Relationship between dietary choline intake and diabetes mellitus in the National Health and Nutrition Examination Survey 2007-2010

Higher dietary choline intake is associated with increased risk of all-cause and cause-specific mortality: A systematic review and dose-response meta-analysis of cohort studies

Evidence indicates that choline and betaine intakes are associated with mortality. Based on the available evidence, we hypothesized that dietary choline and betaine do not increase mortality risk. This meta-analysis was conducted to investigate the association of dietary choline and betaine with mortality from all causes, cardiovascular diseases, and stroke. Online databases including PubMed, Scopus, Web of Science, Embase, and Google Scholar were searched up to 9 March 2024. Six cohort studies comprising 482,778 total participants, 57,235 all-cause, 9351 cardiovascular disease, and 4,400 stroke deaths were included in this study. The linear dose-response analysis showed that each 100 mg/day increase in choline intake was significantly associated with 6% and 11% increases in risk of all-cause (RR = 1.06, 95% CI: 1.03, 1.10, I2 =83.7%, P < .001) and cardiovascular diseases mortality (RR = 1.11, 95% CI: 1.06, 1.16, I2 = 54.3%, P = .02) respectively. However, dietary betaine, was not associated with the risk of mortality. Furthermore, the result of the nonlinear dose-response analysis showed a significant relationship between betaine intake and stroke mortality at the dosages of 50 to 250 mg/day (Pnon-linearity= .0017). This study showed that each 100 mg/day increment in choline consumption was significantly associated with a 6% and 11% higher risk of all-cause and cardiovascular disease mortality respectively. In addition, a significant positive relationship between betaine intake and stroke mortality at doses of 50 to 250 mg/day was observed. Due to the small number of the included studies and heterogeneity among them more well-designed prospective observational studies considering potential confounding variables are required.

Age of hypertension onset and cognitive function in the elderly: an observational study from the NHANES 2011-2014

PURPOSE

This study aims to evaluate the association between age of hypertension onset and cognitive function in a representative sample of US older adults.

METHODS

We assessed 2334 elderly adults (including 1655 hypertensive patients) who participated in the National Health and Nutrition Examination Survey 2011-2014. We used the age when the participants were first informed by the doctor that they had hypertension or were first clinically diagnosed with hypertension as the age of onset of hypertension. The Digit Symbol Substitution test (DSST), the Animal Fluency test, the Consortium to Establish a Registry for Alzheimer's disease (CERAD), and a composite-z score calculated by summing z-scores from these three individual tests, were used to assess cognitive function.

RESULTS

Participants with hypertension onset age < 35 years (early onset hypertension) had the worst performance in almost all cognitive tests, followed by those with onset age ≥ 65 years. Compared with those without hypertension, early onset hypertension was associated with - 4.15 (95% CI - 6.63, - 1.68), - 1.10 (95% CI - 2.08, - 0.12), - 0.75 (95% CI - 1.91, 0.42), and - 0.56 (95% CI - 0.94, - 0.19) scores for DSST, animal fluency test, CERAD, and composite z-score. Participants with early onset hypertension (onset age < 35 years) had higher odds for cognitive decline defined by DSST (OR: 3.28, 95% CI 1.94, 5.54) and composite z-score (OR: 1.77, 95% CI 1.07, 2.92).

CONCLUSIONS

Early onset hypertension was associated with the worst performance in cognitive function and an increased odds of cognitive decline in the elderly.

Characteristics of elderly diabetes patients: focus on clinical manifestation, pathogenic mechanism, and the role of traditional Chinese medicine

Diabetes mellitus has become a major public health issue globally, putting an enormous burden on global health systems and people. Among all diseased groups, a considerable part of patients are elderly, while their clinical features, pathogenic processes, and medication regimens are different from patients of other ages. Despite the availability of multiple therapies and techniques, there are still numerous elderly diabetes patients suffering from poor blood glucose control, severe complications, and drug adverse effects, which negatively affect the quality of life in their golden years. Traditional Chinese Medicine (TCM) has been widely used in the treatment of diabetes for several decades, and its relevant clinical practice has confirmed that it has a satisfactory effect on alleviating clinical symptoms and mitigating the progression of complications. Chinese herbal medicine and its active components were used widely with obvious clinical advantages by multiple targets and signaling pathways. However, due to the particular features of elderly diabetes, few studies were conducted to explore Traditional Chinese Medicine intervention on elderly diabetic patients. This study reviews the research on clinical features, pathogenic processes, treatment principles, and TCM treatments, hoping to provide fresh perspectives on the prevention and management strategies for elderly diabetes.

Dietary Intakes of Choline and Betaine and Incidence of Type 2 Diabetes: Tehran Lipid and Glucose Study

Background: Our knowledge for the possible link between choline and betaine and the risk of type 2 diabetes (T2D) is very limited and contradictory. This study aimed to investigate the prospective association of dietary choline and betaine intakes with the risk of T2D in a group of Tehranian adults. Methods: In this prospective study, 6022 eligible subjects aged ≥18 years were chosen from the participants of the Tehran Lipid and Glucose Study in a secondary analysis. Diet was assessed based on a valid and reliable semiquantitative food frequency questionnaire. At baseline and follow-up examinations, biochemical and anthropometric variables were assessed. Multivariable Cox proportional hazard regression models was used to estimate the new onset of T2D concerning choline and betaine intake. Results: The mean age ± SD of 2707 men and 3315 women were, respectively, 41.4 ± 14.2 and 39.1 ± 13.1. During a median follow-up of 6.63 years, 528 cases of T2D incidence were diagnosed. Participants with a higher intake of choline had a higher intake of protein, fiber, and B12 and a lower intake of energy and carbohydrates. After controlling of confounders a significant positive association was observed between choline intake and the hazard ratio (HR) of T2D across quartiles of choline intake [HR (CI) in the fourth quartile: 1.25 (1.14-1.38), P trend = 0.01], but this significant finding was not reported for betaine intake. For every 100 milligram increase in choline consumption, the HR of T2D increased significantly in all age, sex, and BMI subgroups. Conclusions: Choline consumption increased the risk of T2D in total population and subgroups. No statistically significant association was found between dietary betaine intake and the risk of T2D in total population and subgroups.

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

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.

Dietary choline and betaine intake, cardio-metabolic risk factors and prevalence of metabolic syndrome among overweight and obese adults

BACKGROUND

Choline is an important metabolite involved in phospholipids synthesis, including serum lipids, and is the immediate precursor of betaine. There are numerous studies with inconsistent results that evaluated the association between dietary choline intakes with cardiovascular risk factors. In addition, the association between dietary betaine and choline intakes with cardio-metabolic risk factors is not well studied. In the current study, our aim was to evaluate dietary choline and betaine intakes in the usual diet of obese individuals and to assess its association with serum lipids, blood pressure and glycemic markers among obese individuals.

METHODS

We recruited a total number of 359 obese people aged between 20 and 50 years in the present study. A semi-quantitative food frequency questionnaire (FFQ) was used for dietary assessment; dietary choline and betaine intakes were calculated using the United States Department of Agriculture (USDA) database. National cholesterol education program adult treatment panel (NCEP-ATP)-III criteria was used metabolic syndrome (MetS) definition. Enzymatic methods were used to assess biochemical variables. Body composition was measured with the bioelectrical impedance analysis (BIA) method.

RESULTS

Higher body mass index (BMI), waist to hip ratio (WHR), fat-free mass (FFM) and basal metabolic rate (BMR) were observed in higher tertiles of dietary choline intake (P < 0.01). There was no significant difference in terms of biochemical parameters among different tertiles of dietary choline intake, while systolic blood pressure (SBP) and diastolic blood pressure (DBP) were reduced in higher betaine tertiles (P < 0.05). For total dietary choline and betaine intakes, there was a reduction in DBP and low density lipoprotein (LDL) concentrations (P < 0.05). Also, a non-significant reduction in serum total cholesterol (TC), triglyceride (TG) and MetS prevalence was observed in higher tertiles of dietary choline and betaine intakes. After classification of the study population according to MetS status, there was no significant difference in biochemical variables in subjects with MetS (P > 0.05), while in the non-MetS group, SBP, DBP, TG and insulin levels reduced in higher tertiles of dietary betaine and choline (P > 0.05).

CONCLUSION

According to our findings, higher dietary intakes of choline and betaine were associated with lower levels of blood pressure and LDL concentrations among obese individuals. Further studies are warranted to confirm the results of the current study.

Potential role of inflammation in relation to dietary sodium and β-carotene with non-alcoholic fatty liver disease: a mediation analysis

Background

High sodium intake has been linked to the prevalence of non-alcoholic fatty liver disease (NAFLD), but underlying mechanism remains unclear. This study aims to explore the role of chronic inflammation in the association between sodium and NAFLD. We also observed whether β-carotene, which had a strong anti-inflammatory effect, lowers the odds of NAFLD.

Methods

We performed mediation analyses to assess the mediating effects of C-reactive protein (CRP) and red cell distribution width (RDW) on the relationship between dietary sodium and NAFLD defined by the hepatic steatosis index (HSI) and the fatty liver index (FLI), respectively.

Results

A total of 6725 participants were included in this study. Compared with the high sodium-low carotene group, participants in the high sodium-high carotene group had 16% and 26% lower odds for HSI and FLI-defined NAFLD, respectively. There were positive indirect effects of dietary sodium intake on the HSI-defined NAFLD (indirect effect: 0.0057, 95% CI: 0.0021–0.0091, P < 0.0001), as well as the FLI defined NAFLD (indirect effect: 0.0081, 95% CI: 0.0024–0.0162, P < 0.0001) when C-reactive protein (CRP) was considered as a mediator. The mediating effects were somewhat attenuated after further adjusting for dietary β-carotene intake. Similar results were found when RDW was considered as a mediator in the HSI-defined NAFLD analysis.

Conclusions

Higher sodium intake increases the odds of NAFLD by upregulating inflammation. Dietary β-carotene may attenuate this association by down regulating inflammation.

Trimethylamine N-oxide and hip fracture and bone mineral density in older adults: The cardiovascular health study

CONTEXT

Gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) may adversely affect bone by inducing oxidative stress. Whether this translates into increased fracture risk in older adults is uncertain.

OBJECTIVE

Determine the associations of plasma TMAO with hip fracture and bone mineral density (BMD) in older adults.

DESIGN AND SETTING

Cox hazard models and linear regression stratified by sex examined the associations of TMAO with hip fracture and BMD in the longitudinal cohort of the Cardiovascular Health Study.

PARTICIPANTS

5019 U.S. adults aged ≥65 years.

EXPOSURE

Plasma TMAO.

MAIN OUTCOME MEASURES

Incident hip fractures; total hip BMD dual x-ray absorptiometry in a subset (n = 1400).

RESULTS

Six hundred sixty-six incident hip fractures occurred during up to 26 years of follow-up (67,574 person-years). After multivariable adjustment, TMAO was not significantly associated with hip fracture (women: hazard ratio (HR) [95% confidence interval (CI)] of 1.00[0.92,1.09] per TMAO doubling; men: 1.12[0.95,1.33]). TMAO was also not associated with total hip BMD (women: BMD difference [95% CI] of 0.42 g/cm2*100 [-0.34,1.17] per TMAO doubling; men: 0.19[-1.04,1.42]). In exploratory analyses, we found an interaction between body mass index (BMI) and the association of TMAO with hip fracture (P < 0.01). Higher TMAO was significantly associated with risk of hip fracture in adults with overweight or obesity (BMI ≥ 25) (HR [95% CI]:1.17[1.05,1.31]), but not normal or underweight.

CONCLUSIONS

Among older US men and women, TMAO was not significantly associated with risk of hip fracture or BMD overall. Exploratory analyses suggested a significant association between higher TMAO and hip fracture when BMI was elevated, which merits further study.

Muscle strength and prediabetes progression and regression in middle-aged and older adults: a prospective cohort study

BACKGROUND

Prediabetes progression is associated with increased mortality while its regression decreases it. It is unclear whether muscle strength is related to prediabetes progression or regression. This study investigated the associations of muscle strength, assessed by grip strength and chair-rising time, with prediabetes progression and regression based on the China Health and Retirement Longitudinal Study (CHARLS) enrolling middle-aged and older adults.

METHODS

We included 2623 participants with prediabetes from CHARLS, who were followed up 4 years later with blood samples collected for measuring fasting plasma glucose and haemoglobin A1c. Grip strength (normalized by body weight) and chair-rising time were assessed at baseline and categorized into tertiles (low, middle, and high groups). Prediabetes at baseline and follow-up was defined primarily using the American Diabetes Association (ADA) criteria and secondarily using the World Health Organization (WHO) and International Expert Committee (IEC) criteria. Multinomial logistic regression analysis was applied to obtain the odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

The mean age of included participants was 59.0 ± 8.6 years, and 46.6% of them were males. During follow-up, 1646 participants remained as prediabetes, 379 progressed to diabetes, and 598 regressed to normoglycaemia based on ADA criteria. Participants who progressed to diabetes had lower normalized grip strength than those who remained as prediabetes (0.49 ± 0.15 vs. 0.53 ± 0.15, P < 0.001), but participants who regressed to normoglycaemia showed the opposite (0.55 ± 0.16 vs. 0.53 ± 0.15, P = 0.003). However, chair-rising time was comparable across different groups (P_overall  = 0.17). Compared with participants in low normalized grip strength or high chair-rising time group, those in high normalized grip strength or low chair-rising time group had decreased odds of progression to diabetes (OR 0.62, 95% CI 0.44 to 0.87; and OR 0.69, 95% CI 0.51 to 0.93, respectively) after multivariable adjustment. However, both were unrelated to the odds of regression to normoglycaemia (OR 0.94, 95% CI 0.71 to 1.25; and OR 0.84, 95% CI 0.65 to 1.07, respectively). These outcomes remained generally comparable when prediabetes was defined by WHO or IEC criteria. Higher normalized grip strength but not lower chair-rising time was prospectively associated with lower blood pressure, better glycaemic condition, and lower inflammation (all P ≤ 0.04).

CONCLUSIONS

High muscle strength is associated with reduced odds of progression to diabetes but does not predict regression to normoglycaemia in prediabetes. Future studies are warranted to assess whether increases in muscle strength promote prediabetes regression.

Changes in objectively-measured physical capability over 4-year, risk of diabetes, and glycemic control in older adults: The China Health and Retirement Longitudinal study

AIMS

High physical capability reduces risk of diabetes, but the association of its changes with risk of diabetes and glycemic control is unclear in older adults. This study aimed to quantify their association.

METHODS

A total of 1,667 participants without diabetes and aged ≥ 60 years from the China Health and Retirement Longitudinal Study were included and followed over 4 years. Physical capability was objectively measured at baseline and 4-year later. Logistic regression models were used to assess the association of changes in physical capability with risk of diabetes.

RESULTS

During follow-up, 160 participants developed diabetes. None of the changes in physical capability expressed in continuous scales or in tertiles was associated with risk of diabetes in unadjusted or adjusted models (all P > 0.05), and no favorable joint effects were observed. Changes in physical capability were not associated with changes in fasting plasma glucose or hemoglobin A1c. Yet increases in walking speed or grip strength were related to reduced metabolic score for insulin resistance (both P ≤ 0.03).

CONCLUSIONS

Increases in objectively-measured physical capability were not associated with reduced risk of diabetes but may ameliorate insulin resistance in older adults. Studies with longer follow-up periods are required to confirm these findings.

Prognostic value of metabolic syndrome in renal structural changes in type 2 diabetes

PURPOSE

To investigate the prognostic value of metabolic syndrome (MetS) and its relationship with renal structure changes in patients with type 2 diabetes and associated diabetic nephropathy (DN).

METHODS

411 Chinese patients with type 2 diabetes and biopsy-confirmed DN were enrolled in this retrospective study. MetS was defined according to the modified criteria of the 2005 International Diabetes Federation. Baseline demographics and clinical information at the time of renal biopsy were extracted from the hospital's electronic medical records system. Renal pathological findings were assessed according to Renal Pathology Society system. Univariate and multivariate logistic regression analyses were performed to define the pathological covariates associated with MetS. A competing risk model, with death as the competing risk, was used to estimate the sub-distribution hazard ratio (SHR) of MetS for end-stage kidney disease (ESKD).

RESULTS

224 (55%) patients had MetS. Patients with MetS had poor renal function and more severe interstitial fibrosis tubular atrophy scores (IFTA) than those without MetS. Multivariate logistic regression analysis revealed that IFTA was significantly associated with MetS (odds ratio per score increase 1.45, 95% confidence interval [CI] 1.02-2.05). Of the patients with DN at risk, 40% of patients progressed to ESKD. After adjusting for renal function and pathological parameters, the presence of MetS was an independent predictor for progression to ESKD (SHR 1.93, 95% CI 1.34-2.79). The SHRs for progression to ESKD also increased as the number of MetS components increased. Additionally, adding the IFTA scores improved the prognostic power of a model that only contained MetS and clinical covariates for predicting future ESKD.

CONCLUSION

MetS is an independent prognostic predictor of ESKD in patients with T2D and DN, while adding the IFTA scores increased the prognostic value of MetS for renal outcome.

Association between healthy eating index-2015 and various cognitive domains in US adults aged 60 years or older: the National Health and Nutrition Examination Survey (NHANES) 2011-2014

BACKGROUND

Diet, as a modifiable factor, plays an important role in cognitive function. However, the association between adherence to the 2015-2020 Dietary Guidelines for Americans (DGA), measured by Healthy Eating Index (HEI)-2015, and cognitive function remains unclear. This study aims to explore whether HEI-2015 is associated with various cognitive domains and whether such association is modified by age, gender, or ethnicity in the US adults aged 60 years or older using data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014.

METHODS

HEI-2015 scores were calculated from 24-h dietary recall interviews. Cognitive function was evaluated by Digit Symbol Substitution Test (DSST, a measure of processing speed), Animal Fluency Test (AFT, a measure of executive function), a subtest from Consortium to Establish a Registry for Alzheimer's disease (CERAD, a measure of memory), and a composite-z score calculated by summing z scores of individual tests. The associations between HEI-2015 scores and cognitive performance were explored using multiple linear regression models.

RESULTS

A total of 2450 participants aged 60 years or older were included. Participants with higher HEI-2015 scores were more likely to have higher DSST, AFT as well as composite-z scores (P<0.05). Significant interaction effects were identified between HEI-2015 and ethnicity in specific cognitive domains (P_interaction<0.05). Among HEI-2015 components, higher intakes of whole fruits and seafood and plant protein were associated with better cognitive performance (P<0.05).

CONCLUSION

Higher adherence to DGA is associated with better cognitive performance, especially regarding processing speed and executive function among the US adults aged 60 years or older.

Association between Dietary Choline Intake and Diabetic Retinopathy: National Health and Nutrition Examination Survey 2005-2008

PURPOSE

To explore whether there is an association between dietary choline intake and odds of diabetic retinopathy (DR) in the US diabetic population.

METHODS

A cross-sectional study was conducted using the combined data of the National Health and Nutrition Examination Survey (NHANES) 2005-2008 of a complex, multistage, and probability-sampling design. Energy-adjusted choline intake was calculated separately for men and women using the residual method. Binary logistic regression adjusting for covariates was used to identify the variables associated with DR.

RESULTS

We included 644 male and 628 female diabetic subjects, which were equivalent to a weighted survey sample of 9,339,124 for males and 10,109,553 for females respectively. Female DR patients consumed more choline than non-DR patients (268.6 mg/d vs 250.9 mg/d; p = .046). The estimated prevalence of DR was 17.4%, 21.9%, and 29.7% across three levels of dietary choline intake in females, respectively. In multivariable logistic-regression models, the odds ratio (OR) of DR for female patients in the highest choline intake group was 2.14 (95% confidence interval [CI], 1.38-3.31; p = .001) compared with those in the lowest intake group. This association was positive but not statistically significant in males.

CONCLUSION

Higher intake of dietary choline is associated with increased odds of DR in females, but not in males. Further studies are warranted to investigate the direct role of choline in DR development and determine the recommended daily intake of choline for diabetic patients weighing the pros and cons of dietary choline consumption.