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Meta-Analysis
. 2017 Jul 7;9(7):711.
doi: 10.3390/nu9070711.

Dietary Choline and Betaine and Risk of CVD: A Systematic Review and Meta-Analysis of Prospective Studies

Katie A Meyer  1   2 , Jonathan W Shea  3
Affiliations
Meta-Analysis

Dietary Choline and Betaine and Risk of CVD: A Systematic Review and Meta-Analysis of Prospective Studies

Katie A Meyer et al. Nutrients. .

Abstract

Studies implicate choline and betaine metabolite trimethylamine N-oxide (TMAO) in cardiovascular disease (CVD). We conducted a systematic review and random-effects meta-analysis to quantify a summary estimated effect of dietary choline and betaine on hard CVD outcomes (incidence and mortality). Eligible studies were prospective studies in adults with comprehensive diet assessment and follow-up for hard CVD endpoints. We identified six studies that met our criteria, comprising 18,076 incident CVD events, 5343 CVD deaths, and 184,010 total participants. In random effects meta-analysis, incident CVD was not associated with choline (relative risk (RR): 1.00; 95% CI: 0.98, 1.02) or betaine (RR: 0.99; 95% CI: 0.98, 1.01) intake. Results did not vary by study outcome (incident coronary heart disease, stroke, total CVD) and there was no evidence for heterogeneity among studies. Only two studies provided data on phosphatidylcholine and CVD mortality. Random effects meta-analysis did not support an association between choline and CVD mortality (RR: 1.09, 95% CI: 0.89, 1.35), but one study supported a positive association and there was significant heterogeneity (I² = 84%, p-value < 0.001). Our findings do not support an association between dietary choline/betaine with incident CVD, but call for further research into choline and CVD mortality.

Keywords: betaine; cardiovascular disease; choline; epidemiology; meta-analysis; systematic review.

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Conflict of interest statement

K.A.M. received a research grant from the Egg Nutrition Center (ENC) in 2015–2016. The ENC grant supported work distinct from the present paper, though eggs are a choline-rich food and the findings of this meta-analysis relate to the general research mission of the ENC. J.W.S. declares no conflict of interest.

Figures

Figure 1
Figure 1
Choline intake and CVD incidence.
Figure 2
Figure 2
Betaine intake and CVD incidence.
Figure 3
Figure 3
Phosphatidylcholine intake and CVD mortality.
See this image and copyright information in PMC

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