Threshold-Effect Association of Dietary Cholesterol Intake with Dyslipidemia in Chinese Adults: Results from the China Health and Nutrition Survey in 2015.

The association of dietary cholesterol intake with dyslipidemia and subtypes is controversial. This study aimed to examine the association of dietary cholesterol intake with dyslipidemia and subtypes in Chinese adults. Using data from the China Health and Nutrition Survey (CHNS) in 2015, the present study selected 4383 participants aged 18-59 years who were free of diabetes, apoplexy, and myocardial infarction disease. Information was obtained on dietary intake, anthropometric measurements, and blood laboratory measurements. Dietary cholesterol intake was calculated based on the data collected by consecutive 3 days 24 h recalls combined with the weighing of household seasonings and categorized by 11 levels: The first 10 levels in ranges of 50 mg/day and the 11th level at ≥500 mg/day. Dyslipidemia, hypercholesterolemia, hypertriglyceridemia, low-density lipoprotein (LDL)-hypercholesterolemia, and high-density lipoprotein (HDL)-hypocholesterolemia were defined based on the Chinese adult dyslipidemia prevention guide (2016 edition). Multivariable logistic regressions were performed to examine the association of dietary cholesterol intake levels with dyslipidemia and subtypes. The prevalence of dyslipidemia was 37.5% among Chinese adults in 2015 (hypercholesterolemia 9.6%, HDL-hypocholesterolemia 21.1%, LDL-hypercholesterolemia 12.7%, and hypertriglyceridemia 15.2%). The lowest prevalence of hypercholesterolemia and LDL-hypercholesterolemia was 6.7% and 9.4%, respectively, which was relative to a dietary cholesterol intake level of 100.0 to <150.0 mg/day. After adjusting for all potential confounders, adults with the highest dietary cholesterol intake level of ≥500 mg/day compared with the dietary cholesterol intake of 100.0 to <150.0 mg/day showed one-time higher odds of hypercholesterolemia (odds ratios (OR) 2.0, 95% confidence intervals (CI) 1.3-3.3), as well as LDL-hypercholesterolemia (OR 2.0, 95% CI 1.3-3.0), but a null association of dietary cholesterol intake with dyslipidemia, hypertriglyceridemia, and HDL-hypocholesterolemia. The study suggested that a dietary cholesterol intake level of 500 mg/day and above may be a threshold point for high odds of hypercholesterolemia and LDL-hypercholesterolemia.