Dietary choline and betaine; associations with subclinical markers of cardiovascular disease risk and incidence of CVD, coronary heart disease and stroke: the Jackson Heart Study

Eur J Nutr. 2018 Feb;57(1):51-60. doi: 10.1007/s00394-016-1296-8. Epub 2016 Aug 22.


Purpose: Several mechanisms have been described through which dietary intake of choline and its derivative betaine may be associated in both directions with subclinical atherosclerosis. We assessed the association of dietary intake of choline and betaine with cardiovascular risk and markers of subclinical cardiovascular disease.

Methods: Data from 3924 Jackson Heart Study (JHS) African-American participants with complete food frequency questionnaire at baseline and follow-up measurements of heart disease measures were used. Multivariable linear regression models were employed to assess associations between choline and betaine intake with carotid intima-media thickness, coronary artery calcium, abdominal aortic calcium and left ventricular mass. Cox proportional hazards regression models were used to estimate associations with time to incident coronary heart disease (CHD), ischemic stroke and cardiovascular disease (CVD).

Results: During an average nine years of follow-up, 124 incident CHD events, 75 incident stroke events and 153 incident CVD events were documented. In women, greater choline intake was associated with lower left ventricular mass (p = 0.0006 for trend across choline quartiles) and with abdominal aortic calcium score. Among all JHS participants, there was a statistically significant inverse association between dietary choline intake and incident stroke, β = -0.33 (p = 0.04). Betaine intake was associated with greater risk of incident CHD when comparing the third quartile of intake with the lowest quartile of intake (HR 1.89, 95 % CI 1.14, 3.15).

Conclusions: Among our African-American participants, higher dietary choline intake was associated with a lower risk of incident ischemic stroke, and thus putative dietary benefits. Higher dietary betaine intake was associated with a nonlinear higher risk of incident CHD.

Keywords: Betaine; Choline; Diet; Incident coronary heart disease; Subclinical measures of cardiovascular disease; The Jackson Heart Study.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Betaine / administration & dosage*
  • Black People
  • Cardiovascular Diseases / epidemiology*
  • Choline / administration & dosage*
  • Coronary Disease / epidemiology*
  • Diet Records
  • Diet*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mississippi
  • Proportional Hazards Models
  • Risk Factors
  • Stroke
  • Surveys and Questionnaires


  • Betaine
  • Choline