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Associations of dietary choline intake with risk of incident dementia and with cognitive performance: the Kuopio Ischaemic Heart Disease Risk Factor Study

Ylilauri MPT, Voutilainen S, Lönnroos E, Virtanen HEK, Tuomainen TP, Salonen JT, Virtanen JK (2019) Am J Clin Nutr.  2019 Jul.  pii: nqz148. doi: 10.1093/ajcn/nqz148. [Epub ahead of print] 

Web URL: Read this and related abstracts on PubMed here

Abstract:

BACKGROUND:

Moderate egg intake has been associated with better cognitive performance in observational studies. This association may be due to the rich content of choline, especially phosphatidylcholine, in eggs because choline has been suggested to have a role in the prevention of cognitive decline.

OBJECTIVES:

We investigated the associations of dietary choline intake with the risk of incident dementia and with cognitive performance in middle-aged and older men in the prospective, population-based Kuopio Ischaemic Heart Disease Risk Factor Study.

METHODS:

A population-based sample of 2497 dementia-free men aged 42-60 y was examined in 1984-1989. A subset of 482 men completed 5 different cognitive performance tests 4 y later. Dementia and Alzheimer disease diagnoses were retrieved from Finnish health registers. Dietary intakes were assessed with the use of 4-d food records at baseline. Cox regression and ANCOVA were used for the analyses. All analyses were also stratified by the apolipoprotein E phenotype (APOE-ε4 compared with other phenotypes). These data were available for 1259 men.

RESULTS:

The mean ± SD total choline intake was 431 ± 88 mg/d, of which 188 ± 63 mg/d was phosphatidylcholine. During a 21.9-y follow-up, 337 men were diagnosed with dementia. Those in the highest compared with the lowest phosphatidylcholine intake quartile had 28% (95% CI: 1%, 48%; P-trend = 0.02 across quartiles) lower multivariable-adjusted risk of incident dementia. Total choline intake had no association with the risk of incident dementia. However, both total choline and phosphatidylcholine intakes were associated with better performance in cognitive tests assessing frontal and temporal lobe functioning. For example, higher intakes were associated with better performance in verbal fluency and memory functions. The APOE phenotype had little or no impact on the associations.

CONCLUSION:

Higher phosphatidylcholine intake was associated with lower risk of incident dementia and better cognitive performance in men in eastern Finland.

FAB RESEARCH COMMENT:

As this study was purely observational, it can't provide direct evidence of cause and effect - but it is consistent with other evidence that low dietary choline intakes (particularly in the form of phosphatidylcholine, essential to cell membranes) may increase the risk of age-related cognitive impairment and dementia.

However, animal studies have clearly shown that dietary choline deficiencies impair brain development and function - and that a lack of this nutrient causes cognitive and memory problems, including dementia.

There is also solid evidence for many different mechanisms by which choline is essential for brain health at all ages, explaining its protective effect against the various neurodegenerative processes that predate and predict the development of dementia.

Data show that dietary choline intakes for many people are sub-optimal - largely because dietary changes over time have reduced consumption of the foods richest in choline - most notably liver, and other meat, eggs and fish. 

For more information, please see the associated news article and FAB comment:


For more information on choline, see: