Several mechanisms have been described through which dietary intake of choline and its derivative betaine may be associated in both directions with subclinical atherosclerosis. We assessed the association of dietary intake of choline and betaine with cardiovascular risk and markers of subclinical cardiovascular disease.
Data from 3924 Jackson Heart Study (JHS) African-American participants with complete food frequency questionnaire at baseline and follow-up measurements of heart disease measures were used. Multivariable linear regression models were employed to assess associations between choline and betaine intake with carotid intima-media thickness, coronary artery calcium, abdominal aortic calcium and left ventricular mass. Cox proportional hazards regression models were used to estimate associations with time to incident coronary heart disease (CHD), ischemic stroke and cardiovascular disease (CVD).
During an average nine years of follow-up, 124 incident CHD events, 75 incident stroke events and 153 incident CVD events were documented. In women, greater choline intake was associated with lower left ventricular mass (p = 0.0006 for trend across choline quartiles) and with abdominal aortic calcium score. Among all JHS participants, there was a statistically significant inverse association between dietary choline intake and incident stroke, β = −0.33 (p = 0.04). Betaine intake was associated with greater risk of incident CHD when comparing the third quartile of intake with the lowest quartile of intake (HR 1.89, 95 % CI 1.14, 3.15).
Among our African-American participants, higher dietary choline intake was associated with a lower risk of incident ischemic stroke, and thus putative dietary benefits. Higher dietary betaine intake was associated with a nonlinear higher risk of incident CHD.
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The JHS is supported and conducted in collaboration with Jackson State University (N01-HC-95170), University of Mississippi Medical Center (N01-HC-95171), and Tougaloo College (N01-HC-95172) NIH contracts from the National Heart, Lung, and Blood Institute (NHLBI) and the National Center on Minority Health and Health Disparities (NCMHD) with additional support from NHLBI contract HL076784 and the National Institute of Aging (AG028321). The investigators thank JHS study participants and staff for their valuable contributions and acknowledge the important contributions of Janice Maras, at Northeastern University, to the calculation of the choline and betaine variables. The results described in this article have been presented in part during the American Heart Association Scientific Sessions Conference, November 2014 in Chicago, IL, USA. AB and KLT designed research; HRM, SKM and AB conducted research; HRM, SKM, DTD and AB analyzed data; AB, DTD and KLT wrote the paper; and AB had primary responsibility for final content. All authors read and approved the final manuscript.
Conflict of interest
None of the authors had a personal or financial conflict of interest.
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Millard, H.R., Musani, S.K., Dibaba, D.T. et al. Dietary choline and betaine; associations with subclinical markers of cardiovascular disease risk and incidence of CVD, coronary heart disease and stroke: the Jackson Heart Study. Eur J Nutr 57, 51–60 (2018). https://doi.org/10.1007/s00394-016-1296-8
- Subclinical measures of cardiovascular disease
- Incident coronary heart disease
- The Jackson Heart Study