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Association of dietary choline and betaine intake with all-cause mortality: a longitudinal study from the China Health and Nutrition Survey

Published online by Cambridge University Press:  07 July 2025

Peishan Tan ,
Peiyan Chen ,
Shangling Wu ,
Jialin Lu ,
Jing Shu ,
Dan Li  and
Aiping Fang Open the ORCID record for Aiping Fang [Opens in a new window]
Peishan Tan
Affiliation:
Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
Peiyan Chen
Affiliation:
Department of Clinical Nutrition, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
Shangling Wu
Affiliation:
Department of Clinical Nutrition, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
Jialin Lu
Affiliation:
Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
Jing Shu
Affiliation:
Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
Dan Li*
Affiliation:
Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
Aiping Fang*
Affiliation:
School of Public Health and Emergency Management, School of Medicine, Southern University of Science and Technology, Shenzhen, People’s Republic of China
*
Corresponding authors: Dan Li; Email: lidan58@mail.sysu.edu.cn, Aiping Fang; Email: fangap@sustech.edu.cn
Corresponding authors: Dan Li; Email: lidan58@mail.sysu.edu.cn, Aiping Fang; Email: fangap@sustech.edu.cn
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Abstract

Epidemiologic evidence on the association between dietary choline, betaine and mortality risk remains limited, particularly among non-Western populations. We examined the association of dietary choline and betaine with all-cause mortality in Chinese adults using data from the China Health and Nutrition Survey 1991–2015. We included 9027 men and 8828 women without CVD and cancer at baseline. Dietary intake was assessed using 3-day 24-hour dietary recalls and household food inventories. Death was ascertained through household surveys in each wave. Time-dependent Cox proportional hazards regression models estimated multivariable-adjusted hazard ratios (HRs) and 95 % CIs. During a median follow-up of 9·1 years, 891 men and 687 women were deceased. Higher total choline intake was associated with lower all-cause mortality in both men (HRQ5 v. Q1 = 0·58 (95 % CI: 0·45, 0·74)) and women (HRQ5 v. Q1 = 0·59 (95 % CI: 0·44, 0·78)). The dose–response curve were reverse J-shaped in men and L-shaped in women (both P-nonlinear ≤ 0·005). Similarly, fat-soluble choline intake was inversely associated with mortality in both men (HRQ5 v. Q1 = 0·59 (95 % CI: 0·46, 0·75)) and women (HRQ5 v. Q1 = 0·53 (95 % CI: 0·40, 0·70)), showing reverse J-shaped patterns (both P-nonlinear < 0·001). A J-shaped association between water-soluble choline and 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. Our findings suggest that adequate choline intake is linked to reduced all-cause mortality in Chinese adults with predominantly plant-based diets.

Keywords

Choline intakeBetaine intakeAll-cause mortalityChinese adultsProspective cohort study

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Type
Research Article
Information
British Journal of Nutrition , First View , pp. 1 - 18
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© The Author(s), 2025. Published by Cambridge University Press on behalf of The Nutrition Society

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