Abstract
ABSTRACTBackgroundPrevious studies have shown that elevated trimethylamine N-oxide (TMAO) was associated with a higher risk of diabetes mellitus (DM). Little is known about the relationship between dietary intake of choline, which is a major dietary precursor for gut microbiome-derived TMAO, and DM in the general population.ObjectiveThe present study aims to explore the relationship between dietary choline intakes and DM in the United States (US) adult population.DesignCross-sectional data were derived from the National Health and Nutrition Examination Survey (NHANES) 2007-2010 of 8621 individuals aged 20 years or older. Multivariable logistic regression models were used to determine odds ratios (ORs) and 95% confidence intervals (CIs) for DM of each quartile category of energy-adjusted choline intakes. The restricted cubic spline model was used for the dose-response analysis. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value of choline intake for predicting DM.ResultsA linear dose-response relationship between dietary choline intakes and the odds of DM was found after adjustment for multiple potential confounding factors, p for linear =0.0002. With the lowest quartile category of choline as the reference, the multivariable-adjusted ORs and 95% CIs of the second, third, and highest quartile categories were 1.22 (0.98, 1.52), 1.26 (1.01, 1.56), and 1.42 (1.15, 1.77), respectively, p for trend =0.0024. Per 100 mg/d increase in energy-adjusted choline resulted in 15% (95% CI: 7%, 22%) higher odds of DM. The ROC analysis identified an energy-adjusted choline of 331.7 mg/d as the optimal cut-off value for predicting DM, with 52.5% sensitivity and 60.7% specificity.ConclusionThis study supports a positive and linear relationship between dietary choline intake and DM in the US adult population. Further studies are warranted to replicate our findings in other populations and elucidate the potential mechanisms.
Publisher
Cold Spring Harbor Laboratory