Association of Dietary Choline Intake With Incidence of Frailty: A Nationwide Prospective Cohort Study From China

IF 9.4 1区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of Cachexia Sarcopenia and Muscle Pub Date : 2025-04-06 DOI:10.1002/jcsm.13796

Lian-hong Chen, Jian-feng Zhong, Ying-ying Niu, Cheng-ping Li, Jing Li, Zhi-quan Diao, Hao-yu Yan, Miao Xu, Wen-qi Huang, Zhi-tong Xu, Chang Su, Dan Liu

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Abstract

Background

Emerging evidence suggests that dietary choline is a modifiable nutritional factor linked to various health outcomes. However, most existing studies have focused on isolated health conditions, lacking a comprehensive assessment of overall health status. This study aimed to investigate the association between total dietary choline intake and frailty incidence among Chinese adults, considering its derivatives, soluble forms (water-soluble and lipid-soluble) and food sources (animal-derived and plant-derived).

Methods

Participants without frailty at baseline were enrolled from the China Health and Nutrition Survey (CHNS), with follow-up from 2004 to 2016. Dietary intake was assessed using three consecutive 24-h dietary recalls to estimate total dietary choline intake, its derivatives, soluble forms and food sources. Frailty status was evaluated using a frailty index (FI), with frailty defined as an FI > 0.21. Cox proportional hazards regression and restricted cubic splines were used to analyse the associations between dietary choline intake and frailty incidence.

Results

A total of 10 310 participants (mean age: 46.4 years [SD: 14.5]; 52.6% female) were eligible. During a median follow-up of 6.1 years, 1150 incident frailty cases were recorded. Cox models with penalized splines showed an L-shaped association between total dietary choline intake and frailty incidence. Compared with participants in the lowest quartile of total choline intake, those in the 2nd to 4th quartiles had lower odds of frailty, with hazard ratios (HRs) of 0.84 (95% CI: 0.71, 0.98), 0.80 (95% CI: 0.67, 0.95) and 0.75 (95% CI: 0.61, 0.93), respectively. Intake of lipid-soluble choline in the 2nd to 4th quartiles was associated with an 18% (HR: 0.82; 95% CI: 0.69, 0.98) to 23% (HR: 0.77; 95% CI: 0.63, 0.95) reduction in the odds of frailty. Participants in the 3rd to 4th quartiles of phosphatidylcholine intake exhibited 19% (HR: 0.81; 95% CI: 0.68, 0.96) to 23% (HR: 0.77; 95% CI: 0.63, 0.94) lower odds of frailty. Choline intake from plant-derived food sources was significantly associated with reduced odds of frailty (HR: 0.83; 95% CI: 0.69, 0.99).

Conclusions

Moderate to high dietary choline intake (171.00–464.99 mg/day), particularly phosphatidylcholine (145.20–304.93 mg/day), may be associated with reduced odds of frailty.

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膳食胆碱摄入量与衰弱发生率的关系：一项来自中国的全国性前瞻性队列研究

背景新的证据表明，膳食胆碱是一种与各种健康结果相关的可调节营养因素。然而，现有的研究大多集中于个别健康状况，缺乏对整体健康状态的全面评估。本研究旨在调查中国成年人膳食胆碱总摄入量与虚弱发生率之间的关系，同时考虑胆碱的衍生物、可溶性形式（水溶性和脂溶性）和食物来源（动物源性和植物源性）。方法从中国健康与营养调查（CHNS）中选取基线时无体弱症状的参与者，从 2004 年至 2016 年进行随访。通过连续三次 24 小时膳食回顾评估膳食摄入量，以估算膳食中胆碱的总摄入量、其衍生物、可溶形式和食物来源。虚弱状态采用虚弱指数（FI）进行评估，虚弱指数为 0.21。采用 Cox 比例危险回归和限制性立方样条来分析膳食胆碱摄入量与虚弱发生率之间的关系。结果共有 10 310 名参与者（平均年龄：46.4 岁 [标码：14.5]；52.6% 为女性）符合条件。在 6.1 年的中位随访期间，共记录了 1150 例虚弱病例。采用惩罚性斜线的 Cox 模型显示，膳食胆碱总摄入量与虚弱发病率之间存在 L 型关联。与总胆碱摄入量处于最低四分位数的参与者相比，处于第二至第四四分位数的参与者发生虚弱的几率较低，危险比（HRs）分别为 0.84（95% CI：0.71，0.98）、0.80（95% CI：0.67，0.95）和 0.75（95% CI：0.61，0.93）。脂溶性胆碱摄入量在第 2 至第 4 个四分位数与虚弱几率降低 18% (HR: 0.82; 95% CI: 0.69, 0.98) 至 23% (HR: 0.77; 95% CI: 0.63, 0.95) 有关。磷脂酰胆碱摄入量在第 3 至第 4 个四分位数的参与者的虚弱几率降低了 19% (HR: 0.81; 95% CI: 0.68, 0.96) 到 23% (HR: 0.77; 95% CI: 0.63, 0.94)。从植物性食物中摄入的胆碱与虚弱几率的降低显著相关（HR：0.83；95% CI：0.69，0.99）。结论从膳食中摄入中到高水平的胆碱（171.00-464.99 毫克/天），尤其是磷脂酰胆碱（145.20-304.93 毫克/天），可能与降低虚弱几率有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cachexia Sarcopenia and Muscle MEDICINE, GENERAL & INTERNAL-

CiteScore

13.30

自引率

12.40%

发文量

234

审稿时长

16 weeks

期刊介绍： The Journal of Cachexia, Sarcopenia and Muscle is a peer-reviewed international journal dedicated to publishing materials related to cachexia and sarcopenia, as well as body composition and its physiological and pathophysiological changes across the lifespan and in response to various illnesses from all fields of life sciences. The journal aims to provide a reliable resource for professionals interested in related research or involved in the clinical care of affected patients, such as those suffering from AIDS, cancer, chronic heart failure, chronic lung disease, liver cirrhosis, chronic kidney failure, rheumatoid arthritis, or sepsis.