Updated 27 October 2015

Choline thwarts heart disease risk

Increased intake of choline, a nutrient found in meat, milk and eggs, can reduce circulating levels of homocysteine, an amino acid linked to increased heart disease risk, says a study.


“Our study adds further evidence that intakes of less than 1g of choline or betaine per day can reduce homocysteine concentrations in a free-living population,” wrote lead author Eunyoung Cho from Harvard Medical School.

Few studies have investigated the effects of the nutrient in terms of disease prevention, because food composition databases were not available until only recently.

The new study has taken advantage of these databases and reports that people with increased intake of choline, and its oxidation product betaine (found naturally in vegetables such as spinach), have lower levels of homocysteine.

The amino acid homocysteine has been linked by epidemiological studies to an increased risk of heart disease. A meta-analysis in the British Medical Journal (Vol. 325, pp. 1202-1208) of genetic and prospective studies reported that a 3 micromole per litre decrease in homocysteine levels was associated with a decrease in the risk of ischaemic heart disease of 16 percent.

How the study was done

The Harvard study, published in the American Journal of Clinical Nutrition (Vol. 83, pp. 905-911), analysed the dietary intake of 1960 volunteers (1040 women) with an average age of 54 using a validated 130-item food frequency questionnaire.

Choline and betaine intake was calculated using the Harvard University Food Composition Database, the US Department of Agriculture’s choline database, and values published in 2003 in the Journal of Nutrition (Vol. 133, pp. 1302-1307).

The researchers found that the highest choline intake (401mg per day) was associated with a nine percent lower plasma concentration of homocysteine, compared to the lowest intake group (234mg per day).

When betaine was counted along with choline, a similar reduction in homocysteine level was observed (9,2 percent) when comparing the highest intake groups (689mg per day) with the lowest intake group (383mg per day).

The results took into account possible complicating factors such as age, sex, smoking, alcohol, hypertension, and intakes of B-vitamins.

Increased intake of B-vitamins, and particularly folate/folic acid, has been reported to reduce homocysteine levels, and protect against heart disease.

From choline to betaine

The mechanism behind the benefits is proposed to be the oxidation of choline to betaine, which then donates a methyl group to homocysteine to form methionine. This mechanism, say the researchers, is confined to the kidney and livers.

This also suggests, said Cho, that even if folate intake is low, homocysteine levels can be reduced by having an adequate intake of choline and betaine.

Recommended daily intakes of choline were set in 1998 at values of 550mg per day for men and 425mg a day for women. The mean intake of the entire study population was found to be 313mg a day, indicating this study population were not consuming adequate amounts of the micronutrient.

The results appear to be in line with intervention studies using high-dose betaine or choline supplementation, which have reported homocysteine reductions of up to 20 percent (betaine, 1,5 to 6g per day).

Red meat was reported to be the richest source of choline, giving about 14 percent of the daily intake. Spinach was reported to be the participants’ richest source of betaine, accounting for over 25 percent of the daily intake.

Source: Decision News Media

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