Food Sources Contributing to Intake of Choline and Individual Choline Forms in a Norwegian Cohort of Patients With Stable Angina Pectoris

Abstract

Background: Choline is an essential nutrient involved in a wide range of physiological functions. It occurs in water- and lipid-soluble forms in the body and diet. Foods with a known high choline content are eggs, beef, chicken, milk, fish, and selected plant foods. An adequate intake has been set in the US and Europe, however, not yet in the Nordic countries. A higher intake of lipid-soluble choline forms has been associated with increased risk of acute myocardial infarction, highlighting the need for knowledge about food sources of the individual choline forms. In general, little is known about the habitual intake and food sources of choline, and individual choline forms.Objective: Investigate foods contributing to the intake of total choline and individual choline forms.Design: The study population consisted of 1,929 patients with stable angina pectoris from the Western Norway B Vitamin Intervention Trial. Dietary intake data was obtained through a 169-item food frequency questionnaire. Intake of total choline and individual choline forms was quantified using the USDA database, release 2.Results: The geometric mean (95% prediction interval) total choline intake was 287 (182, 437) mg/d. Phosphatidylcholine accounted for 42.5% of total choline intake, followed by free choline (25.8%) and glycerophosphocholine (21.2%). Phosphocholine and sphingomyelin contributed 4.2 and 4.5%, respectively. The main dietary choline sources were eggs, milk, fresh vegetables, lean fish, and bread. In general, animal food sources were the most important contributors to choline intake.Conclusion: This study is, to the best of our knowledge, the first to assess the intake of all choline forms and their dietary sources in a European population. Most choline was consumed in the form of phosphatidylcholine and animal food sources contributed most to choline intake. There is a need for accurate estimates of the dietary intake of this essential nutrient to issue appropriate dietary recommendations.

Association between dietary choline and betaine intake and 10.6-year cardiovascular disease in adults

“…In contrast, Nagata et al [ 42 ] did not find any association between PtC and CVD deaths in Japanese adults. The distribution of individual choline form intakes found in this cohort is consistent with the pattern reported in the Norwegian cohort [ 38 ]. In the current study, an inverse association between dietary FC and CVD but not the other forms of choline was detected.…”

“…Nonetheless, due to variation in the number of FFQ items, intake of choline and betaine may not be similar between studies [ 36 ]. In addition, discrepancies in dietary assessment tools, adjusting for total energy, dietary pattern, and characteristics of the population, may be involved in different observed values among studies [ 38 ]. According to the National Academies of Medicine (NAM), the recommended adequate intake (AI) for choline is 550 and 425 mg/d for males and females, respectively [ 39 ].…”

“…FC, a water-soluble form, is the second contributor to total choline. Plant-based foods are the most important sources of dietary FC [ 38 ]. Several cohort studies have found an inverse association between higher adherence to plant-based foods and a lower risk of CVD [ 54 , 55 ].…”

Nutrient Adequacy of Global Food Production

“…This is important because previous global studies did not calculate the country-specific production amounts of PUFAs and choline ( 24 , 34 ). An assessment based on the National Health and Nutrition Examination Survey (2009–2012 NHANES) found that the choline intake levels are well below the recommended levels in around 90% of Americans including most pregnant and lactating women ( 55 ), thus underscoring the need to increase awareness among health professionals and consumers regarding choline ( 22 ).…”

“…Previous studies have investigated the nutrient quantities available in the national food supply and matched them with the nutritional requirements to inform food policies that can tackle the food insecurity and malnutrition concerns regarding the current diets. Most such studies have focused on just calories (18)(19)(20) or a couple of nutrients (21)(22)(23) while others have investigated the sufficient production of a limited number of macro and micronutrients (16,24,25). Only a few studies have considered the comprehensive nutritional factors involved (26)(27)(28).…”