Choline and its metabolites are differently associated with cardiometabolic risk factors, history of cardiovascular disease, and MRI-documented cerebrovascular disease in older adults

Am J Clin Nutr. 2017 Jun;105(6):1283-1290. doi: 10.3945/ajcn.116.137158. Epub 2017 Mar 29.


Background: There is a potential role of choline in cardiovascular and cerebrovascular disease through its involvement in lipid and one-carbon metabolism.Objective: We evaluated the associations of plasma choline and choline-related compounds with cardiometabolic risk factors, history of cardiovascular disease, and cerebrovascular pathology.Design: A cross-sectional subset of the Nutrition, Aging, and Memory in Elders cohort who had undergone MRI of the brain (n = 296; mean ± SD age: 73 ± 8.1 y) was assessed. Plasma concentrations of free choline, betaine, and phosphatidylcholine were measured with the use of liquid-chromatography-stable-isotope dilution-multiple-reaction monitoring-mass spectrometry. A volumetric analysis of MRI was used to determine the cerebrovascular pathology (white-matter hyperintensities and small- and large-vessel infarcts). Multiple linear and logistic regression models were used to examine relations of plasma measures with cardiometabolic risk factors, history of cardiovascular disease, and radiologic evidence of cerebrovascular pathology.Results: Higher concentrations of plasma choline were associated with an unfavorable cardiometabolic risk-factor profile [lower high-density lipoprotein (HDL) cholesterol, higher total homocysteine, and higher body mass index (BMI)] and greater odds of large-vessel cerebral vascular disease or history of cardiovascular disease but lower odds of small-vessel cerebral vascular disease. Conversely, higher concentrations of plasma betaine were associated with a favorable cardiometabolic risk-factor profile [lower low-density lipoprotein (LDL) cholesterol and triglycerides] and lower odds of diabetes. Higher concentrations of plasma phosphatidylcholine were associated with characteristics of both a favorable cardiometabolic risk-factor profile (higher HDL cholesterol, lower BMI, lower C-reactive protein, lower waist circumference, and lower odds of hypertension and diabetes) and an unfavorable profile (higher LDL cholesterol and triglycerides).Conclusion: Choline and its metabolites have differential associations with cardiometabolic risk factors and subtypes of vascular disease, thereby suggesting differing roles in the pathogenesis of cardiovascular and cerebral large-vessel disease compared with that of small-vessel disease.

Keywords: cardiometabolic risk; cerebrovascular disease; choline; magnetic resonance imaging; nutrition; older adults.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Betaine / blood*
  • Body Mass Index
  • C-Reactive Protein / metabolism
  • Cardiovascular Diseases / blood*
  • Cerebrovascular Disorders / blood*
  • Cerebrovascular Disorders / pathology
  • Cholesterol / blood
  • Choline / blood*
  • Cross-Sectional Studies
  • Diabetes Mellitus / blood*
  • Female
  • Homocysteine / blood
  • Humans
  • Hypertension / blood
  • Magnetic Resonance Spectroscopy
  • Male
  • Middle Aged
  • Phosphatidylcholines / blood*
  • Risk Factors
  • Triglycerides / blood
  • Waist Circumference


  • Phosphatidylcholines
  • Triglycerides
  • Homocysteine
  • Betaine
  • C-Reactive Protein
  • Cholesterol
  • Choline