School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.
Department of Clinical Nutrition, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Diabetes. 2021 Jul;13(7):554-561. doi: 10.1111/1753-0407.13143. Epub 2020 Dec 23.
Little is known about the relationship between dietary intake of choline, which is a major dietary precursor for gut microbiome-derived trimethylamine N-oxide (TMAO), and diabetes mellitus (DM) in the general population. The present study aims to explore the relationship between dietary choline intake and DM in the US adult population.
Cross-sectional data were derived from the National Health and Nutrition Examination Survey (NHANES) 2007-2010 of 8621 individuals aged 20 years or older. Multivariable logistic regression models were used to determine odds ratios (ORs) and 95% confidence intervals (CIs) for DM of each quartile category of energy-adjusted choline intakes. The restricted cubic spline model was used for the dose-response analysis. The receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value of choline intake for predicting DM.
A linear dose-response relationship between dietary choline intake and the odds of DM was found after adjustment for multiple potential confounding factors. With the lowest quartile category of choline as the reference, the multivariable-adjusted ORs and 95% CIs of the second, third, and highest quartile categories were 1.23 (0.99-1.53), 1.27 (1.02-1.58), and 1.49 (1.20-1.85), respectively, P for trend =0.0004. The ROC analysis identified energy-adjusted choline of 331.7 mg/8.37-MJ per day as the optimal cutoff value for predicting DM, with 52.5% sensitivity and 60.7% specificity.
This study supports a positive and linear relationship between dietary choline intake and DM in the US adult population.
人们对于饮食中胆碱（肠道微生物群衍生三甲胺 N-氧化物（TMAO）的主要膳食前体）的摄入量与 2 型糖尿病（DM）之间的关系知之甚少。本研究旨在探讨美国成年人群中饮食胆碱摄入量与 DM 之间的关系。
横断面数据来自 2007-2010 年全国健康和营养调查（NHANES）中 8621 名年龄在 20 岁或以上的个体。使用多变量逻辑回归模型确定每个能量调整后胆碱摄入量四分位组的 DM 比值比（OR）和 95%置信区间（CI）。受限立方样条模型用于剂量-反应分析。接收者操作特征（ROC）曲线用于确定预测 DM 的最佳胆碱摄入量截断值。
在调整了多个潜在混杂因素后，发现饮食胆碱摄入量与 DM 几率之间存在线性剂量-反应关系。以胆碱最低四分位组为参照，第二、三、四分位组的多变量校正 OR 和 95%CI 分别为 1.23（0.99-1.53）、1.27（1.02-1.58）和 1.49（1.20-1.85），趋势 P 值=0.0004。ROC 分析确定能量调整后胆碱 331.7mg/8.37-MJ 每天为预测 DM 的最佳截断值，敏感性为 52.5%，特异性为 60.7%。
本研究支持美国成年人群中饮食胆碱摄入量与 DM 之间存在正相关和线性关系。
