One-year longitudinal association between changes in dietary choline or betaine intake and cardiometabolic variables in the PREvención con DIeta MEDiterránea-Plus (PREDIMED-Plus) trial

Abstract

Background: Choline and betaine intakes have been related to cardiovascular health.

Objectives: We aimed to explore the relation between 1-y changes in dietary intake of choline or betaine and 1-y changes in cardiometabolic and renal function traits within the frame of the PREDIMED (PREvención con DIeta MEDiterránea)-Plus trial.

Methods: We used baseline and 1-y follow-up data from 5613 participants (48.2% female and 51.8% male; mean ± SD age: 65.01 ± 4.91 y) to assess cardiometabolic traits, and 3367 participants to assess renal function, of the Spanish PREDIMED-Plus trial. Participants met ≥3 criteria of metabolic syndrome and had overweight or obesity [BMI (in kg/m2) ≥27 and ≤40]. These criteria were similar to those of the PREDIMED parent study. Dietary intakes of choline and betaine were estimated from the FFQ.

Results: The greatest 1-y increase in dietary choline or betaine intake (quartile 4) was associated with improved serum glucose concentrations (-3.39 and -2.72 mg/dL for choline and betaine, respectively) and HbA1c levels (-0.10% for quartile 4 of either choline or betaine intake increase). Other significant changes associated with the greatest increase in choline or betaine intake were reduced body weight (-2.93 and -2.78 kg, respectively), BMI (-1.05 and -0.99, respectively), waist circumference (-3.37 and -3.26 cm, respectively), total cholesterol (-4.74 and -4.52 mg/dL, respectively), and LDL cholesterol (-4.30 and -4.16 mg/dL, respectively). Urine creatinine was reduced in quartile 4 of 1-y increase in choline or betaine intake (-5.42 and -5.74 mg/dL, respectively).

Conclusions: Increases in dietary choline or betaine intakes were longitudinally related to improvements in cardiometabolic parameters. Markers of renal function were also slightly improved, and they require further investigation.This trial was registered at https://www.isrctn.com/ as ISRCTN89898870.

Keywords: Mediterranean diet; betaine; cardiometabolic parameters; cardiovascular disease risk; choline; renal variables.

FIGURE 1

Participant flowchart.

FIGURE 2

Forest plots showing the association of 20-mg increments in dietary choline intake (A) and dietary betaine intake (B) with changes in cardiometabolic parameters, after 1 y of follow-up (n = 5613). Dietary choline and betaine intakes were adjusted by energy residuals. The model was adjusted by age, sex, center, years of schooling, civil status, smoking habits, sedentary lifestyle, choline and betaine intake at baseline, PA and difference in PA, adherence to an er-MedDiet and difference in adherence to an er-MedDiet, and energy intake and difference in energy intake (1 y–baseline). Values are represented as β ± 95% CI, and P value. BP, blood pressure; er-MedDiet, energy-restricted traditional Mediterranean diet; PA, physical activity.