Written by Harold Oster, MD. Results suggest that increased dietary choline is associated with higher cognitive function in older adults and slower cognitive decline in adult females.
Cognitive decline or dementia affects almost half of the adults over 85 years old in the United States1. The most important risk factor for dementia is age, but depression, hypertension, nutrition, diabetes, and hearing loss play a role2. Choline is an essential nutrient in humans, required for healthy fetal development. It is a precursor of several substances necessary for normal organ function, including betaine and acetylcholine, an important neurotransmitter. Choline deficiency has been implicated as a possible risk factor in the development of dementia, primarily in animal studies3. Significant sources of choline in the diet are eggs, fish, meat, milk, and grains4.
Feifei Huang et al. studied the association between dietary choline intake and cognitive function and the rate of cognitive decline in older adults. The authors analyzed data gathered between 1997 and 2015 by the China Health and Nutrition Survey (CHNS)5, a longitudinal study examining how social and dietary factors affect the health of Chinese residents. Participants were evaluated at least twice, two to four years apart, and the first evaluation was defined as the baseline. The participants’ dietary consumption was assessed by questionnaires conducted over three consecutive days. Responses were compared to the Chinese Food Composition Table6 to determine choline intake, and the participants were divided into quartiles based on average daily consumption. The quartile with the lowest choline consumption was designated quartile one, and the group with the highest was quartile four. Cognitive function, which encompassed memory, calculation, and attention, was assessed through face-to-face interviews based on the Telephone Interview for Cognitive Status (TICS)7. TICS scores were normalized to correct for the different weighting of each domain, resulting in total scores between zero and three, with higher scores representing better cognition. The participants were evaluated for covariables, including education level, income, hypertension, diabetes, and smoking.
The authors noted the following:
- Based on inclusion criteria, data from 1,887 individuals between 55 and 79 years old at baseline was included in the study.
- The mean age at baseline was 60.1 years, and 50.7% were male.
- The average length of follow-up was 12.2 years.
- After adjustment for covariables, participants in the highest quartile of choline intake scored significantly higher on cognitive testing than those in the lowest intake group. (0.085 points higher for males and 0.077 points higher for females).
- For every ten years of age, cognitive scores decreased by 0.250 points in males and 0.333 points in females. As age increased, cognitive scores showed a linear decline.
- In females, age-related cognitive decline was less in quartile three of choline intake than in the lowest intake group. The rate of cognitive decline in the highest quartile of choline intake was not significantly different than those in the lowest quartile.
- In males, the rate of age-related cognitive decline was not significantly associated with dietary choline intake.
Results suggest that increased dietary choline intake is associated with higher cognitive function in older adults. Increased choline intake may also be associated with slower cognitive decline in females. The study’s limitations include its cross-sectional design, the use of questionnaires to assess choline intake, and possible residual confounding.
Source: Huang, Feifei, Fangxu Guan, Xiaofang Jia, Jiguo Zhang, Chang Su, Wenwen Du, Yifei Ouyang et al. “Dietary Choline Intake Is Beneficial for Cognitive Function and Delays Cognitive Decline: A 22-Year Large-Scale Prospective Cohort Study from China Health and Nutrition Survey.” Nutrients 16, no. 17 (2024): 2845.
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Posted October 8, 2024.
Harold Oster, MD graduated from medical school in Miami, Florida in 1992 and moved to Minnesota in 2004. After more than 25 years of practicing Internal Medicine, he recently retired. Dr. Oster is especially interested in nutrition, weight management, and disease prevention. Visit his website at haroldoster.com.
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- Bishop NA, Lu T, Yankner BA. Neural mechanisms of ageing and cognitive decline. Nature. Mar 25 2010;464(7288):529-35. doi:10.1038/nature08983
- Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. Aug 8 2020;396(10248):413-446. doi:10.1016/s0140-6736(20)30367-6
- Dave N, Judd JM, Decker A, et al. Dietary choline intake is necessary to prevent systems-wide organ pathology and reduce Alzheimer’s disease hallmarks. Aging Cell. Feb 2023;22(2):e13775. doi:10.1111/acel.13775
- Arias N, Arboleya S, Allison J, et al. The Relationship between Choline Bioavailability from Diet, Intestinal Microbiota Composition, and Its Modulation of Human Diseases. Nutrients. Aug 5 2020;12(8)doi:10.3390/nu12082340
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- Shen X, Fang A, He J, et al. Trends in dietary fat and fatty acid intakes and related food sources among Chinese adults: a longitudinal study from the China Health and Nutrition Survey (1997-2011). Public Health Nutr. Nov 2017;20(16):2927-2936. doi:10.1017/s1368980017001781
- Fong TG, Fearing MA, Jones RN, et al. Telephone interview for cognitive status: Creating a crosswalk with the Mini-Mental State Examination. Alzheimer’s & dementia : the journal of the Alzheimer’s Association. Nov 2009;5(6):492-7. doi:10.1016/j.jalz.2009.02.007
