Dietary Choline is Positively Related to Overall and Cause-Specific Mortality: Results from Individuals of the National Health and Nutrition Examination Survey and Pooling Prospective Data
Artikel i vetenskaplig tidskrift, 2019
Little is known about the association between dietary choline intake and mortality. We evaluated the link between choline consumption and overall as well as cause-specific mortality by using both individual data and pooling prospective studies by meta-analysis and systematic review. Furthermore, adjusted means of cardiometabolic risk factors across choline intake quartiles were calculated. Data from the National Health and Nutrition Examination Survey (1999-2010) were collected. Adjusted Cox regression was performed to determine the risk ratio (RR) and 95 % CI (95 % CI), as well as random-effects models and generic inverse variance methods to synthesise quantitative and pooling data, followed by a leave-one-out method for sensitivity analysis. After adjustments, we found that individuals consuming more choline had worse lipid profile and glucose homeostasis, but lower CRP levels (p < 0·001 for all comparisons) with no significant differences in anthropometric parameters and blood pressure. Multivariable Cox regression models revealed that individuals in the highest quartile (Q4) of choline consumption had a greater risk of total (23 %), cardiovascular disease (CVD) (33 %) and stroke (30 %) mortality compared with the first quartile (Q1) (p < 0·001 for all comparison). These results were confirmed in a meta-analysis, showing that choline intake was positively and significantly associated with overall (RR: 1·12, 95 % CI: 1·08-1·17, I2: 2·9) and CVD (RR: 1·28, 95 % CI: 1·17-1·39, I2: 9·6) mortality risk. In contrast, the positive association between choline consumption and stroke mortality became non-significant (RR: 1·18, 95 % CI: 0·97-1·43, p = 0·092, I2: 1·1). Our findings shed light on the potential adverse effects of choline intake on selected cardiometabolic risk factors and mortality risk.