The Association of Dietary Choline and Betaine With the Risk of Type 2 Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

Overview

Journal Diabetes Care

Specialty Endocrinology

Date 2020 Sep 9

PMID 32900787

Citations 18

Authors

Daniel T Dibaba

Karen C Johnson

Anna M Kucharska-Newton

Katie Meyer

Steven H Zeisel

Aurelian Bidulescu

Affiliations

Soon will be listed here.

Abstract

Objective: To examine the association between dietary intake of choline and betaine and the risk of type 2 diabetes.

Research Design And Methods: Among 13,440 Atherosclerosis Risk in Communities (ARIC) study participants, the prospective longitudinal association between dietary choline and betaine intake and the risk of type 2 diabetes was assessed using interval-censored Cox proportional hazards and logistic regression models adjusted for baseline potential confounding variables.

Results: Among 13,440 participants (55% women, mean age 54 [SD 7.4] years), 1,396 developed incident type 2 diabetes during median follow-up of 9 years from 1987 to 1998. There was no statistically significant association between every 1-SD increase in dietary choline and risk of type 2 diabetes (hazard ratio [HR] 1.01 [95% CI 0.87, 1.16]) nor between dietary betaine intake and the risk of type 2 diabetes (HR 1.01 [0.94, 1.10]). Those in the highest quartile of dietary choline intake did not have a statistically significant higher risk of type 2 diabetes than those in the lowest choline quartile (HR 1.09 [0.84, 1.42]); similarly, dietary betaine intake was not associated with the risk of type 2 diabetes comparing the highest quartile to the lowest (HR 1.06 [0.87, 1.29]). Among women, there was a higher risk of type 2 diabetes, comparing the highest to lowest dietary choline quartile (HR 1.54 [1.06, 2.25]), while in men, the association was null (HR 0.82 [0.57, 1.17]). Nevertheless, there was a nonsignificant interaction between high choline intake and sex on the risk of type 2 diabetes ( = 0.07). The results from logistic regression were similar.

Conclusions: Overall and among male participants, dietary choline or betaine intakes were not associated with the risk of type 2 diabetes. Among female participants, there was a trend for a modestly higher risk of type 2 diabetes among those with the highest as compared with the lowest quartile of dietary choline intake. Our study should inform clinical trials on dietary choline and betaine supplementation in relationship with the risk of type 2 diabetes.

Citing Articles

Choline and betaine intakes during pregnancy in relation to risk of gestational diabetes mellitus among Chinese women.

Lamkin K, Xu L, Wang K, Liu Y, Yang K, Wu H Br J Nutr. 2024; 132(7):971-978.

PMID: 39429119 PMC: 11576091. DOI: 10.1017/S0007114524001995.

Choline Metabolites and 15-Year Risk of Incident Diabetes in a Prospective Cohort of Adults: Coronary Artery Risk Development in Young Adults (CARDIA) Study.

Sprinkles J, Lulla A, Hullings A, Trujillo-Gonzalez I, Klatt K, Jacobs Jr D Diabetes Care. 2024; 47(11):1985-1994.

PMID: 39259767 PMC: 11502527. DOI: 10.2337/dc24-1033.

Alterations in Choline Metabolism in Non-Obese Individuals with Insulin Resistance and Type 2 Diabetes Mellitus.

Al-Sulaiti H, Anwardeen N, Bashraheel S, Naja K, Elrayess M Metabolites. 2024; 14(8).

PMID: 39195553 PMC: 11356528. DOI: 10.3390/metabo14080457.

Combined effects of blood pressure and glucose status on the risk of chronic kidney disease.

Toyama M, Satoh M, Nakayama S, Hashimoto H, Muroya T, Murakami T Hypertens Res. 2024; 47(7):1831-1841.

PMID: 38671217 PMC: 11224015. DOI: 10.1038/s41440-024-01683-x.

One-Carbon Metabolism Nutrients, Genetic Variation, and Diabetes Mellitus.

Zhu J, Saikia G, Zhang X, Shen X, Kahe K Diabetes Metab J. 2024; 48(2):170-183.

PMID: 38468500 PMC: 10995489. DOI: 10.4093/dmj.2023.0272.

References

Ozarda Ilcol Y, Gurun M, Taga Y, Ulus I . Choline increases serum insulin in rat when injected intraperitoneally and augments basal and stimulated aceylcholine release from the rat minced pancreas in vitro. Eur J Biochem. 2003; 270(5):991-9. DOI: 10.1046/j.1432-1033.2003.03472.x. View

Huang T, Ren J, Huang J, Li D . Association of homocysteine with type 2 diabetes: a meta-analysis implementing Mendelian randomization approach. BMC Genomics. 2013; 14:867. PMC: 3878883. DOI: 10.1186/1471-2164-14-867. View

Wu G, Zhang L, Li T, Lopaschuk G, Vance D, Jacobs R . Choline Deficiency Attenuates Body Weight Gain and Improves Glucose Tolerance in ob/ob Mice. J Obes. 2012; 2012:319172. PMC: 3385711. DOI: 10.1155/2012/319172. View

Li Y, Wang D, Chiuve S, Manson J, Willett W, Hu F . Dietary phosphatidylcholine intake and type 2 diabetes in men and women. Diabetes Care. 2015; 38(2):e13-4. PMC: 4302257. DOI: 10.2337/dc14-2093. View

Zeisel S, da Costa K . Choline: an essential nutrient for public health. Nutr Rev. 2009; 67(11):615-23. PMC: 2782876. DOI: 10.1111/j.1753-4887.2009.00246.x. View

Gayoso-Diz P, Otero-Gonzalez A, Rodriguez-Alvarez M, Gude F, Garcia F, de Francisco A . Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study. BMC Endocr Disord. 2013; 13:47. PMC: 4016563. DOI: 10.1186/1472-6823-13-47. View

Yan J, Winter L, Burns-Whitmore B, Vermeylen F, Caudill M . Plasma choline metabolites associate with metabolic stress among young overweight men in a genotype-specific manner. Nutr Diabetes. 2012; 2:e49. PMC: 3488811. DOI: 10.1038/nutd.2012.23. View

Virtanen J, Tuomainen T, Voutilainen S . Dietary intake of choline and phosphatidylcholine and risk of type 2 diabetes in men: The Kuopio Ischaemic Heart Disease Risk Factor Study. Eur J Nutr. 2020; 59(8):3857-3861. PMC: 7669791. DOI: 10.1007/s00394-020-02223-2. View

Raubenheimer P, Nyirenda M, Walker B . A choline-deficient diet exacerbates fatty liver but attenuates insulin resistance and glucose intolerance in mice fed a high-fat diet. Diabetes. 2006; 55(7):2015-20. DOI: 10.2337/db06-0097. View

10.

Wiedeman A, Barr S, Green T, Xu Z, Innis S, Kitts D . Dietary Choline Intake: Current State of Knowledge Across the Life Cycle. Nutrients. 2018; 10(10). PMC: 6213596. DOI: 10.3390/nu10101513. View

11.

Sotos-Prieto M, Bhupathiraju S, Mattei J, Fung T, Li Y, Pan A . Association of Changes in Diet Quality with Total and Cause-Specific Mortality. N Engl J Med. 2017; 377(2):143-153. PMC: 5589446. DOI: 10.1056/NEJMoa1613502. View

12.

Zeisel S, Mar M, Howe J, Holden J . Concentrations of choline-containing compounds and betaine in common foods. J Nutr. 2003; 133(5):1302-7. DOI: 10.1093/jn/133.5.1302. View

13.

Sadre-Marandi F, Dahdoul T, Reed M, Nijhout H . Sex differences in hepatic one-carbon metabolism. BMC Syst Biol. 2018; 12(1):89. PMC: 6201565. DOI: 10.1186/s12918-018-0621-7. View

14.

Miyagawa N, Miura K, Okuda N, Kadowaki T, Takashima N, Nagasawa S . Long-chain n-3 polyunsaturated fatty acids intake and cardiovascular disease mortality risk in Japanese: a 24-year follow-up of NIPPON DATA80. Atherosclerosis. 2014; 232(2):384-9. DOI: 10.1016/j.atherosclerosis.2013.11.073. View

15.

Tang W, Wang Z, Levison B, Koeth R, Britt E, Fu X . Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. N Engl J Med. 2013; 368(17):1575-84. PMC: 3701945. DOI: 10.1056/NEJMoa1109400. View

16.

Stern M, Williams K, Haffner S . Identification of persons at high risk for type 2 diabetes mellitus: do we need the oral glucose tolerance test?. Ann Intern Med. 2002; 136(8):575-81. DOI: 10.7326/0003-4819-136-8-200204160-00006. View

17.

Bidulescu A, Chambless L, Siega-Riz A, Zeisel S, Heiss G . Usual choline and betaine dietary intake and incident coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) study. BMC Cardiovasc Disord. 2007; 7:20. PMC: 1934379. DOI: 10.1186/1471-2261-7-20. View

18.

. The decline of ischaemic heart disease mortality in the ARIC study communities. The ARIC Study Investigators. Int J Epidemiol. 1989; 18(3 Suppl 1):S88-98. DOI: 10.1093/ije/18.supplement_1.s88. View

19.

Floegel A, Stefan N, Yu Z, Muhlenbruch K, Drogan D, Joost H . Identification of serum metabolites associated with risk of type 2 diabetes using a targeted metabolomic approach. Diabetes. 2012; 62(2):639-48. PMC: 3554384. DOI: 10.2337/db12-0495. View

20.

Shan Z, Sun T, Huang H, Chen S, Chen L, Luo C . Association between microbiota-dependent metabolite trimethylamine--oxide and type 2 diabetes. Am J Clin Nutr. 2017; 106(3):888-894. DOI: 10.3945/ajcn.117.157107. View