Betaine Supplementation Moderately Increases Total Cholesterol Levels: A Systematic Review and Meta-Analysis

Low Dietary Betaine Intake Is Associated with Increased Blood Cholesterol in Mexican Subjects

BACKGROUND

Betaine, an osmolyte derivative of the metabolite choline and the amino acid glycine, acts as a methyl donor in the conversion of homocysteine to methionine and is involved in the maintenance of adequate lipid metabolism. There is growing evidence for the role of betaine in the development of various lipid-related diseases, including dyslipidemia and cardiovascular risk. This study aimed to analyze associations between betaine intake and blood lipid profiles in Mexican subjects.

METHODS

A total of 212 adults were randomly recruited in the city of Tijuana, Baja California, Mexico. Betaine intake was estimated using Nutritionist Pro software. Body composition and metabolic measurements were obtained by conventional methods. In the total sample, the average intake of betaine was 14.32 mg/d. Individuals were categorized into three groups according to tertiles of betaine consumption: tertile/group 1 (<4.16 mg/d), tertile/group 2 (4.16-12.02 mg/d), and tertile/group 3 (>12.02 mg/d).

RESULTS

Compared to group 3, subjects within group 1 had higher serum levels of total cholesterol (p = 0.001), LDL-c (p = 0.026), and non-HDL-c (p = 0.021). In addition, significant negative Pearson correlations were found between betaine intake and the serum levels of total cholesterol (r = -0.432, 95% CI, -0.684, -0.185, p = 0.001), LDL-c (r = -0.370, 95% CI, -0.606, -0.134, p = 0.002), and non-HDL-c (r = -0.351, 95%CI, -0.604, -0.098, p = 0.007).

CONCLUSIONS

Our results show that a low intake of betaine is associated with elevated blood cholesterol levels in Mexican subjects. On this basis, betaine consumption could be used as an additional dietary measure for cardiovascular care. However, additional studies are required to confirm our results in other Mexican regions as well as in other populations worldwide.

Betaine as a Functional Ingredient: Metabolism, Health-Promoting Attributes, Food Sources, Applications and Analysis Methods

Betaine is a non-essential amino acid with proven functional properties and underutilized potential. The most common dietary sources of betaine are beets, spinach, and whole grains. Whole grains-such as quinoa, wheat and oat brans, brown rice, barley, etc.-are generally considered rich sources of betaine. This valuable compound has gained popularity as an ingredient in novel and functional foods due to the demonstrated health benefits that it may provide. This review study will provide an overview of the various natural sources of betaine, including different types of food products, and explore the potential of betaine as an innovative functional ingredient. It will thoroughly discuss its metabolic pathways and physiology, disease-preventing and health-promoting properties, and further highlight the extraction procedures and detection methods in different matrices. In addition, gaps in the existing scientific literature will be emphasized.

Dietary Betaine Interacts with Very Long Chain n-3 Polyunsaturated Fatty Acids to Influence Fat Metabolism and Circulating Single Carbon Status in the Cat

Simple Summary

The domestic cat can metabolize and thrive on a range of intakes of different dietary polyunsaturated fatty acids (PUFA). However, changes in the intake of PUFA have relatively unknown effects on concentrations of other fatty acids and metabolites. Similarly, the effect of increasing dietary betaine (which is a single carbon donor) on circulating concentrations of metabolites and fatty acids is relatively unreported. As might be expected, increasing intake of specific dietary fatty acids resulted in an increased concentration of that fatty acid and moieties containing that fatty acid. Dietary betaine increased concentration of many compounds associated with single carbon metabolism (e.g., dimethyl glycine, sarcosine, methionine) and many PUFA such as the n-6 PUFA linoleic acid (LA) and arachidonic acid (ARA) and the n-3 fatty acids α-linolenic acid (αLA), and docosahexaenoic acid (DHA). Dietary betaine interacted with the addition of dietary fish oil to dampen diet-induced increase of ARA while potentiating the increase of circulating DHA occurring with increased DHA dietary intake. Dietary betaine and fish oil also combined to reduce the circulating concentration of the renal toxin 3-indoxyl sulfate, suggesting a positive effect on the gut microbiota. These data suggest a positive effect of a daily betaine intake which exceeds 60 mg per kg body weight. The data also support an added benefit of a combined EPA+DHA daily intake of greater than 26 mg/kg body weight as well as a daily intake of 75 mg/kg body weight of alpha linolenic acid.

Abstract

Six foods were used to evaluate the interaction of dietary betaine and n-3 PUFA in the cat. There was no ingredient added to the control food to specifically increase betaine or n-3 fatty acids. The experimental design was a 3 × 2 factorial (fatty acids were varied from the control food which had no added source of n-3 fatty acids, flax was included as a source of 18 carbon n-3, or menhaden fish oil as a source of EPA and DHA). Foods were then formulated using these three foods as a base with added betaine or without added betaine. Forty eight cats were used in this study. Equal numbers of cats were allotted by age and gender to each of the six dietary treatments. The cats were offered food amounts to maintain weight and consumed the food to which they were assigned for the length of the study (60 days). Metabolomics, selected circulating analytes and fatty acids were analyzed at the beginning and end of the feeding period. There was an increase in single carbon metabolites (betaine, dimethyl glycine, and methionine) with the consumption of dietary betaine. Betaine also increased the concentration of specific PUFA (ARA, αLA, DHA, and the sum of all circulating PUFA). The combination of dietary betaine and fish oil resulted in a reduction of circulating 3-indoxyl sulfate which suggests a renal benefit from their combined dietary presence.

Implications of trimethylamine N-oxide (TMAO) and Betaine in Human Health: Beyond Being Osmoprotective Compounds

Osmolytes are naturally occurring small molecular weight organic molecules, which are accumulated in large amounts in all life forms to maintain the stability of cellular proteins and hence preserve their functions during adverse environmental conditions. Trimethylamine N-oxide (TMAO) and N,N,N-trimethylglycine (betaine) are methylamine osmolytes that have been extensively studied for their diverse roles in humans and have demonstrated opposing relations with human health. These osmolytes are obtained from food and synthesized endogenously using dietary constituents like choline and carnitine. Especially, gut microbiota plays a vital role in TMAO synthesis and contributes significantly to plasma TMAO levels. The elevated plasma TMAO has been reported to be correlated with the pathogenesis of numerous human diseases, including cardiovascular disease, heart failure, kidney diseases, metabolic syndrome, etc.; Hence, TMAO has been recognized as a novel biomarker for the detection/prediction of several human diseases. In contrast, betaine acts as a methyl donor in one-carbon metabolism, maintains cellular S-adenosylmethionine levels, and protects the cells from the harmful effects of increased plasma homocysteine. Betaine also demonstrates antioxidant and anti-inflammatory activities and has a promising therapeutic value in several human diseases, including homocystinuria and fatty liver disease. The present review examines the multifarious functions of TMAO and betaine with possible molecular mechanisms towards a better understanding of their emerging and diverging functions with probable implications in the prevention, diagnosis, and treatment of human diseases.

The Effect of 3-Week Betaine Supplementation on Blood Biomarkers of Cardiometabolic Health in Young Physically Active Males

Betaine (BET) supplementation decreases homocysteine concentration in plasma, but it may also have an adverse effect on health by increasing blood lipid concentrations, at least in overweight and obese individuals. The aim of this study was to evaluate the effect of BET supplementation on the lipid profile and concentrations of homocysteine, inflammatory cytokines, and liver enzymes in physically active, healthy males. This was a randomized, placebo (PL)-controlled, double-blinded, crossover trial. BET (2.5 or 5.0 g/d) was administered for 21 days. Before and after supplementation with BET or PL, anthropometric measurements and blood were collected in a fasted state. Our results show that BET supplementation significantly decreased homocysteine concentration (from 17.1 ± 4.0 μmol/L before BET to 15.6 ± 3.5 μmol/L after BET, p = 0.009, η² = 0.164). However, the intervention had no effect on total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triacylglycerol, interleukins 1β and 6, and tumour necrosis factor α concentrations, or alanine and aspartate activities. In addition, there were no interactions between the MTHFR genotype and BET dose. In conclusion, BET supplementation may be beneficial for homocysteine concentration in healthy, physically active males, with no detrimental effect on lipid profile.

Effects of 6-Week Betaine Supplementation on Muscular Performance in Male Collegiate Athletes

The purpose of this study was to investigate the effects of 6-week betaine supplementation during a preparatory period of collegiate athletes on muscular power and strength. Sixteen male collegiate athletes received 5 g/day of betaine (betaine group, n = 9) or carboxymethyl cellulose (placebo group, n = 7) for 6 weeks. All participants engaged in their regular training during the experimental period. The overhead medicine-ball throw (OMBT), countermovement jump, and maximal strength (one repetition maximum, 1-RM) on the bench press, overhead press, half squat, and sumo dead lift by the participants were assessed before and after betaine supplementation. Blood lipids were also analyzed before and after betaine supplementation. After supplementation, there were no significant differences between betaine and placebo groups on any variables. Compared to presupplementation, the performance of OMBT and 1-RM of overhead press and half squat in the betaine group had significantly improved (p < 0.05). By contrast, no significant differences were observed in the placebo group before and after supplementation. Blood analysis revealed no negative effect on blood lipid profiles. Betaine seems to be a useful nutritional strategy to improve and maintain performance during 6-week preparatory periods in collegiate athletes.

Betaine hydrochloride addition in Bama mini-pig's diets during gestation and lactation enhances immunity and alters intestine microbiota of suckling piglets

BACKGROUND

Maternal nutrition during gestation and lactation is essential for offspring's health. The present study aimed to investigate the effects of betaine hydrochloride addition to sow diets during gestation and lactation on suckling piglet's immunity and intestine microbiota composition. Forty Bama mini-pigs were randomly allocated into two groups and fed a basal diet (control group) and a basal diet supplemented with 3.50 kg ton^-1 betaine hydrochloride (betaine group) from day 3 after mating to day 21 of lactation. After 21 days of the delivery, 12 suckling piglets from each group with similar body weight were selected for sample collection.

RESULTS

The results showed that maternal betaine hydrochloride addition decreased (P < 0.05) the plasma levels of interleukin (IL)-1β, IL-2, IL-6, and tumor necrosis factor-α in suckling piglets. Furthermore, dietary betaine hydrochloride addition in sow diets increased (P < 0.05) the villus height (VH) and VH to crypt depth ratio in the jejunum and ileum of suckling piglets. In the piglets' intestinal microbiota community, the relative abundances of Roseburia (P < 0.05) and Clostridium (P = 0.059) were lower in the betaine group compared to those in the control group. Moreover, betaine hydrochloride addition in sow diets decreased the colonic tyramine (P = 0.091) and skatole (P = 0.070) concentrations in suckling piglets.

CONCLUSION

Betaine hydrochloride addition in sow diets enhanced the intestinal morphology, improved immunity, and altered intestinal microbiota of suckling piglets. These findings indicated that betaine hydrochloride addition in sow diets during gestation and lactation will impact suckling piglets' health. © 2021 Society of Chemical Industry.

Health Functionalities of Betaine in Patients With Homocystinuria

Homocystinuria is a medical condition that can have widespread and harmful effects on multiple organ systems within the body. This disease is caused by a deficiency in one of the enzymes involved in the methionine metabolism pathway. One example would be a deficiency in cystathionine-β-synthase (CBS), which is seen in classical homocystinuria. A deficiency in CBS can lead to elevated levels of homocysteine (HCY) and possible depletion of methionine and/or cysteine. There are several different treatment options for patients with this condition, one of which is the administration of the drug betaine. Here we review the use of betaine to decrease these elevated levels of homocysteine back to within normal ranges. Published literature indicates that the use of this choline derivative is most beneficial to patients who are either not compliant with the recommended low methionine and low protein diet or wish to consume a less restricted diet.

Associations of circulating choline and its related metabolites with cardiometabolic biomarkers: an international pooled analysis

BACKGROUND

Choline is an essential nutrient; however, the associations of choline and its related metabolites with cardiometabolic risk remain unclear.

OBJECTIVE

We examined the associations of circulating choline, betaine, carnitine, and dimethylglycine (DMG) with cardiometabolic biomarkers and their potential dietary and nondietary determinants.

METHODS

The cross-sectional analyses included 32,853 participants from 17 studies, who were free of cancer, cardiovascular diseases, chronic kidney diseases, and inflammatory bowel disease. In each study, metabolites and biomarkers were log-transformed and standardized by means and SDs, and linear regression coefficients (β) and 95% CIs were estimated with adjustments for potential confounders. Study-specific results were combined by random-effects meta-analyses. A false discovery rate <0.05 was considered significant.

RESULTS

We observed moderate positive associations of circulating choline, carnitine, and DMG with creatinine [β (95% CI): 0.136 (0.084, 0.188), 0.106 (0.045, 0.168), and 0.128 (0.087, 0.169), respectively, for each SD increase in biomarkers on the log scale], carnitine with triglycerides (β = 0.076; 95% CI: 0.042, 0.109), homocysteine (β = 0.064; 95% CI: 0.033, 0.095), and LDL cholesterol (β = 0.055; 95% CI: 0.013, 0.096), DMG with homocysteine (β = 0.068; 95% CI: 0.023, 0.114), insulin (β = 0.068; 95% CI: 0.043, 0.093), and IL-6 (β = 0.060; 95% CI: 0.027, 0.094), but moderate inverse associations of betaine with triglycerides (β = -0.146; 95% CI: -0.188, -0.104), insulin (β = -0.106; 95% CI: -0.130, -0.082), homocysteine (β = -0.097; 95% CI: -0.149, -0.045), and total cholesterol (β = -0.074; 95% CI: -0.102, -0.047). In the whole pooled population, no dietary factor was associated with circulating choline; red meat intake was associated with circulating carnitine [β = 0.092 (0.042, 0.142) for a 1 serving/d increase], whereas plant protein was associated with circulating betaine [β = 0.249 (0.110, 0.388) for a 5% energy increase]. Demographics, lifestyle, and metabolic disease history showed differential associations with these metabolites.

CONCLUSIONS

Circulating choline, carnitine, and DMG were associated with unfavorable cardiometabolic risk profiles, whereas circulating betaine was associated with a favorable cardiometabolic risk profile. Future prospective studies are needed to examine the associations of these metabolites with incident cardiovascular events.

Effects of betaine supplementation on cardiovascular markers: A systematic review and Meta-analysis

Controversy regarding the effects of betaine supplementation on cardiovascular markers has persisted for decades. This systematic review and meta-analysis compared the effects of betaine supplementation on cardiovascular disease (CVD) markers. Studies examining betaine supplementation on CVD markers published up to February 2021 were identified through PubMed, the Cochrane Library, Web of Science, Embase, and SCOPUS. Betaine supplementation had a significant effect on concentrations of betaine (MD: 82.14 μmol/L, 95% CI: 67.09 to 97.20), total cholesterol (TC) (MD: 14.12 mg/dl, 95% CI%: 9.23 to 19.02), low-density lipoprotein (LDL) (MD: 10.26 mg/dl, 95% CI: 6.14 to 14.38)], homocysteine (WMD: -1.30 micromol/L, 95% CI: -1.61 to -0.98), dimethylglycine (DMG) (MD: 21.33 micromol/L, 95% CI: 13.87 to 28.80), and methionine (MD: 2.06 micromol/L, 95% CI: 0.23 to 3.88). Moreover, our analysis indicated that betaine supplementation did not affect serum concentrations of triglyceride (TG), high-density lipoprotein (HDL), fasting blood glucose (FBG), C-reactive protein (CRP), liver enzymes [alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT)], and blood pressure. Our subgroup analysis suggested that a maximum dose of 4 g/d might have homocysteine-lowering effects without any adverse effect on lipid profiles reported with doses of ≥4 g/d. In conclusion, the present systematic review and meta-analysis supports the advantage of a lower dose of betaine supplementation (<4 g/d) on homocysteine concentrations without the lipid-augmenting effect observed with a higher dosage.