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Jieru P, Zhang S, Cai L, Long W, Wang Y, Zhang L, Dong Y, Zhang W, Liao J, Yang C. Dietary choline intake and health outcomes in U.S. adults: exploring the impact on cardiovascular disease, cancer prevalence, and all-cause mortality. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:59. [PMID: 38711145 DOI: 10.1186/s41043-024-00528-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/16/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Choline, an indispensable nutrient, plays a pivotal role in various physiological processes. The available evidence regarding the nexus between dietary choline intake and health outcomes, encompassing cardiovascular disease (CVD), cancer, and all-cause mortality, is limited and inconclusive. This study aimed to comprehensively explore the relationship between dietary choline intake and the aforementioned health outcomes in adults aged > 20 years in the U.S. METHODS This study utilized data from the National Health and Nutrition Examination Survey between 2011 and 2018. Dietary choline intake was evaluated using two 24-h dietary recall interviews. CVD and cancer status were determined through a combination of standardized medical status questionnaires and self-reported physician diagnoses. Mortality data were gathered from publicly available longitudinal Medicare and mortality records. The study utilized survey-weighted logistic and Cox regression analyses to explore the associations between choline consumption and health outcomes. Restricted cubic spline (RCS) analysis was used for dose‒response estimation and for testing for nonlinear associations. RESULTS In our study of 14,289 participants (mean age 48.08 years, 47.71% male), compared with those in the lowest quintile (Q1), the adjusted odds ratios (ORs) of CVD risk in the fourth (Q4) and fifth (Q5) quintiles of choline intake were 0.70 (95% CI 0.52, 0.95) and 0.65 (95% CI 0.47, 0.90), respectively (p for trend = 0.017). Each 100 mg increase in choline intake was associated with a 9% reduced risk of CVD. RCS analysis revealed a linear correlation between choline intake and CVD risk. Moderate choline intake (Q3) was associated with a reduced risk of mortality, with an HR of 0.75 (95% CI 0.60-0.94) compared with Q1. RCS analysis demonstrated a significant nonlinear association between choline intake and all-cause mortality (P for nonlinearity = 0.025). The overall cancer prevalence association was nonsignificant, except for colon cancer, where each 100 mg increase in choline intake indicated a 23% reduced risk. CONCLUSION Elevated choline intake demonstrates an inverse association with CVD and colon cancer, while moderate consumption exhibits a correlated reduction in mortality. Additional comprehensive investigations are warranted to elucidate the broader health implications of choline.
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Affiliation(s)
- Peng Jieru
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Shanshan Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lin Cai
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Non-communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wencheng Long
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yueshan Wang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lu Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yao Dong
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wenqi Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Juan Liao
- Department of Gastroenterology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
- Non-communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Chunxia Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Zhou R, Yang M, Yue C, Shi Y, Tan Y, Zha L, Zhang J, Chen S. Association between Dietary Choline Intake and Cardiovascular Diseases: National Health and Nutrition Examination Survey 2011-2016. Nutrients 2023; 15:4036. [PMID: 37764819 PMCID: PMC10534328 DOI: 10.3390/nu15184036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Choline is an essential nutrient for human body, but dietary choline is metabolized into the hazard metabolite for the cardiovascular system. Because of the conflicting results between dietary choline intake and cardiovascular disease (CVD) risk in previous studies, we aimed to investigate this in US adults. Non-pregnant participants and those aged >20 years from National Health and Nutrition Examination Survey 2011-2016, with CVD assessment and reliable dietary recall status, were included. The dietary choline intake was assessed as a mean value of two total dietary choline intakes, including dietary choline intake and supplemental choline intake, in 24-h dietary recall interviews. The association between dietary choline intake and the presence of CVD was examined using logistic regression. We enrolled 14,323 participants. The participants without CVD had substantially higher dietary choline intakes (318.4 mg/d vs. 297.2 mg/d) compared to those with CVD (p < 0.05). After multivariable adjustments, the highest quartile of dietary choline intake was associated with a lower CVD risk, OR 0.693, 95%CI [0.520, 0.923], when compared to the lowest quartile. Consistent results were also found for stroke. Subgroup analyses also supported these, especially in participants aged ≥60 years and in those with BMI < 30 kg/m2. We found that a higher dietary choline intake was associated with a lower CVD risk, especially the risk of stroke. Further clinical trials are needed in order to confirm this finding and to provide dietary suggestions for the appropriate amount of choline intake.
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Affiliation(s)
- Rong Zhou
- Department of Intensive Medicine, Qujing First People’s Hospital, Qujing 655000, China; (R.Z.); (M.Y.); (C.Y.)
| | - Mei Yang
- Department of Intensive Medicine, Qujing First People’s Hospital, Qujing 655000, China; (R.Z.); (M.Y.); (C.Y.)
| | - Chaofu Yue
- Department of Intensive Medicine, Qujing First People’s Hospital, Qujing 655000, China; (R.Z.); (M.Y.); (C.Y.)
| | - Yi Shi
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China; (Y.S.); (Y.T.); (S.C.)
| | - Yanan Tan
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China; (Y.S.); (Y.T.); (S.C.)
| | - Lingfeng Zha
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Key Laboratory of Biological Targeted Therapy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Provincial Engineering Research Center of Immunological Diagnosis and Therapy for Cardiovascular Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Junxia Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China; (Y.S.); (Y.T.); (S.C.)
| | - Shaoliang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China; (Y.S.); (Y.T.); (S.C.)
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Soleimani E, Ardekani AM, Fayyazishishavan E, Farhangi MA. The interactive relationship of dietary choline and betaine with physical activity on circulating creatine kinase (CK), metabolic and glycemic markers, and anthropometric characteristics in physically active young individuals. BMC Endocr Disord 2023; 23:158. [PMID: 37491240 PMCID: PMC10367233 DOI: 10.1186/s12902-023-01413-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 07/12/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND There is conflicting evidence on the relationship between dietary choline and betaine with metabolic markers and anthropometric characteristics. The aim of this study is to investigate the relationship between the interaction effects of dietary choline and betaine and physical activity (PA) on circulating creatine kinase (CK), metabolic and glycemic markers, and anthropometric characteristics in active youth. METHODS In this cross-sectional study, data were collected from 120 to 18 to 35-year-old people. The food frequency questionnaire was used to assess dietary data; United States Department of Agriculture website was used to calculate choline and betaine in foods. CK, fasting blood sugar (FBS) and lipid profile markers were measured with ELISA kits. Low-density lipoprotein, and insulin sensitivity markers were calculated. Sociodemographic status, physical activity, and anthropometric characteristics were assessed based on a valid and reliable method. Analysis of co-variance (ANCOVA) tests adjusted for sex, PA, age, energy, and body mass index were used. RESULTS Increasing dietary betaine and total choline and betaine was positively related to weight, waist-to-hip ratio, fat-free mass and bone mass (P < 0.05). Increasing dietary betaine lowered total cholesterol (P = 0.032) and increased high density lipoprotein (HDL) (P = 0.049). The interaction effect of dietary choline and physical activity improved insulin resistance (P < 0.05). As well as dietary betaine interacted with physical activity increased HDL (P = 0.049). In addition, dietary total choline and betaine interacted with physical activity decreased FBS (P = 0.047). CONCLUSIONS In general, increasing dietary choline and betaine along with moderate and high physical activity improved insulin resistance, increased HDL, and lowered FBS in the higher tertiles of dietary choline and betaine.
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Affiliation(s)
- Ensiye Soleimani
- Department of Community Nutrition, Faculty of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abnoos Mokhtari Ardekani
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Science, & Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Ehsan Fayyazishishavan
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX77030, USA
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Vega-Cabello V, Struijk EA, Caballero FF, Lana A, Arias-Fernández L, Banegas JR, Artalejo FR, Lopez-Garcia E. Dietary micronutrient adequacy and risk of multimorbidity in community-dwelling older adults. Am J Clin Nutr 2023:S0002-9165(23)48901-0. [PMID: 37146761 DOI: 10.1016/j.ajcnut.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/21/2023] [Accepted: 05/01/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Multimorbidity refers to the coexistence of multiple chronic health conditions. The effect of nutritional adequacy on multimorbidity is mostly unknown. OBJECTIVE The aim of this study was to assess the prospective association between dietary micronutrient adequacy and multimorbidity among community-dwelling older adults. METHODS This cohort study included 1461 adults aged ≥65 years from the Seniors-ENRICA II cohort. Habitual diet was assessed at baseline (2015 to 2017) with a validated computerized diet history. Intake of 10 micronutrients (calcium, magnesium, potassium, vitamins A, C, D, E, zinc, iodine, and folate) was expressed as a percentage relative to dietary reference intakes, with higher scores indicating greater adequacy. Dietary micronutrient adequacy was computed as the average of all the nutrient scores. Information on medical diagnosis was obtained from the electronic health records up to December 2021. Conditions were grouped into a comprehensive list of 60 categories and occurrence of multimorbidity was defined as having ≥6 chronic conditions. Analyses were conducted using Cox proportional hazard models adjusted for relevant confounders. RESULTS The mean age was 71.0 (SD: 4.2) years and 57.8% of participants were males. During a median follow-up of 4.79 years, we documented 561 incident cases of multimorbidity. Participants in the highest (85.8-97.7%) versus the lowest tertile (40.1-78.7%) of dietary micronutrient adequacy had a lower risk of multimorbidity [fully adjusted hazard ratio (95% confidence interval): 0.75 (0.59-0.95); p trend: 0.02]. A 1-SD increment in minerals adequacy and in vitamins adequacy were associated with lower risk of multimorbidity, although estimates were attenuated after additional adjustment for the opposite subindex [minerals subindex: 0.86 (0.74-1.00); vitamins subindex: 0.89 (0.76-1.04)]. No differences were observed by strata of sociodemographic and lifestyle factors. CONCLUSION A higher micronutrient index score was associated with lower risk of multimorbidity. Improving the dietary micronutrient adequacy could prevent multimorbidity among older adults. CLINICAL TRIAL REGISTRY ClinicalTrials.gov NCT03541135.
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Affiliation(s)
- Veronica Vega-Cabello
- Department of Preventive Medicine and Public Health, School of Medicine. Universidad Autónoma de Madrid, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Ellen A Struijk
- Department of Preventive Medicine and Public Health, School of Medicine. Universidad Autónoma de Madrid, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Francisco Félix Caballero
- Department of Preventive Medicine and Public Health, School of Medicine. Universidad Autónoma de Madrid, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Alberto Lana
- Department of Medicine, School of Medicine and Health Sciences. Universidad de Oviedo/ISPA, Oviedo, Asturias, Spain
| | | | - José Ramón Banegas
- Department of Preventive Medicine and Public Health, School of Medicine. Universidad Autónoma de Madrid, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Fernando Rodríguez Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine. Universidad Autónoma de Madrid, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; IMDEA-Food Institute. CEI UAM+CSIC, Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine. Universidad Autónoma de Madrid, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; IMDEA-Food Institute. CEI UAM+CSIC, Madrid, Spain..
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Díez-Ricote L, Ruiz-Valderrey P, Micó V, Blanco R, Tomé-Carneiro J, Dávalos A, Ordovás JM, Daimiel L. TMAO Upregulates Members of the miR-17/92 Cluster and Impacts Targets Associated with Atherosclerosis. Int J Mol Sci 2022; 23:ijms232012107. [PMID: 36292963 PMCID: PMC9603323 DOI: 10.3390/ijms232012107] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/30/2022] [Accepted: 10/08/2022] [Indexed: 11/24/2022] Open
Abstract
Atherosclerosis is a hallmark of cardiovascular disease, and lifestyle strongly impacts its onset and progression. Nutrients have been shown to regulate the miR-17/92 cluster, with a role in endothelial function and atherosclerosis. Choline, betaine, and L-carnitine, found in animal foods, are metabolized into trimethylamine (TMA) by the gut microbiota. TMA is then oxidized to TMAO, which has been associated with atherosclerosis. Our aim was to investigate whether TMAO modulates the expression of the miR-17/92 cluster, along with the impact of this modulation on the expression of target genes related to atherosclerosis and inflammation. We treated HepG-2 cells, THP-1 cells, murine liver organoids, and human peripheral mononuclear cells with 6 µM of TMAO at different timepoints. TMAO increased the expression of all analyzed members of the cluster, except for miR-20a-5p in murine liver organoids and primary human macrophages. Genes and protein levels of SERPINE1 and IL-12A increased. Both have been associated with atherosclerosis and cardiovascular disease (CDVD) and are indirectly modulated by the miR-17-92 cluster. We concluded that TMAO modulates the expression of the miR-17/92 cluster and that such modulation could promote inflammation through IL-12A and blood clotting through SERPINE1 expression, which could ultimately promote atherosclerosis and CVD.
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Affiliation(s)
- Laura Díez-Ricote
- Nutritional Control of the Epigenome Group, Precision Nutrition and Obesity Program, IMDEA Food, UAM + CSIC, 28049 Madrid, Spain
| | - Paloma Ruiz-Valderrey
- Nutritional Control of the Epigenome Group, Precision Nutrition and Obesity Program, IMDEA Food, UAM + CSIC, 28049 Madrid, Spain
| | - Víctor Micó
- Nutritional Control of the Epigenome Group, Precision Nutrition and Obesity Program, IMDEA Food, UAM + CSIC, 28049 Madrid, Spain
| | - Ruth Blanco
- Nutritional Control of the Epigenome Group, Precision Nutrition and Obesity Program, IMDEA Food, UAM + CSIC, 28049 Madrid, Spain
- Research and Development Department, Biosearch Life Company, 28031 Madrid, Spain
| | - Joao Tomé-Carneiro
- Epigenetics of Lipid Metabolism Group, Precision Nutrition and Cardiometabolic Health Program, IMDEA Food, UAM + CSIC, 28049 Madrid, Spain
| | - Alberto Dávalos
- Epigenetics of Lipid Metabolism Group, Precision Nutrition and Cardiometabolic Health Program, IMDEA Food, UAM + CSIC, 28049 Madrid, Spain
| | - José M. Ordovás
- Nutritional Control of the Epigenome Group, Precision Nutrition and Obesity Program, IMDEA Food, UAM + CSIC, 28049 Madrid, Spain
- Nutrition and Genomics Laboratory, JM_USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA
| | - Lidia Daimiel
- Nutritional Control of the Epigenome Group, Precision Nutrition and Obesity Program, IMDEA Food, UAM + CSIC, 28049 Madrid, Spain
- Correspondence: ; Tel.: +34-917278100 (ext. 309)
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