膳食胆碱摄入量与衰弱发生率的关联：一项来自中国的全国性前瞻性队列研究

Association of Dietary Choline Intake With Incidence of Frailty: A Nationwide Prospective Cohort Study From China.

作者信息

Chen Lian-Hong, Zhong Jian-Feng, Niu Ying-Ying, Li Cheng-Ping, Li Jing, Diao Zhi-Quan, Yan Hao-Yu, Xu Miao, Huang Wen-Qi, Xu Zhi-Tong, Su Chang, Liu Dan

机构信息

Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.

National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China.

出版信息

J Cachexia Sarcopenia Muscle. 2025 Apr;16(2):e13796. doi: 10.1002/jcsm.13796.

DOI:10.1002/jcsm.13796

PMID:40189218

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11972690/

Abstract

BACKGROUND

Emerging evidence suggests that dietary choline is a modifiable nutritional factor linked to various health outcomes. However, most existing studies have focused on isolated health conditions, lacking a comprehensive assessment of overall health status. This study aimed to investigate the association between total dietary choline intake and frailty incidence among Chinese adults, considering its derivatives, soluble forms (water-soluble and lipid-soluble) and food sources (animal-derived and plant-derived).

METHODS

Participants without frailty at baseline were enrolled from the China Health and Nutrition Survey (CHNS), with follow-up from 2004 to 2016. Dietary intake was assessed using three consecutive 24-h dietary recalls to estimate total dietary choline intake, its derivatives, soluble forms and food sources. Frailty status was evaluated using a frailty index (FI), with frailty defined as an FI > 0.21. Cox proportional hazards regression and restricted cubic splines were used to analyse the associations between dietary choline intake and frailty incidence.

RESULTS

A total of 10 310 participants (mean age: 46.4 years [SD: 14.5]; 52.6% female) were eligible. During a median follow-up of 6.1 years, 1150 incident frailty cases were recorded. Cox models with penalized splines showed an L-shaped association between total dietary choline intake and frailty incidence. Compared with participants in the lowest quartile of total choline intake, those in the 2nd to 4th quartiles had lower odds of frailty, with hazard ratios (HRs) of 0.84 (95% CI: 0.71, 0.98), 0.80 (95% CI: 0.67, 0.95) and 0.75 (95% CI: 0.61, 0.93), respectively. Intake of lipid-soluble choline in the 2nd to 4th quartiles was associated with an 18% (HR: 0.82; 95% CI: 0.69, 0.98) to 23% (HR: 0.77; 95% CI: 0.63, 0.95) reduction in the odds of frailty. Participants in the 3rd to 4th quartiles of phosphatidylcholine intake exhibited 19% (HR: 0.81; 95% CI: 0.68, 0.96) to 23% (HR: 0.77; 95% CI: 0.63, 0.94) lower odds of frailty. Choline intake from plant-derived food sources was significantly associated with reduced odds of frailty (HR: 0.83; 95% CI: 0.69, 0.99).

CONCLUSIONS

Moderate to high dietary choline intake (171.00-464.99 mg/day), particularly phosphatidylcholine (145.20-304.93 mg/day), may be associated with reduced odds of frailty.

摘要

背景

新出现的证据表明，膳食胆碱是一种与多种健康结果相关的可改变的营养因素。然而，大多数现有研究都集中在孤立的健康状况上，缺乏对整体健康状况的全面评估。本研究旨在探讨中国成年人膳食总胆碱摄入量与衰弱发生率之间的关联，并考虑其衍生物、可溶形式（水溶性和脂溶性）以及食物来源（动物源性和植物源性）。

方法

从中国健康与营养调查（CHNS）中招募基线时无衰弱的参与者，随访时间为2004年至2016年。通过连续三次2４小时膳食回顾评估膳食摄入量，以估计膳食总胆碱摄入量、其衍生物、可溶形式和食物来源。使用衰弱指数（FI）评估衰弱状态，衰弱定义为FI＞0.21。采用Cox比例风险回归和限制立方样条分析膳食胆碱摄入量与衰弱发生率之间的关联。

结果

共有10310名参与者（平均年龄：46.4岁[标准差：14.5]；52.6%为女性）符合条件。在中位随访6.1年期间，记录了1150例新发衰弱病例。采用惩罚样条的Cox模型显示，膳食总胆碱摄入量与衰弱发生率之间呈L形关联。与总胆碱摄入量最低四分位数的参与者相比，第二至第四四分位数的参与者发生衰弱的几率较低，风险比（HR）分别为0.84（95%置信区间：0.71，0.98）、0.80（95%置信区间：0.67，0.95）和0.75（95%置信区间：0.61，0.93）。第二至第四四分位数的脂溶性胆碱摄入量与衰弱几率降低18%（HR：0.82；95%置信区间：0.69，0.98）至23%（HR：0.77；95%置信区间：0.63，0.95）相关。磷脂酰胆碱摄入量第三至第四四分位数的参与者发生衰弱的几率降低19%（HR：0.81；95%置信区间：0.68，0.96）至23%（HR：0.77；95%置信区间：0.63，0.94）。植物源性食物来源的胆碱摄入量与衰弱几率降低显著相关（HR：0.83；95%置信区间：0.69，0.99）。