A recent study published in BMC Public Health explores the relationship between atherosclerotic cardiovascular disease (ASCVD) and dietary choline, using data from the National Health and Nutrition Examination Survey (NHANES).
What is Choline?
Choline is an essential nutrient vital for the synthesis of several key biological molecules, including acetylcholine, a neurotransmitter involved in memory, mood, and muscle control. Additionally, choline is a precursor for phosphatidylcholine and sphingomyelin, which are significant phospholipids found in cell membranes.
Due to its limited endogenous synthesis, it is essential to obtain choline through dietary sources. High-protein foods such as beef, fish, milk, eggs, cruciferous vegetables, legumes, and nuts are rich in choline.
Choline and ASCVD: The Debate
Existing research presents mixed findings regarding the relationship between choline and ASCVD. Some studies indicate that choline influences the trimethylamine N-oxide (TMAO) pathway, potentially increasing the risk of cardiac dysfunction, stroke, and heart failure. Conversely, other research suggests choline’s beneficial role in mitigating cardiac hypertrophy through metabolic remodeling.
Metabolic Syndrome (MetS) and ASCVD
Metabolic syndrome (MetS) encompasses conditions like atherogenic dyslipidemia, high fasting blood glucose levels, hypertension, and obesity. Affecting 20-30% of adults worldwide, MetS significantly raises the risk of ASCVD, myocardial infarction, coronary heart disease, and stroke.
The Study
The study aimed to elucidate the impact of choline intake on ASCVD and MetS development. Researchers analyzed data from 5,525 individuals in the NHANES database (2011-2018), categorizing 510 participants into a non-ASCVD group and 5,015 into an ASCVD group. Various statistical methods, including univariate, multivariate, and logistic regression, were used to analyze the data.
Findings
The study found no significant correlation between choline intake and MetS. However, individuals in the third quartile of choline intake showed a lower likelihood of congestive heart failure and stroke. This protective effect diminished with choline intake exceeding 342 mg/d, which increased the risk of ASCVD.
Adequate choline intake for beneficial effects was identified as 244 mg/d for women and 367 mg/d for men. Sub-group analyses suggested that men experienced more protective effects from high choline intake.
In women, estrogen promotes endogenous phosphatidylcholine synthesis, potentially reducing organ dysfunction symptoms in pre-menopausal women compared to men and post-menopausal women. However, no significant interaction between choline intake and sex was observed in the logistic analysis.
Choline’s role in various chronic diseases and neurodevelopment is crucial, as deficiency can lead to muscle damage and fatty liver. The study indicated that excessive choline intake did not increase stroke risk, suggesting the brain might regulate excessive choline through absorption and metabolism control.
Comparative Studies
The PREDIMED study found an association between plasma choline and increased heart failure risk, while animal studies linked TMAO and choline supplementation to atherosclerosis and heart failure. Conversely, the SURDIAGENE study reported no significant association between heart failure and choline in type 2 diabetes patients. These conflicting findings highlight the complex role of dietary choline in cardiovascular health.
For further reading on the topic, refer to the NHANES database and related studies on choline and heart health.
