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Cited by 100Nutritional Studies and DietFatty Acid Research and HealthGut microbiota and health

Dietary phosphatidylcholine and risk of all-cause and cardiovascular-specific mortality among US women and men ,

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Zheng, Yan, Li, Yanping, Rimm, Eric B, Hu, Frank B, Albert, Christine M, Rexrode, Kathryn M, Manson, JoAnn E, Qi, Lu·2016·The American Journal of Clinical Nutrition
DOI 10.3945/ajcn.116.131771PMC PMC4919531
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Abstract

Background The trimethylamine-containing nutrient phosphatidylcholine is the major dietary source for the gut microbiota metabolite trimethylamine-N-oxide (TMAO), which has been related to cardiovascular diseases (CVDs) and mortality. Previous research suggested that the relation of TMAO with CVD risk might be stronger in diabetic than in nondiabetic populations. However, the evidence for an association of dietary phosphatidylcholine with CVD and mortality is limited.Objectives We aimed to examine whether dietary consumption of phosphatidylcholine, which is mainly derived from eggs, red meat, and fish, is related to all-cause and CVD mortality in 2 cohorts of US women and men. In particular, we also tested if such an association was modified by diabetes status.Design We followed 80,978 women from the Nurses' Health Study (1980-2012) and 39,434 men from the Health Professionals Follow-Up Study (1986-2012), who were free of cancer and CVD at baseline, for mortality. Dietary intakes and potential confounders were assessed with regularly administered questionnaires. We used Cox proportional hazards models to estimate HRs and 95% CIs.Results We documented 17,829 all-cause and 4359 CVD deaths during follow-up. After multivariate adjustment for potential confounders, including demographic factors, disease status, lifestyle, and dietary intakes, higher phosphatidylcholine intakes were associated with an increased risk of all-cause and CVD mortality. HRs (95% CIs) comparing the top and bottom quintiles of phosphatidylcholine intake were 1.11 (1.06, 1.17; P-trend across quintiles < 0.0001) for all-cause mortality and 1.26 (1.15, 1.39; P-trend < 0.0001) for CVD mortality in the combined data of both cohorts. The associations of phosphatidylcholine with all-cause and CVD mortality were stronger in diabetic than in nondiabetic participants (P-interaction = 0.0002 and 0.001, respectively).Conclusion These data suggest that higher phosphatidylcholine consumption is associated with increased all-cause and CVD mortality in the US population, especially in patients with diabetes, independent of traditional risk factors.

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  • High plasma choline level is associated with a high risk of cardiovascular disease via trimethylamine-N-oxide (TMAO) produced by gut microbiota from choline.

    “a growing body of evidence suggests that a high plasma choline level is associated with a high risk of cardiovascular disease via trimethylamine-N-oxide (TMAO) produced by gut microbiota from choline.”

    From Association of L-α Glycerylphosphorylcholine With Subsequent Stroke Risk After 10 Years (2021) · cites this paper as [12]

    The Introduction and Discussion (page numbers unavailable) describe gut-microbiota production of TMAO from phosphatidylcholine, a dietary source of choline, and report an association between higher blood TMAO and CVD risk. The study examined dietary phosphatidylcholine intake and mortality; our copy does not establish that high plasma choline itself is associated with CVD risk or that TMAO mediates such an association. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Higher dietary PtdCho intake was associated with increased mortality risk in women in the Nurses' Health Study and men in the Health Professionals Follow-Up Study.

    “Higher dietary intake of PtdCho, another precursor for TMAO formation, was associated with increased mortality risk in an analysis of 80,978 women from the Nurses' Health Study (1980-2012) and 39,434 men from the Health Professionals Follow-Up Study (1986-2012) (135).”

    From Trimethylamine <i>N</i> -Oxide, the Microbiome, and Heart and Kidney Disease (2017) · cites this paper as [135]

  • Phosphatidylcholine consumption is associated with increased all-cause and cardiovascular mortality independent of traditional risk factors.

    “recent large-scale epidemiological studies examining phosphatidylcholine ingestion, a nutrient that is more abundant in animal products, and mortality risks in >100 000 subjects with over a quarter century of follow-up, revealed phosphatidylcholine consumption is associated with increased all-cause and cardiovascular mortality independent of traditional risk factors.43”

    From Gut microbiota-dependent trimethylamine N-oxide in acute coronary syndromes: a prognostic marker for incident cardiovascular events beyond traditional risk factors (2017) · cites this paper as [43]

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Authors
Zheng, Y., Li, Y., Rimm, E. B., Hu, F. B., Albert, C. M., Rexrode, K. M., Manson, J. E., & Qi, L.
Affiliations
  • Harvard University (US)
  • Brigham and Women's Hospital (US)
  • Tulane University (US)
Corresponding author
Qi, Lu
ORCID
Venue
The American Journal of Clinical Nutrition
Publisher
Elsevier BV
Published
2016-07
Volume
104
Issue
1
Pages
173-180
ISSN
0002-9165 (ISSN-L)
DOI
10.3945/ajcn.116.131771
PMC
PMC4919531
OpenAlex
W2410932015
Cited by
100
References
30
Citations by year
2026: 5 · 2025: 10 · 2024: 11 · 2023: 10 · 2022: 7 · 2021: 14 · 2020: 10 · 2019: 14 · 2018: 9 · 2017: 8 · 2016: 1
FWCI
10.58
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Clinical Nutrition (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
  • NIH (UM1 CA186107, R01 HL034594, UM1 CA167552, R01 HL35464)
  • National Heart, Lung, and Blood Institute (HL071981, HL034594, HL126024)
  • National Institute of Diabetes and Digestive and Kidney Diseases (DK091718, DK100383, DK078616)
  • Boston Obesity Nutrition Research Center (DK46200)
  • United States–Israel Binational Science Foundation (2011036)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
Keywords
phosphatidylcholine, trimethylamine N-oxide, cardiovascular mortality, all-cause mortality, dietary intake, diabetes mellitus, gut microbiota metabolites, Nurses' Health Study, Health Professionals Follow-up Study, cardiovascular risk, dietary cholesterol, red meat, eggs, fish, sex differences
MeSH terms
Adult, Cardiovascular Diseases, Diet, Female, Humans, Male, Methylamines, Middle Aged, Phosphatidylcholines, Risk Factors, United States, Cohort Studies, Diabetes Complications

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