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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
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.
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- © The Author(s), 2025. Published by Cambridge University Press on behalf of The Nutrition Society
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Tan et al. supplementary material
Tan et al. supplementary material
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