 yrs since injury, and in individuals using a manual (2.17; 1.53-3.08) or electrical (2.16; 1.41-3.31) wheelchair versus no aids. There were significant interaction effects for gender with time since injury, contractures, and depression. Determinants of between-subject variability in shoulder pain were female gender, lesion severity, time since injury, specific health conditions, and wheelchair use.

Burden of infant group B Streptococcus disease and impact of maternal screening and antibiotic prophylaxis in Ontario, Canada: a population-based cohort study

Group B Streptococcus (GBS) significantly contributes to neonatal sepsis and meningitis, with varying disease rates reported globally and limited population-based data. We estimated infant GBS disease burden in Ontario, Canada and assessed the association of maternal GBS screening (35-37 weeks' gestation) and intrapartum antibiotic prophylaxis (IAP) provision with infant disease rates. Our population-based cohort study included pregnant individuals and their offspring from April 2012 to March 2018, utilising the provincial birth registry linked to health administrative data. GBS cases were ascertained through culture results and diagnostic codes. We calculated incidence rates for early-onset disease (EOD: 0-6 days), late-onset disease (LOD: 7-89 days), and ultra-LOD (ULOD: 90-365 days). Adjusted incidence rate ratios (aIRR) were derived via log-binomial regression to compare infant GBS rates according to screening and IAP-receipt. Among 776,148 liveborn infants, we identified 803 with GBS, with multiples exhibiting a threefold incidence increase. Incidence rates of EOD, LOD and ULOD were 0.49, 0.46 and 0.07 per 1000 livebirths, respectively. Of eligible pregnancies, 94% were screened; 23% screened positive, and 81% of them received IAP. Nearly 12% of term EOD infants had mothers who missed IAP despite screening positive. Maternal screening was associated with lower rates of any infant GBS disease (aIRR: 0.60; 95% CI: 0.45, 0.80). Among screen-positive births, IAP-receipt was associated with reduced rates of EOD (aIRR: 0.72, 95% CI: 0.48, 1.29) and LOD/ULOD (aIRR: 0.69; 95% CI: 0.46, 1.05), but confidence intervals included 1.0. Our study, the largest Canadian investigation into infant GBS disease, highlights both widespread adoption and ongoing challenges of the current prevention strategy. Canadian Institutes of Health Research.

Intellectual Disabilities and Risk of Cardiovascular Diseases: A Population-based Cohort Study

Intellectual Disabilities and Risk of Cardiovascular Diseases: A Population-based Cohort Study

Brain metastasis burden and management in patients with small cell lung cancer in Canada: a retrospective, population-based cohort study

Patients with small cell lung cancer (SCLC) have historically been characterised by poor overall survival (OS) and high risk for brain metastasis (BM), but large-scale real-world evidence on clinical presentation and treatment in this population is lacking. Our aim was to describe the clinical characteristics and outcomes of patients with SCLC and BM in Ontario, Canada. This population-based, retrospective cohort study included all patients in Ontario, Canada, who were diagnosed with SCLC between April 1, 2010, and March 31, 2018. Data were analysed between June 2, 2022, and December 20, 2023. Patients with second cancer diagnosis were excluded. Patients were identified and data retrieved from the Institute for Clinical Evaluative Sciences (ICES) databases. Kaplan-Meier and multivariable Cox regression analyses were performed to compare OS between patient cohorts stratified by disease stage, BM diagnosis, and intracranial treatment modality. Propensity score-matching based on age, disease stage, time to BM, and receipt of chemotherapy was performed to compare OS between intracranial treatment modalities. 8705 patients were included (male: 4433, female: 4272). Median age at diagnosis was 68 years (interquartile range, IQR, 61-75). Median OS of all patients was 7.46 months (95% confidence interval, CI, 7.23-7.69). 32% (n=2686) of patients developed BM (synchronous, 43.7%; asynchronous, 56.3%) with median OS of 9.76 months (95% CI, 9.36-10.22). 102 (4%), 1654 (62%), and 930 (35%) patients received stereotactic radiosurgery (SRS), whole brain radiation therapy (WBRT), or no treatment, respectively, for their BM in the first-line setting or after prophylactic cranial irradiation (PCI). In propensity score-matched analyses, OS from time of BM diagnosis was non-inferior between SRS- and WBRT-treated cohorts among patients who did not receive PCI (hazard ratio, HR, 0.68, 95% CI, 0.44-1.06, p=0.091, n=86) and in favour of SRS for those who received PCI prior to BM development (HR, 0.47, 95% CI, 0.31-0.72, p=0.0042, n=112). OS for patients with SCLC remains poor, and many patients present with BM. With careful selection, patients with SCLC and BM may benefit from SRS treatment. Future research should incorporate information on burden of intracranial disease and novel immunotherapies. None.

Endometriosis and Mental Health: A Population-Based Cohort Study

Endometriosis and Mental Health: A Population-Based Cohort Study

Utilization of Surgical Fixation for Distal Radius Fractures in the United States: A Population-Based Cohort Study

In contrast to younger adult populations, clinical practice guidelines state that there is no difference in long-term functional outcomes in surgically versus nonoperatively treated distal radius fractures in patients ≥65 years old. In this study, we asked the following questions: (1) has treatment for distal radius fractures in younger and older adult populations changed over time? (2) What patient and surgeon factors are associated with treatment trends? Using a national administrative claims database, we identified patients aged ≥18 years with isolated, closed distal radius fractures, subdivided by age (18-64 years, ≥65 years old). We characterized the proportion of patients who underwent open reduction and internal fixation (ORIF) over time. We stratified our analysis by surgeon subspecialty, region, and mean area income. Changes in ORIF utilization over time were evaluated using linear regression models. The proportion of distal radius ORIF, including in patients aged ≥65 years, increased from 10.4% in 2012 to 15.1% in 2020. Of the ORIF procedures performed, hand surgeons accounted for an increasing proportion over time, with a corresponding decrease in those performed by general orthopedic surgeons. The proportion of ORIF increased over time in all US regions, with the largest rate of increase in the Midwest for patients aged ≥65 years and Northeast for patients aged 18-64 years. Patients living in areas with mean family income ≥$65,000 were more likely to undergo ORIF. The proportion of distal radius ORIF including in older adult populations is increasing in all US regions, and an increasing proportion is performed by hand surgeons. Further analysis of the drivers of these trends is warranted, given the rising incidence of surgical treatment in older patients, which could reflect evolving patient activity demands and suggest a need to further evaluate conventional treatment algorithms based on age.

Ibuprofen for Acute Pericarditis and Associated Cardiovascular Risks: A Danish Nationwide, Population-Based Cohort Study

Ibuprofen for Acute Pericarditis and Associated Cardiovascular Risks: A Danish Nationwide, Population-Based Cohort Study

Sex differences in the impact of lower respiratory tract infections on older adults’ health trajectories: a population-based cohort study

BackgroundLower respiratory tract infections (LRTIs) are a major global health concern, particularly among older adults, who have an increased risk of poorer health outcomes that persist beyond the acute infectious episode. We aimed to investigate the mid-term (up to 7 years) and long-term (up to 12 years) effects of LRTIs on the objective health status trajectories of older adults, while also considering potential sex differences.MethodsCohort data of adults aged ≥ 60 years from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K) collected between 2001 and 2016 was analyzed. Information on LRTIs was obtained from the Swedish National Patient Register, and objective health status was assessed using the Health Assessment Tool (HAT) which incorporates indicators of mild and severe disability, cognitive and physical functioning, and multimorbidity. The LRTI-exposed and -unexposed participants were matched using propensity score matching based on an expansive list of potential confounders. Mixed linear models were used to analyze the association between LRTIs and changes in HAT scores.ResultsThe study included 2796 participants, 567 of whom were diagnosed with a LRTI. LRTIs were independently associated with an excess annual decline of 0.060 (95% CI: -0.107, -0.013) in the HAT score over a 7-year period. The associations were stronger among males, who experienced an excess annual decline of 0.108 (95% CI: -0.177, -0.039) in up to 7-years follow-up, and 0.097 (95% CI: -0.173, -0.021) in up to 12-years follow-up. The associations were not statistically significant among females in either follow-up period.ConclusionLRTIs, even years after the acute infectious period, seem to have a prolonged negative effect on the health of older adults, particularly among males. Preventative public health measures aimed at decreasing LRTI cases among older adults could help in preserving good health and functioning in old age.

Are People Living With Dementia Receiving High Intensity Statin Therapy After Stroke? A Population-Based Cohort Study.

This Australian population-based study investigated statin intensity after hospitalization for ischemic stroke in a matched cohort of people living with and without dementia. We identified all patients aged ≥ 30 years hospitalized in the state of Victoria, Australia, for ischemic stroke from July 1, 2013 to April 30, 2018 from the Victorian Admitted Episodes Data set. People with dementia were matched 1:4 for sex, 5-year age group and index date ± 90 days with people without dementia. Records of statin dispensing within 60 days postdischarge were extracted from prescription claims data. The intensity of the first postdischarge statin dispensing was determined. Odds ratios for high versus low-moderate intensity and no statin dispensing were estimated using multinomial logistic regression adjusted for factors including age, sex, and comorbidity. The cohorts comprised 11,105 people (dementia: N = 2221; without dementia: N = 8884 and 52% were female. Compared to people without dementia, people with dementia had 35% (95% confidence interval [CI]: 24%-44%) lower odds of receiving a high intensity versus a low-moderate intensity statin and 54% (95% CI: 48%-59%) lower odds of receiving a high intensity versus no statin. Compared to men, women with and without dementia had 16% (95% CI: 5%-25%) lower odds of receiving a high- versus low-moderate intensity statin and 28% (95% CI: 19%-35%) lower odds of receiving a high intensity versus no statin. People living with dementia are less likely to receive high-intensity statins post-discharge compared to people without dementia. There is a gender gap in receipt of guideline-recommended high-intensity statin therapy for secondary prevention after ischemic stroke. Guidelines recommend all people with reasonable life expectancy receive a high-intensity statin after stroke to reduce the risk of recurrent stroke and other adverse cardiovascular events. More research is needed to understand why people living with dementia might not receive guideline recommended care, and how statin use and statin intensity impact the health outcomes of people living with dementia and stroke.

Risk of Self-Harm Among Individuals Diagnosed With Endometriosis: A Population-Based Cohort Study

Risk of Self-Harm Among Individuals Diagnosed With Endometriosis: A Population-Based Cohort Study

A glossary for social-to-biological research

Research has shown that our socially structured experiences elicit a biological response, leading to the observation that numerous biomarkers (objective biological measures that are representative of various biological processes) are socially patterned. This ‘social-to-biological’ research is of interest to researchers across multiple disciplines and topics and especially to those with an interest in understanding the biological embodiment of the ‘social environment’. Combining social and biomarker data is also of relevance to those examining the biological determinants of social behaviours (for example, the relationship between genetics and certain behaviours like smoking). However, as much of the research involving biomarkers and social data are multidisciplinary, researchers need to understand why and how to optimally use and combine such data. This article provides a resource for researchers by introducing a range of commonly available biomarkers across studies and countries. Because of the breadth of possible analyses, we do not aim to provide an exhaustive and detailed review of each. Instead, we have structured the glossary to include: an easy-to-understand definition; a description of how it is measured; key considerations when using; and an example of its use in a relevant social-to-biological study. We have limited this glossary to biomarkers that are available in large health and social surveys or population-based cohort studies and focused on biomarkers in adults. We have structured the glossary around the main physiological systems studied in research on social to biological transition and those that go across systems and highlight some basic terms and key theoretical concepts.

Impact of surgical intervention on overall survival in malignant pleural mesothelioma: A population-based cohort study with propensity score matching

BackgroundMalignant pleural mesothelioma (MPM) is a rare and aggressive cancer with limited treatment options. This study aims to assess the impact of surgical intervention on overall survival (OS) in patients with MPM and to identify prognostic factors influencing survival outcomes. MethodsData from the SEER-17 Database between 2000 and 2019 were analyzed. Patients were categorized into surgery and no-surgery groups. Survival analyses were conducted using Kaplan-Meier curves and Cox proportional hazards models. Propensity score matching (PSM) was applied to reduce biases. ResultsThe study included a total of 3901 MPM patients, with 1190 in the surgery group and 2711 in the no-surgery group. The median OS for the entire cohort was 10 months. The surgery group had a median OS of 15 months compared to 8 months in the no-surgery group (p < 0.001). The 1-year and 5-year OS rates for surgery patients were 56.9% and 11.2%, respectively, while for no-surgery patients, they were 34.9% and 3.7% (p < 0.001). Multivariate analysis indicated that no-surgery was an independent risk factor for worse OS (HR 1.38, 95% CI 1.21-1.39, p < 0.001). After PSM, no-surgery remained an independent risk factor influencing OS. Subgroup analysis indicated that surgery benefited most groups except those aged ≥80 years, bilateral disease, N3 stage, and certain histological grades. ConclusionSurgical intervention significantly improves survival in patients with MPM. However, benefits vary across subgroups, and careful consideration of patient-specific factors is essential.

Association between thyroid function and osteoarthritis: a population-based cohort study

ObjectivesPrevious genetic and animal studies indicated a causal role of thyroid hormones in osteoarthritis (OA), which has not been observed in the general population. We aimed to investigate whether thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were associated with hand, hip, or knee OA. MethodsParticipants from the Rotterdam Study with baseline TSH, FT4, and joint radiographs were included. We used multivariable regression models to investigate the association of thyroid function with the prevalence, severity, incidence, and progression of OA. We conducted stratified analyses by sex, age, body mass index (BMI) and weight-bearing physical activity. ResultsAmong 9054 participants included (mean age 65 years, 56.3% women), higher FT4 concentrations were associated with an increased risk of prevalent knee OA (OR 1.04 per pmol/L, 95% CI 1.01-1.06, corresponding to an OR of 1.62 across the reference range [i.e., 14pmol/L changes] of FT4) and more severe knee OA. There was a positive association between FT4 and overall progression of knee OA (OR 1.03 per pmol/L, 1.00-1.07). No association of TSH with hand, hip, or knee OA was identified. Stratified analysis revealed an association between FT4 and prevalent knee OA among individuals with BMI≥30 kg/m2 (OR 1.05 per pmol/L, 1.01-1.08) and those with high levels of weight-bearing physical activity (OR 1.05 per pmol/L, 1.01-1.10). ConclusionsOur study indicated that higher FT4 concentrations may increase the risk of knee OA. This association might be greater in individuals with extra joint loading, such as those with obesity.

Association of Snoring and Daytime Sleepiness With Subsequent Incident Hypertension: A Population-Based Cohort Study.

There is a strong association between obstructive sleep apnea and hypertension, but the effects of obstructive sleep apnea symptoms on the risk of incident hypertension are not well documented. The aim of this prospective study was to examine whether snoring and sleepiness are associated with incident hypertension. Data from the French population-based CONSTANCES cohort were analyzed. Normotensive participants, aged 18 to 69 years, were included between 2012 and 2016 and screened for snoring, morning fatigue, and daytime sleepiness in 2017 using items of the Berlin Questionnaire. We used Cox models, adjusted for multiple potential confounders, including body mass index, baseline blood pressure, sleep duration, and depressive symptoms, to compute hazards ratios of incidentally treated hypertension. Among 34 727 subjects, the prevalence of self-reported habitual snoring, morning fatigue, and excessive daytime sleepiness (≥3× a week for each) was 23.6%, 16.6%, and 19.1%, respectively. During a median follow-up of 3.1 years (interquartile range, 3.0-3.5), the incidence of treated hypertension was 3.8%. The risk of de novo treated hypertension was higher in participants who reported habitual snoring (adjusted hazard ratio, 1.17 [95% CI, 1.03-1.32]) and excessive daytime sleepiness (adjusted hazard ratio, 1.42 [95% CI, 1.24-1.62]), and increased with the weekly frequency of symptoms, with a dose-dependent relationship (Ptrend≤0.02 for all symptoms). Self-reported snoring and excessive daytime sleepiness are associated with an increased risk of developing hypertension. Identification of snoring and daytime sleepiness may be a useful public health screening tool in primary care for hypertension prevention.

The association between sleep duration trajectories and successful aging: a population-based cohort study

BackgroundInsufficient or excessive sleep duration are associated with increased risk of individual adverse outcomes. However, it remains largely unknown whether sleep duration trajectories are associated with overall health among older adults. This study aimed to examine the association between sleep duration trajectories and successful aging.MethodsIn the China Health and Retirement Longitudinal Study (CHARLS), 3,306 participants without major chronic diseases at baseline and survived to aged 60 years and older at the end of follow-up were potentially eligible participants. Total sleep duration was assessed in 2011, 2013, and 2015, and successful aging was evaluated in 2020 and was defined as being free of major chronic diseases, no physical impairment, high cognitive function, good mental health, and active engagement with life. Latent class mixed model (LCMM) was used to identify sleep duration trajectories and logistic regression was performed to explore the association between these trajectories and successful aging.ResultsDuring the 9-year follow-up, 455 individuals (13.8%) met the criteria for successful aging. Five sleep duration trajectories were identified: normal stable, long stable, decreasing, increasing, and short stable. Compared with the normal stable trajectory, the adjusted ORs (95% CI) for achieving successful aging for participants with long stable, decreasing, increasing, and short stable trajectories were 1.00 (0.77, 1.30), 0.64 (0.40, 1.03), 0.64 (0.45, 0.92), and 0.48 (0.35, 0.66), respectively. The stratified and sensitivity analyses were generally consistent with the main results.ConclusionsIncreasing and short stable trajectories of sleep duration are associated with lower odds of successful aging relative to participants in the normal stable trajectory. The findings underscore the critical importance of monitoring dynamic changes in sleep duration in middle-aged and older Chinese adults.

Emotional and behavioral problems are associated with hypothalamic development from childhood to adolescence: Findings from a longitudinal cohort study

BackgroundDespite the pivotal role of the hypothalamus in regulating various physiological processes, our understanding of its developmental trajectory and subregional organization during childhood and adolescence remains limited, as well as how emotional and behavioral problems can impact hypothalamic development, potentially leading to neurodevelopmental disorders. MethodsThis population-based longitudinal cohort study utilized data from a representative sample of 702 children, who were followed two to five times. Emotional and behavioral problems were assessed using the Strengths and Difficulties Questionnaire (SDQ). Linear mixed models were employed to delineate developmental trajectories and behavioral regulation. ResultsUsing an automated segmentation technique, we quantified the volumes and asymmetries of the hypothalamus and its subregions in a large longitudinal sample of 702 subjects aged 6–15 years with 1371 MRI scans, and mapped their developmental trajectories. Our findings indicate that while the anterior and posterior regions of the hypothalamus exhibit a tendency toward decline, the tubular region demonstrates a linear increase which is influenced by lateralization, sex, and intracranial volume. Furthermore, emotional and behavioral problems - particularly emotional symptoms and peer relationship problems - are related to faster development in superior tubular and anterior-superior regions. ConclusionsIn this study, we initially delineated the developmental trajectories of the hypothalamus and its subregions from childhood to adolescence based on a longitudinal cohort study. Our findings revealed that the development of hypothalamus followed the pattern of “lateral early to medial late, and dorsomedial early to ventromedial late”, and the emotional and behavioral problems are associated with faster hypothalamic development. This study provides preliminary evidence regarding the impact of emotional and behavioral problems on the dynamic development of the hypothalamus, offering a crucial foundation for future prevention and intervention strategies targeting cognitive and emotional behavioral problems.

Association of dietary choline intake with incidence of dementia, Alzheimer's disease and mild cognitive impairment: a large population-based prospective cohort study

ObjectiveExplore the associations between dietary choline intake and the incidence of dementia, Alzheimer's disease (AD), mild cognitive impairment (MCI), and current cognitive performance in the UK Biobank cohort. MethodsDietary choline intake was categorized into quartiles of consumption based on 24-hour dietary recalls, with units expressed as milligrams per day. Diagnoses of dementia, AD, and MCI were identified using ICD-9/10 codes. Current cognitive performance was assessed via the computerized touchscreen interface. After adjusting for sociodemographic factors, dietary and lifestyle behaviors, and comorbid conditions, Cox proportional hazards regression, logistic regression, and restricted cubic splines were used to analyze the association between choline intake and dementia or cognitive performance. ResultsAmong 125,594 participants (55.8% female), with a mean age of 56.1 years (range: 40 to 70 years) at baseline, and a median follow-up of 11.8 years, 1,103 cases of dementia (including 385 AD) and 87 cases of MCI were recorded. U-shaped associations were observed between choline intake and dementia and AD. Participants in the 2nd quartile of total choline intake had lower risks compared to those in the lowest quartile, with HR of 0.80 (95% CI: 0.67, 0.96) for dementia and 0.76 (0.58, 1.00) for AD. Moderate intake of choline derivative, including free choline (HR, 0.77; 95%CI, 0.65, 0.92), phosphatidylcholine (0.82; 0.68, 0.98), sphingomyelin (0.82; 0.69, 0.98) and glycerophosphocholine (0.83; 0.70, 1.00), were associated with a 17% to 23% lower odds of dementia. Additionally, moderate total choline intake was associated with an 8% to 13% lower odds of poor cognitive performance in visual attention (OR, 0.92; 95%CI, 0.86, 0.99), fluid intelligence (0.87; 0.82, 0.92), and complex processing speed (0.90; 0.84, 0.95). ConclusionsIn conclusion, our findings suggest that moderate dietary choline intake, ranging from 332.89 mg/d to 353.93 mg/d, is associated with lower odds of dementia and better cognitive performance.