Yu Danxia, Shu Xiao-Ou, Xiang Yong-Bing, Li Honglan, Yang Gong, Gao Yu-Tang, Zheng Wei, Zhang Xianglan
Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN; and.
Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China.
J Nutr. 2014 Dec;144(12):2034-40. doi: 10.3945/jn.114.197533. Epub 2014 Oct 15.
Choline deficiency has been shown to induce liver fat accumulation in both rodent and human studies. However, it is unclear whether dietary choline intake is related to fatty liver in the general population.
We examined the association between choline intake and nonalcoholic fatty liver.
Participants included 56,195 Chinese women and men, 40-75 y of age, with no or negligible alcohol consumption and with no history of hepatitis, cardiovascular disease, or cancer. All participants reported undergoing liver ultrasonography. Fatty liver was defined by self-report of a physician diagnosis. Habitual dietary intakes were assessed via validated food-frequency questionnaires.
The average total choline intakes were 289 ± 85 mg/d in women and 318 ± 92 mg/d in men. Major food sources were eggs, soy foods, red meat, fish, and vegetables. A higher choline intake was associated with lower risk of fatty liver; after adjustment for sociodemographic characteristics, lifestyle factors, and other dietary intakes, the ORs (95% CIs) for the highest vs. the lowest quintiles of choline intake were 0.68 (0.59, 0.79) in women and 0.75 (0.60, 0.93) in men (both P-trend < 0.01). The inverse association was attenuated after further adjustment for history of metabolic disease and, in particular, BMI. The corresponding ORs (95% CIs) were 0.88 (0.75, 1.03) in women (P-trend = 0.05) and 0.85 (0.68, 1.06) in men (P-trend = 0.09). Stratified analyses suggested a potential effect modification by obesity status in women; the OR (95% CI) across extreme quintiles was 0.72 (0.57, 0.91) in normal-weight women vs. 1.05 (0.84, 1.31) in overweight or obese women (P-trend = 0.007 vs. 0.99, P-interaction < 0.0001).
Higher dietary choline intake may be associated with lower risk of nonalcoholic fatty liver only in normal-weight Chinese women.
在啮齿动物和人类研究中均已表明，胆碱缺乏会导致肝脏脂肪堆积。然而，尚不清楚在普通人群中，膳食胆碱摄入量是否与脂肪肝有关。
我们研究了胆碱摄入量与非酒精性脂肪肝之间的关联。
参与者包括56195名年龄在40 - 75岁之间的中国男性和女性，他们饮酒量极少或不饮酒，且无肝炎、心血管疾病或癌症病史。所有参与者均报告接受过肝脏超声检查。脂肪肝由医生诊断的自我报告定义。通过经过验证的食物频率问卷评估习惯性膳食摄入量。
女性的平均总胆碱摄入量为289±85毫克/天，男性为318±92毫克/天。主要食物来源为鸡蛋、大豆类食品、红肉、鱼类和蔬菜。胆碱摄入量较高与脂肪肝风险较低相关；在调整社会人口学特征、生活方式因素和其他膳食摄入量后，胆碱摄入量最高五分位数与最低五分位数相比，女性的比值比（95%置信区间）为0.68（0.59，0.79），男性为0.75（0.60，0.93）（两者P趋势<0.01）。在进一步调整代谢疾病史，尤其是体重指数后，这种负相关减弱。女性相应的比值比（95%置信区间）为0.88（0.75，1.03）（P趋势 = 0.05），男性为0.85（0.68，1.06）（P趋势 = 0.09）。分层分析表明，肥胖状态可能对女性有效应修饰作用；正常体重女性中，极端五分位数之间的比值比（95%置信区间）为0.72（0.57，0.91），超重或肥胖女性为1.05（0.84，1.31）（P趋势分别为0.007和0.99，P交互作用<0.0001）。
仅在正常体重的中国女性中，较高的膳食胆碱摄入量可能与较低的非酒精性脂肪肝风险相关。
