Increasing your choline intake may help reduce your risk of heart disease

, medical expert
Last reviewed: 14.06.2024

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13 June 2024, 12:58

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 and vascular disease is less clear.

Choline, an important nutritional component found in animal and plant foods, is gaining attention for its potential benefits for heart health, although its role in atherosclerosis remains a matter of debate.

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

However, some animal studies indicate 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 association between choline intake and atherosclerotic heart disease in US adults.

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

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

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

Relationship between choline intake and risk of atherosclerotic heart disease

This cross-sectional study examined data from 5,525 American 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, approximately the same number of men and women.

The majority were non-Hispanic white, had low levels of physical activity, and more than 76% were hypertrophic obese.

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

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

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

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 average choline intake. Participants' choline intake was divided into four quartiles, placing each participant in one of four groups based on their intake.

Using statistical software, the team analyzed how choline intake is associated with atherosclerotic heart and vascular disease. They took into account demographic and lifestyle factors and looked at differences by gender and choline intake.

Moderate choline intake associated with lower risk

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

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

These amounts are below the National Institutes of Health guidelines for adults over 19 years of age, which are 425 milligrams 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 per 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.

In general, an inverse and nonlinear relationship was found between choline and atherosclerotic heart and vascular disease, less noticeable in men.

The present study did not find a significant association between choline intake and metabolic syndrome and its components, despite the syndrome being a strong predictor of mortality in heart disease.

This contradicts recent research that suggested that increased choline intake is associated with lower levels of some components of the metabolic syndrome in obese adults.

Limitations of the Study 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 the sensitive analysis showed that the protective effect of choline against atherosclerotic heart disease lost statistical significance after adjusting for participants' total caloric intake.

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

Some of the best dietary sources of choline include:

Whole eggs fish such as salmon and cod dairy products such as cottage cheese organ and red meat such as liver and beef red potatoes shiitake nuts and seeds such as almonds, flaxseeds and raw pumpkin seeds whole grains and pseudo-cereals such as wheat germ and quinoa brassicas vegetables 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 is likely to contain adequate amounts of choline without the risk of possible overdose from commercially available foods. 

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