Choline Pathway Nutrients and Metabolites and Cognitive Impairment After Acute Ischemic Stroke

Zhong, Chongke; Lu, Zian; Che, Bizhong; Qian, Sifan; Zheng, Xiaowei; Wang, Aili; Bu, Xiaoqing; Zhang, Jintao; Ju, Zhong; Xu, Tan; Zhang, Yonghong

doi:10.1161/strokeaha.120.031903

Cited by 32 publications

(21 citation statements)

References 41 publications

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“…Many reports have shown that supplementing the maternal (during gestation and lactation) diet with additional choline benefits cognition [34][35][36]. A recent study showed that Chinese ischemic stroke patients with higher choline and betaine levels had a lower risk of cognitive impairment, using data derived from CATIS (China Antihypertensive Trial in Acute Ischemic Stroke) [37]. The effectiveness of choline intake was allied with the findings of our study.…”

Section: Discussionsupporting

confidence: 80%

Choline Intake Correlates with Cognitive Performance among Elder Adults in the United States

Liu

Qiao

Zhuang

et al. 2021

Behavioural Neurology

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Objective. This research attempted to explore the neuroprotective effect of choline and establish evidence for future dietary recommendations and nutritional interventions to maintain a proper cognitive function among elders aged >60 years in the US. Method. This cross-sectional study retrieved data of 2,393 eligible elderly participants from the 2011-2014 National Health and Nutrition Examination Survey. Combining dietary and supplement choline intake, total choline intake was evaluated using the 24-hour dietary recall method and the dietary supplement questionnaire. Total choline intake was categorized into tertiles, which ranged at <187.60 mg/day (T1), 187.60-399.50 mg/day (T2), and >399.50 mg/day (T3). The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) Word Learning subtest, Animal Fluency (AF) test, and Digit Symbol Substitution test (DSST) was used to measure cognitive function. Participants who scored the lowest 25th percentile in each cognitive test were classified in the low cognitive function (LC) group. Logistic regression models were implemented to examine the association between total choline intake and the incidence of LC. Results. In the CERAD test, the risk of LC was significantly lower in T2 than T1 (OR: 0.668, 95% CI: 0.493-0.904, and P = 0.006 ) when adjusted for age, gender, BMI, alcohol consumption, and hypertension. Similarly, T2 was associated with a significantly lower risk of LC when assessed by the AF test (OR: 0.606, 95% CI: 0.580-0.724, and P < 0.001 ) and DSST (0.584, 95% CI: 0.515-0.661, and P < 0.001 ). In all three cognitive measures, the T3 of the total choline intake was not associated with cognitive function compared to T1. Conclusion. Total choline intake at 187.06-399.50 mg/day reduces the risk of LC by approximately 50% compared to intake at <187.6 mg/day. The findings of this research may be used to establish dietary recommendations and nutritional interventions to optimize the cognitive function among elders.

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Section: Discussionsupporting

confidence: 80%

Choline Intake Correlates with Cognitive Performance among Elder Adults in the United States

Liu

Qiao

Zhuang

et al. 2021

Behavioural Neurology

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Section: Discussionmentioning

confidence: 79%

“…Experimental studies suggested that dietary supplementation with choline could increase the neuroprotective cellular response, facilitate development of collateral circulation, and improve ischemic stroke outcomes in a rat model [8–10]. Our recent prospective study found that patients with higher plasma choline and betaine levels had a lower risk of cognitive impairment after ischemic stroke [24]. PSD is another frequent neuropsychiatric complication following ischemic stroke; however, very limited population‐based studies have investigated the relationships between circulating choline pathway nutrients and PSD.…”

Section: Discussionmentioning

confidence: 99%

Circulating choline pathway nutrients and depression after ischemic stroke

Miao

Che

et al. 2021

Euro J of Neurology

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Background and purpose Choline pathway nutrients, including choline and betaine, are reported to exert antidepressant effects. However, there is little population‐based evidence on the relationships between circulating choline and betaine and poststroke depression (PSD). We aimed to prospectively explore the associations between plasma choline and betaine and depression after ischemic stroke. Methods This study was based on the China Antihypertensive Trial in Acute Ischemic Stroke. A total of 612 participants with plasma choline and betaine concentrations were included in the analysis. The study outcome was depression 3 months after ischemic stroke. Logistic regression models were performed to estimate the relationships between plasma choline and betaine and the risk of PSD. Risk reclassification and calibration of models with choline or betaine were analyzed. Results Patients with PSD had lower choline and betaine levels than those without PSD (p < 0.05). Compared with tertile 1, the multivariable‐adjusted odds ratios (95% CIs) for tertile 3 of choline and betaine were 0.54 (0.35–0.83) and 0.59 (0.38–0.92), respectively. Per 1 SD increase in choline or betaine was associated with a 25% (95% CI 9%–37%) or an 19% (95% CI 3%–32%) decreased risk of PSD, respectively. Furthermore, the addition of choline or betaine to the established risk factors model improved the risk reclassification for PSD, as shown by an increase in the net reclassification index and integrated discrimination improvement (all p < 0.05). Conclusions Patients with elevated levels of choline and betaine had a lower risk of depression after acute ischemic stroke, suggesting the protective significance of choline pathway nutrients for PSD.

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“…Several studies have shown that choline metabolism plays pathophysiological roles in central nervous system (CNS) diseases. For instance, choline metabolism has a potentially prognostic role in cognitive impairment after stoke ( 58 ). Choline is the precursor of neurotransmitter acetylcholine and also acts as an agonist for the receptors that could regulate CNS immune responses, and their dysregulation is associated with the pathogenesis of several neurological diseases ( 59 ).…”

Section: Discussionmentioning

confidence: 99%

Disturbance of Gut Bacteria and Metabolites Are Associated with Disease Severity and Predict Outcome of NMDAR Encephalitis: A Prospective Case–Control Study

Gong

Liu

et al. 2022

Front. Immunol.

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ObjectiveWe aimed to investigate the associations between the intestinal microbiota, metabolites, cytokines, and clinical severity in anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis and to further determine the predictive value of the intestinal microbiota or metabolites in clinical prognosis.MethodsIn this prospective observational cohort study of 58 NMDAR encephalitis patients and 49 healthy controls, fecal microbiota, metabolites, and cytokines were quantified and characterized by16S rRNA gene sequencing, liquid chromatography–mass spectrometry, and the Luminex assay, respectively.ResultsThere were marked variations in the gut microbiota composition and metabolites in critically ill patients. We identified 8 metabolite modules (mainly characterized by fatty acid, glycerophosphoethanolamines, and glycerophosphocholines) that were distinctly classified as negatively or positively associated with bacterial co-abundance groups (CAGs). These CAGs were mainly composed of Bacteroides, Eubacterium_hallii_group, Anaerostipes, Ruminococcus, Butyricicoccus, and Faecalibacterium, which were substantially altered in patients. In addition, these fecal and serum metabolic modules were further correlated with the serum cytokines. Additionally, the combination of clinical features, microbial marker (Granulicatella), and a panel of metabolic markers could further enhance the performance of prognosis discrimination significantly, which yielded an area under the receiver operating characteristic curve of (AUC) of 0.94 (95%CI = 0.7–0.9). Patients with low bacterial diversity are more likely to develop relapse than those with higher bacterial diversity (log-rank p = 0.04, HR = 2.7, 95%CI = 1.0–7.0).InterpretationThe associations between the multi-omics data suggested that certain bacteria might affect the pathogenesis of NMDAR encephalitis by modulating the metabolic pathways of the host and affecting the production of pro-inflammatory cytokines. Furthermore, the disturbance of fecal bacteria may predict the long-term outcome and relapse in NMDAR encephalitis.

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Choline Pathway Nutrients and Metabolites and Cognitive Impairment After Acute Ischemic Stroke

Cited by 32 publications

References 41 publications

Choline Intake Correlates with Cognitive Performance among Elder Adults in the United States

Choline Intake Correlates with Cognitive Performance among Elder Adults in the United States

Circulating choline pathway nutrients and depression after ischemic stroke

Disturbance of Gut Bacteria and Metabolites Are Associated with Disease Severity and Predict Outcome of NMDAR Encephalitis: A Prospective Case–Control Study

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