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Dietary choline and betaine intake in relation to psychological disorders in adults

Published online by Cambridge University Press:  20 June 2025

Shervin Kazeminejad Open the ORCID record for Shervin Kazeminejad [Opens in a new window] ,
Zahra Moradmand Open the ORCID record for Zahra Moradmand [Opens in a new window] ,
Farnaz Shahdadian ,
Zahra Hajhashemy ,
Parisa Rouhani  and
Parvane Saneei Open the ORCID record for Parvane Saneei [Opens in a new window]
Shervin Kazeminejad
Affiliation:
Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
Zahra Moradmand
Affiliation:
Students’ Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran Department of Community Nutrition, School of Nutrition and Food Science, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Farnaz Shahdadian
Affiliation:
Department of Clinical Nutrition, School of Nutrition and Food Science, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Zahra Hajhashemy
Affiliation:
Students’ Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran Department of Community Nutrition, School of Nutrition and Food Science, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Parisa Rouhani
Affiliation:
Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
Parvane Saneei*
Affiliation:
Department of Community Nutrition, School of Nutrition and Food Science, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
*
Corresponding author: Parvane Saneei; Email: saneeip@yahoo.com/saneei@nutr.mui.ac.ir
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Abstract

Dietary choline and betaine, suggested as neuroprotective nutrients, have not been sufficiently studied in relation to psychological disorders. This study aimed to investigate the association between dietary choline and betaine and common psychological disorders (depression, anxiety and psychological distress) among Iranian adults. Using a multistage cluster random sampling method, 533 middle-aged adults were included in this cross-sectional study. Dietary intakes were assessed using a validated semi-quantitative 168-item FFQ. Depression, anxiety and psychological distress were evaluated using the Hospital Anxiety and Depression Scale and the General Health Questionnaire, both validated for the Iranian population. Binary logistic regression was applied to explore the associations. Mean age of participants was 42·6 (sd 11·14) years; of whom 18·9, 5·1 and 33·4 % had depression, anxiety and psychological distress, respectively. In the crude model, the highest intake of choline was negatively associated with depression (OR = 0·52; 95 % CI: 0·30, 0·91), anxiety (OR = 0·38; 95 % CI: 0·14, 0·99) and distress (OR = 0·60; 95 % CI: 0·38, 0·94) compared with the lowest intake. After considering all confounders, such associations remained significant in the case of depression (OR = 0·51; 95 % CI: 0·26, 0·98) but not for anxiety and distress. Additionally, there was no significant association between betaine intake and odds of depression, anxiety or distress in both crude and adjusted models. This study suggests a protective association between choline intake and depression, while no significant relation was found in the case of anxiety and distress. Betaine intake was not related to psychological disorders. Further prospective studies are crucial to replicate these findings.

Keywords

CholineBetainePsychological distressAnxietyDepressionPsychological disorders

Information

Type
Research Article
Information
British Journal of Nutrition , Volume 133 , Issue 11 , 14 June 2025 , pp. 1431 - 1438
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Nutrition Society

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References

Adogu, P, Ubajaka, C, Emelumadu, O, et al. (2015) Epidemiologic transition of diseases and health-related events in developing countries: a review. Am J Med Med Sci 5, 150–157.Google Scholar
Machado, MO, Veronese, N, Sanches, M, et al. (2018) The association of depression and all-cause and cause-specific mortality: an umbrella review of systematic reviews and meta-analyses. BMC Med 16, 112.CrossRefGoogle ScholarPubMed
Nielsen, RE, Banner, J & Jensen, SE (2021) Cardiovascular disease in patients with severe mental illness. Nat Rev Cardiol 18, 136–145.CrossRefGoogle ScholarPubMed
Wang, YH, Li, JQ, Shi, JF, et al. (2020) Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies. Mol Psychiatry 25, 1487–1499.CrossRefGoogle ScholarPubMed
Baxter, AJ, Scott, KM, Vos, T, et al. (2013) Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med 43, 897–910.CrossRefGoogle ScholarPubMed
Kessler, RC (2012) The costs of depression. Psychiatr Clin North Am 35, 1–14.CrossRefGoogle ScholarPubMed
Charlson, F, van Ommeren, M, Flaxman, A, et al. (2019) New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. Lancet 394, 240–248.CrossRefGoogle ScholarPubMed
Maroufizadeh, S, Pourshaikhian, M, Pourramzani, A, et al. (2022) Prevalence of anxiety and depression in the Iranian general population during the COVID-19 pandemic: a web-based cross-sectional study. Iran J Psychiatry 17, 230–239.Google ScholarPubMed
Ansari, S, Parsaei, M, Noorbala, AA, et al. (2024) Prevalence and associated factors of mental health distress among hospitalized patients in general hospitals: a multi-center cross-sectional study in Iran. Discov Ment Health 4, 66.CrossRefGoogle ScholarPubMed
Malhi, GS & Mann, JJ (2018) Depression. Lancet 392, 2299–2312.CrossRefGoogle ScholarPubMed
Saveanu, RV & Nemeroff, CB (2012) Etiology of depression: genetic and environmental factors. Psychiatr Clin North Am 35, 51–71.CrossRefGoogle ScholarPubMed
Gibson-Smith, D, Bot, M, Brouwer, IA, et al. (2020) Association of food groups with depression and anxiety disorders. Eur J Nutr 59, 767–778.CrossRefGoogle ScholarPubMed
Hosseinzadeh, M, Vafa, M, Esmaillzadeh, A, et al. (2016) Empirically derived dietary patterns in relation to psychological disorders. Public Health Nutr 19, 204–217.CrossRefGoogle ScholarPubMed
Ventriglio, A, Sancassiani, F, Contu, MP, et al. (2020) Mediterranean diet and its benefits on health and mental health: a literature review. Clin Pract Epidemiol Ment Health: CP & EMH 16, 156.CrossRefGoogle ScholarPubMed
Dahal, S & Devi, NK (2024) Genes Associated with One-Carbon Metabolic Pathway and Depression. Handbook of the Biology and Pathology of Mental Disorders. Cham: Springer. pp. 1–22.CrossRefGoogle Scholar
Anderson, OS, Sant, KE & Dolinoy, DC (2012) Nutrition and epigenetics: an interplay of dietary methyl donors, one-carbon metabolism and DNA methylation. J Nutr Biochem 23, 853–859.CrossRefGoogle ScholarPubMed
Glenn, MJ, Adams, RS & McClurg, L (2012) Supplemental dietary choline during development exerts antidepressant-like effects in adult female rats. Brain Res 1443, 52–63.CrossRefGoogle ScholarPubMed
Schulz, KM, Pearson, JN, Gasparrini, ME, et al. (2014) Dietary choline supplementation to dams during pregnancy and lactation mitigates the effects of in utero stress exposure on adult anxiety-related behaviors. Behav Brain Res 268, 104–110.CrossRefGoogle ScholarPubMed
Jeyhoonabadi, M, Alimoahmmadi, S, Hassanpour, S, et al. (2022) Betaine ameliorates depressive-like behaviors in zinc oxide nanoparticles exposed mice. Biol Trace Elem Res 200, 4771–4781.CrossRefGoogle ScholarPubMed
Li, J, Kang, X, Zhang, L, et al. (2022) Dietary choline is inversely associated with depressive symptoms: a cross-sectional study of the National Health and Nutrition Examination Survey (NHANES) 2011 to 2018. J Affect Disord 301, 23–29.CrossRefGoogle ScholarPubMed
Bjelland, I, Tell, GS, Vollset, SE, et al. (2009) Choline in anxiety and depression: the Hordaland Health Study. Am J Clin Nutr 90, 1056–1060.CrossRefGoogle ScholarPubMed
van Lee, L, Quah, PL, Saw, SM, et al. (2017) Maternal choline status during pregnancy, but not that of betaine, is related to antenatal mental well-being: the growing up in Singapore toward healthy outcomes cohort. Depress Anxiety 34, 877–887.CrossRefGoogle Scholar
Poursalehi, D, Shahdadian, F, Hajhashemy, Z, et al. (2023) Diet in relation to metabolic, sleep and psychological health status (DiMetS): protocol for a cross-sectional study. BMJ Open 13, e076114.CrossRefGoogle ScholarPubMed
Willett, W & Hu, F (1998) Anthropometric measures and body composition. Nutr Epidemiol 2, 244–272.CrossRefGoogle Scholar
Mirmiran, P, Esfahani, FH, Mehrabi, Y, et al. (2010) Reliability and relative validity of an FFQ for nutrients in the Tehran lipid and glucose study. Public Health Nutr 13, 654–662.CrossRefGoogle ScholarPubMed
Ghaffarpour, M, Houshiar-Rad, A & Kianfar, H (1999) The Manual for Household Measures, Cooking Yields Factors and Edible Portion of Foods. vol. 7, pp. 42–58. Tehran: Nashre Olume Keshavarzy.Google Scholar
Patterson, KY, Bhagwat, SA, Williams, JR, et al. (2008) USDA Database for the Choline Content of Common Foods, Release Two. Beltsville, MD: Nutrient Data Laboratory, Beltsville Human Nutrition Research Center, ARS, USDA.Google Scholar
Montazeri, A, Vahdaninia, M, Ebrahimi, M, et al. (2003) The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version. Health Qual Life Outcomes 1, 14.CrossRefGoogle ScholarPubMed
Montazeri, A, Harirchi, AM, Shariati, M, et al. (2003) The 12-item General Health Questionnaire (GHQ-12): translation and validation study of the Iranian version. Health Qual Life Outcomes 1, 66.CrossRefGoogle ScholarPubMed
Moghaddam, MB, Aghdam, FB, Jafarabadi, MA, et al. (2012) The Iranian Version of International Physical Activity Questionnaire (IPAQ) in Iran: content and construct validity, factor structure, internal consistency and stability. World Appl Sci J 18, 1073–1080.Google Scholar
Willett, WC, Howe, GR & Kushi, LH (1997) Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr 65, 1220S–1228S; discussion 9S–31S.CrossRefGoogle ScholarPubMed
Stein, DJ, Benjet, C, Gureje, O, et al. (2019) Integrating mental health with other non-communicable diseases. BMJ 364, l295.CrossRefGoogle Scholar
Blasco, BV, García-Jiménez, J, Bodoano, I, et al. (2020) Obesity and depression: its prevalence and influence as a prognostic factor: a systematic review. Psychiatry Investig 17, 715–724.CrossRefGoogle ScholarPubMed
Dash, SR, O’Neil, A & Jacka, FN (2016) Diet and common mental disorders: the imperative to translate evidence into action. Front Public Health 4, 81.CrossRefGoogle ScholarPubMed
Wendołowicz, A, Stefańska, E, Jankowska, D, et al. (2020) Intake of selected nutraceuticals and the clinical condition of patients with mental disorders. Arch Psychiatry Psychother 22, 17–29.CrossRefGoogle Scholar
Di Pierro, F, Orsi, R & Settembre, R (2015) Role of betaine in improving the antidepressant effect of S-adenosyl-methionine in patients with mild-to-moderate depression. J Multidiscip Healthcare 8, 39–45.CrossRefGoogle ScholarPubMed
Di Pierro, F & Settembre, R (2015) Preliminary results of a randomized controlled trial carried out with a fixed combination of S-adenosyl-L-methionine and betaine v. amitriptyline in patients with mild depression. Int J Gen Med 8, 73–78.CrossRefGoogle Scholar
Beurel, E, Toups, M & Nemeroff, CB (2020) The bidirectional relationship of depression and inflammation: double trouble. Neuron 107, 234–256.CrossRefGoogle ScholarPubMed
Danese, A, Moffitt, TE, Pariante, CM, et al. (2008) Elevated inflammation levels in depressed adults with a history of childhood maltreatment. Arch Gen Psychiatry 65, 409–415.CrossRefGoogle ScholarPubMed
Sorci, G & Faivre, B (2009) Inflammation and oxidative stress in vertebrate host-parasite systems. Philos Trans R Soc Lond B Biol Sci 364, 71–83.CrossRefGoogle ScholarPubMed
Fujii, T, Tsuchiya, T, Yamada, S, et al. (1996) Localization and synthesis of acetylcholine in human leukemic T cell lines. J Neurosci Res 44, 66–72.3.0.CO;2-G>CrossRefGoogle ScholarPubMed
Han, B, Li, X & Hao, J (2017) The cholinergic anti-inflammatory pathway: an innovative treatment strategy for neurological diseases. Neurosci Biobehav Rev 77, 358–368.CrossRefGoogle ScholarPubMed
Sarter, M & Parikh, V (2005) Choline transporters, cholinergic transmission and cognition. Nat Rev Neurosci 6, 48–56.CrossRefGoogle ScholarPubMed
Biringer, E, Mykletun, A, Dahl, AA, et al. (2005) The association between depression, anxiety, and cognitive function in the elderly general population--the Hordaland Health Study. Int J Geriatr Psychiatry 20, 989–997.CrossRefGoogle ScholarPubMed
Roy, P, Tomassoni, D, Nittari, G, et al. (2022) Effects of choline containing phospholipids on the neurovascular unit: a review. Front Cell Neurosci 16, 988759.CrossRefGoogle ScholarPubMed
Arumugam, MK, Paal, MC, Donohue, TM Jr, et al. (2021) Beneficial effects of betaine: a comprehensive review. Biology 10, 456.CrossRefGoogle Scholar