ArticleThe American journal of clinical nutrition2020
Associations of choline-related nutrients with cardiometabolic and all-cause mortality: results from 3 prospective cohort studies of blacks, whites, and Chinese.
Article in The American journal of clinical nutrition, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.
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Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it, 61 citations in OpenAlex.
- Dietary Choline and Betaine Are Not Associated With the Risk of Type 2 Diabetes. A Systematic Review and Meta-Analysis of Observational Studies.Journal of diabetes research · 2026Pooled it
- Plasma choline and betaine and neurological function trajectory after acute ischemic stroke.BMC neurology · 2026Trial
- Changes in Choline Metabolites and Ceramides in Response to a DASH-Style Diet in Older Adults.Nutrients · 2023Trial
- Choline status and related health outcomes in humans: A scoping review.Nutrition and health · 2026Article
- The association of dietary choline intakes with cognitive function among the older people in underdeveloped regions: findings from the NCDFaC study.Nutrition journal · 2025Article
- Association between dietary betaine intake and overweight or obesity.Scientific reports · 2024Article
- A Case-Control Study of Dietary Choline Intake and Risk of Colorectal Cancer Modified by Dietary B-Vitamin Intake.Nutrients · 2024Article
- Plasma trimethylamine N-oxide (TMAO): associations with cognition, neuroimaging, and dementia.Alzheimer's research & therapy · 2024Article
- Dietary choline intake and health outcomes in U.S. adults: exploring the impact on cardiovascular disease, cancer prevalence, and all-cause mortality.Journal of health, population, and nutrition · 2024Article
- Associations of dietary choline and betaine with all-cause mortality: a prospective study in a large Swedish cohort.European journal of nutrition · 2024Article
- Plasma metabolomic profile in orthostatic intolerance children with high levels of plasma homocysteine.Italian journal of pediatrics · 2024Article
- Choline - a scoping review for Nordic Nutrition Recommendations 2023.Food & nutrition research · 2023Article
- Association between dietary choline and betaine intake and 10.6-year cardiovascular disease in adults.Nutrition journal · 2022Article
- Association of Choline Intake with Blood Pressure and Effects of Its Microbiota-Dependent Metabolite Trimethylamine-N-Oxide on Hypertension.Cardiovascular therapeutics · 2022Article
- Circulating choline pathway nutrients and risk of moyamoya disease.Frontiers in nutrition · 2022Article
- Hydrogen Sulfide Ameliorated High Choline-Induced Cardiac Dysfunction by Inhibiting cGAS-STING-NLRP3 Inflammasome Pathway.Oxidative medicine and cellular longevity · 2022Article
- Association of intestinal microbiota markers and dietary pattern in Chinese patients with type 2 diabetes: The Henan rural cohort study.Frontiers in public health · 2022Article
- Association between dietary intake of one-carbon metabolism nutrients and hyperglycemia in coal-burning fluorosis areas of Guizhou, China.Frontiers in nutrition · 2022Article
- Association of serum choline levels and all-cause mortality risk in adults with hypertension: a nested case-control study.Nutrition & metabolism · 2021Article
- Gut Metabolite Trimethylamine N-Oxide Protects INS-1 β-Cell and Rat Islet Function under Diabetic Glucolipotoxic Conditions.Biomolecules · 2021Article
Corrections and comments
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Authors and funding
10 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundCholine-related nutrients are dietary precursors of a gut microbial metabolite, trimethylamine-N-oxide, which has been linked to cardiometabolic diseases and related death. However, epidemiologic evidence on dietary choline and mortality remains limited, particularly among nonwhite populations.
objectivesThis study aimed to investigate the associations of choline-related nutrients with cardiometabolic and all-cause mortality among black and white Americans and Chinese adults.
methodsIncluded were 49,858 blacks, 23,766 whites, and 134,001 Chinese, aged 40-79 y, who participated in 3 prospective cohorts and lived ≥1 y after enrollment. Cox regression models were used to estimate HRs and 95% CIs for cardiometabolic [e.g., ischemic heart disease (IHD), stroke, and diabetes] and all-cause deaths. To account for multiple testing, P values < 0.003 were considered significant.
resultsMean choline intake among blacks, whites, and Chinese was 404.1 mg/d, 362.0 mg/d, and 296.8 mg/d, respectively. During a median follow-up of 11.7 y, 28,673 deaths were identified, including 11,141 cardiometabolic deaths. After comprehensive adjustments, including for overall diet quality and disease history, total choline intake was associated with increased cardiometabolic mortality among blacks and Chinese (HR for highest compared with lowest quintile: 1.26; 95% CI: 1.13, 1.40 and HR: 1.23; 95% CI: 1.11, 1.38, respectively; both P-trend < 0.001); among whites, the association was weaker (HR: 1.12; 95% CI: 0.95, 1.33; P-trend = 0.02). Total choline intake was also associated with diabetes and all-cause mortality in blacks (HR: 1.66; 95% CI: 1.26, 2.19 and HR: 1.20; 95% CI: 1.12, 1.29, respectively), with diabetes mortality in Chinese (HR: 2.24; 95% CI: 1.68, 2.97), and with IHD mortality in whites (HR: 1.31; 95% CI: 1.02, 1.69) (all P-trend < 0.001). The choline-mortality association was modified by alcohol consumption and appeared stronger among individuals with existing cardiometabolic disease. Betaine intake was associated with increased cardiometabolic mortality in Chinese only (HR: 1.16; 95% CI: 1.08, 1.25; P-trend < 0.001).
conclusionsHigh choline intake was associated with increased cardiometabolic mortality in racially diverse populations.
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