(P17-069-25) Association of Dietary Choline and Betaine Intake With All-Cause Mortality: A Longitudinal Study From the China Health and Nutrition Survey

Objectives: To examine the association of dietary intake of total choline, individual choline forms, and betaine with all-cause mortality in Chinese adults with predominantly plant-based diets.

Methods: Our analytical sample included participants who participated in the China Health and Nutrition Survey during 1991-2015. Study participants (9,027 men and 8,828 women; mean age at baseline was 40.3 ± 16.1 years for men and 42.4 ± 16.3 years for women) were free from cardiovascular disease and cancer at baseline and had completed at least one follow-up survey. Choline and betaine intake were repeatedly assessed using 3-day 24-hour dietary recalls at the individual level combined with weighing methods at the household level. Death was ascertained through household surveys in each wave. Participants were classified into five groups according to sex-specific quintiles of dietary choline and betaine intake. We used time-dependent Cox proportional hazards regression models to estimate multivariable-adjusted hazard ratios and 95% confidence intervals with the first quintile as the reference. We also conducted restricted cubic spline regression analyses to assess nonlinear associations between choline or betaine intake and mortality risk.

Results: During a median follow-up of 9.1 years, 891 men and 687 women deceased. Higher dietary intake of total choline was associated with a lower risk of all-cause mortality in both men [HR_{Q5 vs. Q1} = 0.58 (95%CI: 0.45, 0.74)] and women [HR_{Q5 vs. Q1} = 0.59 (95%CI: 0.44, 0.78)]. The dose-response curve followed a reverse J-shape in men and an L-shape in women (both P-nonlinear ≤ 0.005). Similarly, dietary intake of fat-soluble choline was inversely associated with the risk of all-cause mortality in both men [HR_{Q5 vs. Q1} = 0.59 (95%CI: 0.46, 0.75)] and women [HR_{Q5 vs. Q1} = 0.53 (95%CI: 0.40, 0.70)], showing reverse J-shaped patterns (both P-nonlinear < 0.001). A J-shaped association between dietary water-soluble choline intake and all-cause mortality was observed in women (P-nonlinear < 0.001), but a null association was found in men. Betaine intake was not associated with all-cause mortality in either sex.

Conclusions: Our findings suggest that adequate intake of choline, but not betaine, may reduce the risk of death among Chinese adults; while excessive intake of water-soluble choline might promote death in women.

Funding Sources: No funding.