Choline Intake Correlates with Cognitive Performance among Elder Adults in the United States

Behavioural Neurology

Oct 2021

DOI: 10.1155/2021/2962245

Citations:33

Influential Citations:4

Observational Studies (Human)

Enhanced Details

Methods

Cross-sectional NHANES analysis (2011-2014). Participants: U.S. adults aged ≥60 years; N=2,393 with complete cognitive data. Data from MEC; cognitive function assessed using CERAD Word Learning subset, Animal Fluency test, and Digit Symbol Substitution Test. Total choline intake (dietary plus supplements) estimated from 24-hour dietary recall and supplement questionnaire; participants categorized into tertiles (<187.06 mg/day, 187.06-399.50 mg/day, >399.50 mg/day). Low cognitive function defined as the lowest 25th percentile on each test. Logistic regression examined associations, adjusting for age, gender, BMI, alcohol use, and hypertension.

Results

Total choline intake in the 187.06-399.50 mg/day range was associated with lower odds of low cognitive function across CERAD (OR 0.668; 95% CI 0.493-0.904; P=0.006), AF (OR 0.606; 95% CI 0.508-0.724; P<0.001), and DSST (OR 0.584; 95% CI 0.515-0.661; P<0.001) after covariate adjustment. Intake >399.50 mg/day showed no additional benefit (not different from <187.06 mg/day). A U-shaped pattern suggests an optimal total choline intake around 187-399 mg/day for reducing risk of low cognitive performance. Findings may inform dietary recommendations and nutritional interventions to optimize cognitive function in elders.

Limitations

Cross-sectional design cannot establish causality. Dietary choline intake estimated from a single 24-hour recall plus supplement data, which may not reflect usual intake. Exclusions of extreme intakes and underweight individuals limit generalizability. Potential residual confounding and measurement error in self-reported data. Findings apply to older US adults and may not generalize to other populations.

Abstract

Objective This research attempted to explore the neuroprotective effect of choline and establish evidence for future dietary recommendations and nutritional interventions to maintain a proper cognitive function among elders aged >60 years in the US. Method This cross-sectional study retrieved data of 2,393 eligible elderly participants from the 2011-2014 National Health and Nutrition Examination Survey. Combining dietary and supplement choline intake, total choline intake was evaluated using the 24-hour dietary recall method and the dietary supplement questionnaire. Total choline intake was categorized into tertiles, which ranged at <187.60 mg/day (T1), 187.60-399.50 mg/day (T2), and >399.50 mg/day (T3). The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word Learning subtest, Animal Fluency (AF) test, and Digit Symbol Substitution test (DSST) was used to measure cognitive function. Participants who scored the lowest 25th percentile in each cognitive test were classified in the low cognitive function (LC) group. Logistic regression models were implemented to examine the association between total choline intake and the incidence of LC. Results In the CERAD test, the risk of LC was significantly lower in T2 than T1 (OR: 0.668, 95% CI: 0.493-0.904, and P = 0.006) when adjusted for age, gender, BMI, alcohol consumption, and hypertension. Similarly, T2 was associated with a significantly lower risk of LC when assessed by the AF test (OR: 0.606, 95% CI: 0.580-0.724, and P < 0.001) and DSST (0.584, 95% CI: 0.515-0.661, and P < 0.001). In all three cognitive measures, the T3 of the total choline intake was not associated with cognitive function compared to T1. Conclusion Total choline intake at 187.06-399.50 mg/day reduces the risk of LC by approximately 50% compared to intake at <187.6 mg/day. The findings of this research may be used to establish dietary recommendations and nutritional interventions to optimize the cognitive function among elders. show less