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First published: Jan 28, 2025
Summary: Choline may protect against Dementia
Dietary choline plays a role in protecting against dementia, cognitive decline, and Alzheimer’s disease according to this January 2025 study. (1)
Choline. A. Whittall
Choline and its link to Dementia
A study by Ying-ying Niu et al., (1) published this week, investigated the association between dietary choline intake and dementia, cognitive performance, and Alzheimer's Disease (AD).
They used data from 125,954 participants of the UK Biobank aged 40-70 years and followed them for 11.8 years.
The participants were split into four quartiles. A quartile is a statistical term applied to each of four equal sections, each of which contains 25% of the data. They are named, from the lowest to the highest as follows: 1st quartile (0-25%), 2nd quartile (25-50%), 3rd quartile (50-75%), and 4th quartile (75-100%).
In this study, the average intake of choline was: 1st Quartile: 176 mg per day, 2nd Quartile: 253 mg per day, 3rd Quartile: 322 mg per day, and 4th Quartile: 465 mg per day.
The study found a U-shaped association between the amount of choline they ingested, and the risk of suffering dementia, and Alzheimer's disease.
U-shaped association with a disease means that the risk is higher in the upper and lower ranges, and lowest in the middle ranges, forming a "U" shaped plot. This relationship can be seen in the image below (from the paper), where a lower or higher intake of choline is associated with a higher risk of dementia and Alzheimer's disease (AD), while a moderate intake has a lower risk. Notice the red line marking a "U" shaped curve.
Associations of total choline with dementia and Alzheimer's Disease, from Ying-ying Niu et al., 2025 (1)
Highlights
Subjects in the 2nd quartile of total choline intake had lower risks than those in the lowest quartile, 20% less for dementia and 24% for Alzheimer's disease.
"Additionally, moderate total choline intake was associated with an 8%–13% lower odds of poor cognitive performance in visual attention [8%], fluid intelligence [13%], and complex processing speed [10%]."
"Moderate dietary choline intake, ranging from 332.89 mg/d to 353.93 mg/d, is associated with lower odds of dementia and better cognitive performance." This is roughly equivalent to the choline content of 2 eggs.
What is Choline
Choline or 2-Hydroxy-N,N,N-trimethylethan-1-aminium is an essential nutrient, that can be synthesized in the liver but is mainly obtained from food.
It has many biological functions and is utilized by the cells to make the phospholipids that make up their membranes, it is also a precursor to acetylcholine, a neurotransmitter.
Different studies have shown it plays an important role in cognition, and a low choline intake has been linked to a higher risk of dementia and Alzheimer's disease.
An excessive intake of choline has been linked to a higher risk of cardiovascular disease. The authors of this study suggest that excess choline is not absorbed by the intestine but, instead, is degraded by the gut microbiome into trimethylamine (TMA) that later is transformed by the liver into trimethylamine N-oxide (TMAO).
Some studies have found that both compounds, TMA and TMAO are associated with heart disease, stroke, and... Alzheimer's disease.
Another factor to consider is that choline is more abundant in meats and eggs, and these contain fats. A higher intake of choline would imply a higher intake of fats. The fat-choline combination could increase the risk of cognitive decline.
It makes up our diet as lecithin that is found in eggs, milk, meat, and in fruits, and grains. Many processed foods also contain lecithin, which is added as an emulsifying agent in gravies, salad dressings, soups, mayonnaise, ice creams, and margarine, and as a preservative for cooking oils just to mention a few.
The European Food Safety Authority defined an Adequate intakes (AIs) for adults as 400 mg/day. In the U.S. the guidelines are 425 mg per day for women and 550 mg per day for men. (2). These three values are slightly higher than the optimal level reported in this study.
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