The Journal of Nutrition
Dietary Choline and Betaine Intakes Vary in
an Adult Multiethnic Population1–3
Kim M. Yonemori, Unhee Lim,* Karin R. Koga, Lynne R. Wilkens, Donna Au, Carol J. Boushey,
Loı ¨c Le Marchand, Laurence N. Kolonel, and Suzanne P. Murphy
Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI
Choline and betaine are important nutrients for human health, but reference food composition databases for these nutrients
became available only recently. We tested the feasibility of using these databases to estimate dietary choline and betaine
intakes among ethnically diverse adults who participated in the Multiethnic Cohort (MEC) Study. Of the food items (n = 965)
usedtoquantifyintakesfor theMECFFQ,189itemswereexactlymatchedwithitemsintheUSDADatabasefor theCholine
USDA National Nutrient Database for Standard Reference for total choline (n = 547) and 148 for betaine. When a match was
not found, choline and betaine values were imputed based on the same food with a different form (124 food items for
choline,300 for choline compounds, 236 for betaine), a similar food(n = 98, 284, and227, respectively) orthe closest itemin
the same food category (n = 6, 191, and 157, respectively), or the values were assumed to be zero (n = 1, 1, and 8,
respectively). The resulting mean intake estimates for choline and betaine among 188,147 MEC participants (aged 45–75)
varied by sex (372 and 154 mg/d in men, 304 and 128 mg/d in women, respectively; P-heterogeneity < 0.0001) and by race/
ethnicity among Caucasians, African Americans, Japanese Americans, Latinos, and Native Hawaiians (P-heterogeneity <
0.0001),largelydue tothevariationinenergyintake.Our findingsdemonstratethe feasibilityof assessingcholine andbetaine
intake and characterize the variation in intake that exists in a multiethnic population.J. Nutr. 143: 894–899, 2013.
Choline and betaine are important nutrients for human devel-
opment and health (1,2). Choline is an essential nutrient and a
precursor to the neurotransmitter acetylcholine, to phospho-
lipids that constitute cell membrane and transport cholesterol,
and to betaine that provides up to 60% of the methyl moieties
required for DNA methylation, synthesis, and repair (3,4). Betaine,
consumed in foods or endogenously derived from choline, also
serves as an osmolyte (2). Studies have indicated that dietary
choline promotes perinatal development (5–9), and an insuffi-
ciency may increase adults? risk for hepatic steatosis (fatty liver)
and other liver damage (10). In fact, the dietary recommenda-
tion established for choline [an Adequate Intake (AI) of 550 mg/d
for men and 425 mg/d for women] is based on the choline re-
quirement to prevent liver damage in healthy adult men (11,12).
Although research on these nutrients is of high priority (12), they
have been examined in only a few epidemiologic studies of
chronic diseases associated with aberrant DNA methylation and
synthesis (13–15). This is likely because the reference food
composition databases (FCDs)4for dietary assessment of these
nutrients have become available only in recent years (16,17).
Choline is found in foods as free choline or as choline esters,
including glycerophosphocholine, phosphocholine, phosphati-
dylcholine (lecithin), and sphingomyelin, with the reported main
food sources being red meat, eggs, poultry, and milk (15,18).
Betaine is obtained mostly from grain products and spinach
(15,18). The food content information for total choline, choline-
containing compounds (i.e., free choline and choline esters that
sum up to total choline), and betaine is available from the USDA
Database for the Choline Content of Common Foods, created in
2004 and updated in 2008 (16,17). The total choline and betaine
contents in some additional food items are also found in the
USDA National Nutrient Database for Standard Reference (19).
Limited epidemiologic studies on dietary intake of choline
and betaine indicate that a substantial proportion of adults may
have intake below the AI levels (9,13,20). Even fewer data are
available for choline and betaine intake in non-Caucasian popu-
lations, whose dietary patterns are known to vary and whose
1Supported by grants from the American Institute for Cancer Research
(AICR-09A143, U. Lim) and the National Cancer Institute (R37 CA054281, L.N.
2Author disclosures: K. M. Yonemori, U. Lim, K. R. Koga, L. R. Wilkens, D. Au,
C. J. Boushey, L. Le Marchand, L. N. Kolonel, and S. P. Murphy, no conflicts of
3Supplemental Figures 1 and 2 and Supplemental Table 1 are available from the
"Online Supporting Material" link in the online posting of the article and from the
same link in the online table of contents at http://jn.nutrition.org.
* To whom correspondence should be addressed. E-mail: firstname.lastname@example.org.
4Abbreviations used: AI, Adequate Intake; choline database, the USDA Database
for Choline Content of Common Foods (Release Two, 2008); FCD, food
composition database; MEC, Multiethnic Cohort; MSG, monosodium glutamate;
SR, USDA National Nutrient Database for Standard Reference (Release 20, 2007).
ã 2013 American Society for Nutrition.
Manuscript received October 25, 2012. Initial review completed November 28, 2012. Revision accepted March 21, 2013.
First published online April 24, 2013; doi:10.3945/jn.112.171132.
by guest on December 27, 2015
Supplemental Material can be found at:
study also did not include a biomarker validation of the dietary
assessment. However, Cho et al. (18) previously observed a
strong inverse association between blood concentrations of ho-
mocysteine, a commonly used biomarker of 1-carbon metabo-
lism, and dietary intake of choline or betaine.
The strengths of this study are that intake of several under-
studied nutrients were estimated in a large population-based
cohort with a broadly representative sample of 5 ethnic groups
and using a dietary instrument developed to capture most of the
ethnic variations. This work will be updated in the future as
more information on the choline and betaine content of foods
becomes available. These intake estimates will provide the basis
for unique examinations of the health impact of choline and
betaine nutriture in our ethnically diverse populations.
The authors thank Lucy Shen, Yun-Oh Jung, and Maj Earle of
the University of Hawaii Cancer Center?s Biostatistics and
Informatics Shared Resource for their programming support.
L.N.K., L.L.M., and L.R.W. established the cohort; U.L., L.L.M.,
and S.P.M. designed the research; U.L., K.M.Y., K.R.K., and
D.A. conducted the research; L.R.W., D.A., and C.J.B. provided
essential data; U.L. and K.M.Y. analyzed data and wrote the
paper draft; K.R.K., C.J.B., L.L.M., L.N.K., and S.P.M. pro-
vided input for the paper; and U.L. had primary responsibility
for the final content. All authors read and approved the final
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