title: Are dietary choline and betaine intakes determinants of total homocysteine concentration?
abstract: BACKGROUND
  Elevated homocysteine concentrations are associated with an increased risk of cardiovascular disease and a decline in cognitive function. Intakes of choline and betaine, as methyl donors, may affect homocysteine concentrations.
  
  
  OBJECTIVE
  The objective was to examine whether choline and betaine intakes, assessed from food-frequency questionnaires, are associated with total plasma homocysteine concentrations under both fasting and post-methionine-load conditions in both pre- and post-folic acid fortification periods in the United States.
  
  
  METHODS
  We assessed the association between choline and betaine intakes and fasting and post-methionine-load homocysteine concentrations using the US Department of Agriculture revised food-composition tables and evaluated whether the associations varied by folic acid fortification periods in 1325 male and 1407 female participants in the sixth examination (1995-1998) of the Framingham Offspring Study.
  
  
  RESULTS
  A higher choline-plus-betaine intake was associated with lower concentrations of post-methionine-load homocysteine; the multivariate geometric means were 24.1 micromol/L (95% CI: 23.4, 24.9 micromol/L) in the top quintile of intake and 25.0 micromol/L (95% CI: 24.2, 25.7 micromol/L) in the bottom quintile (P for trend = 0.01). We found an inverse association between choline-plus-betaine intake and fasting homocysteine concentrations; the multivariate geometric mean fasting homocysteine concentrations were 9.6 micromol/L (95% CI: 9.3, 9.9 micromol/L) in the top quintile and 10.1 micromol/L (95% CI: 9.8, 10.4 micromol/L) in the bottom quintile (P for trend < 0.001). When we stratified by plasma folate and vitamin B-12 concentrations, the inverse association was limited to participants with low plasma folate or vitamin B-12 concentrations. In the postfortification period, the inverse association between choline-plus-betaine intake and either fasting or post-methionine-load homocysteine was no longer present.
  
  
  CONCLUSIONS
  Choline and betaine intakes were associated with both fasting and post-methionine-load total homocysteine concentrations, especially in participants with low folate and vitamin B-12 status. The inverse association between choline and betaine intakes and homocysteine concentrations was no longer present in the postfortification period.
authors.affiliation: Department of Food and Nutrition, Sookmyung Women's University, Seoul, Republic of Korea.
authors.forename: Jung Eun
authors.initials: JE
authors.lastname: Lee
authors.forename: Paul F
authors.initials: PF
authors.lastname: Jacques
authors.forename: Lauren
authors.initials: L
authors.lastname: Dougherty
authors.forename: Jacob
authors.initials: J
authors.lastname: Selhub
authors.forename: Edward
authors.initials: E
authors.lastname: Giovannucci
authors.forename: Steven H
authors.initials: SH
authors.lastname: Zeisel
authors.forename: Eunyoung
authors.initials: E
authors.lastname: Cho
mesh_terms: D001622:Betaine / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002794:Choline / Q000378:metabolism*; D003072:Cognition Disorders / Q000453:epidemiology; D004032:Diet; D005260:Female; D005492:Folic Acid / Q000378:metabolism / Q000494:pharmacology*; D006710:Homocysteine / Q000009:adverse effects / Q000097:blood*; D006801:Humans; D008297:Male; D008715:Methionine / Q000378:metabolism / Q000494:pharmacology; D014805:Vitamin B 12 / Q000378:metabolism; D025101:Vitamin B 6 / Q000378:metabolism
chemical_list: D006710:Homocysteine; D001622:Betaine; D025101:Vitamin B 6; D005492:Folic Acid; D008715:Methionine; D002794:Choline; D014805:Vitamin B 12