Increasing choline intake may help reduce the risk of cardiovascular disease

Cardiovascular disease is the leading cause of death in the United States, primarily due to atherosclerosis (plaque buildup) affecting the cardiovascular system.

Although traditional risk factors such as high blood pressure, diabetes, and metabolic syndrome are well known, the role of specific dietary components in atherosclerotic heart disease is less clear.

Choline, an essential nutrient found in animal and plant foods, has gained attention for its potential heart health benefits, although its role in atherosclerosis remains controversial.

Observational studies, including one recently published in the Journal of Health, Population, and Nutrition, have suggested that higher choline intake may reduce the risk of cardiovascular disease.

However, some animal studies suggest that choline may increase the risk of cardiovascular disease, and there is a lack of clinical studies in humans.

Now, a new observational study published in BMC Public Health aims to clarify the link between choline intake and atherosclerotic heart disease in US adults.

The second aim was to study how choline affects metabolic syndrome and its risk factors that contribute to the development of atherosclerotic heart disease and blood vessels.

The results showed that moderate choline intake was associated with a lower risk of atherosclerotic heart disease and blood vessels. However, no significant association was found between choline intake and metabolic syndrome.

Despite the mixed research results, experts recognize the potential of adequate choline intake to support heart health and prevent disease.

Association between choline intake and risk of atherosclerotic heart disease

This cross-sectional study examined data from 5,525 US adults aged 20 years and older collected through the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018.

The average age of the participants was 48 years, with approximately equal numbers of men and women.

Most were non-Hispanic white, had low levels of physical activity, and more than 76% were overweight or obese.

The researchers identified atherosclerotic heart and vascular disease in participants who had at least one of the following conditions:

• heart failure
• coronary heart disease
• angina (chest pain)
• myocardial infarction stroke

Participants were divided into two groups: 5,015 participants with atherosclerotic heart disease and 510 without it.

Metabolic syndrome was defined by the presence of at least three risk factors: high fasting blood sugar, blood pressure, triglycerides, waist circumference, or low high-density lipoprotein (HDL) cholesterol.

The researchers categorized participants as having conditions such as diabetes, hypertension and dyslipidemia based on blood values or medication use.

Using two 24-hour dietary questionnaires from each NHANES participant, they calculated the average choline intake. Participants' choline intake was divided into four quartiles, placing each participant into one of four groups based on their intake.

Using statistical software, the team analyzed how choline intake was associated with atherosclerotic heart disease and vascular disease. They controlled for demographic and lifestyle factors and looked at differences by gender and choline intake.

Moderate choline intake is associated with a lower risk

The study results suggest that optimal heart health benefits from choline consumption may be seen at specific levels, with both excess and deficiency being less beneficial.

Choline intakes of about 244 milligrams per day for women and 367 milligrams per day for men appeared to benefit heart health.

These amounts are below the National Institutes of Health's recommended daily intake for adults over age 19, which is 425 milligrams per day for women and 550 milligrams per day for men.

In their adjusted analysis, the researchers found that choline intake in the third quartile was potentially associated with a lower likelihood of heart failure and stroke.

However, consuming more than 342 milligrams a day seemed to slightly increase the risk of heart failure, although it did not significantly affect the risk of stroke. This may be due to the brain's ability to manage excess choline, the study authors noted.

Overall, an inverse and nonlinear relationship was found between choline and atherosclerotic cardiovascular disease, less pronounced in men.

In the present study, no significant association was found between choline intake and metabolic syndrome and its components, despite the syndrome being a strong predictor of mortality in heart disease.

This is contrary to recent research that has suggested that higher choline intake is associated with lower levels of some components of metabolic syndrome in obese adults.

Study limitations The observational nature of the study, reliance on dietary questionnaires, and lack of data on plasma TMAO may limit its accuracy.

The study authors also note that sensitive analyses showed that choline's protective effect against atherosclerotic cardiovascular disease lost statistical significance after adjusting for participants' total calorie intake.

The best way to get enough choline each day is to follow a balanced diet that includes different types of choline-rich foods.

Some of the best food sources of choline include:

Whole eggs Fish, such as salmon and cod Dairy products, such as cottage cheese Organ and red meats, such as liver and beef Red potatoes Shiitake Nuts and seeds, such as almonds, flaxseeds, and raw pumpkin seeds Whole grains and pseudograins, such as wheat germ and quinoa Brassicas, such as Brussels sprouts, broccoli, cabbage, and cauliflower Legumes, such as soybeans (edamame), lima beans, kidney beans, lentils, and lentils

However, instead of increasing your intake of animal products rich in saturated fat, she recommends increasing your intake of low-fat proteins and plant sources of choline in your diet.

A balanced, heart-healthy diet likely contains enough choline without the risk of possible overdose from commercially available foods.