Skip to main content Accessibility help
Hostname: page-component-559fc8cf4f-d5zgf Total loading time: 0.484 Render date: 2021-03-07T22:22:38.657Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false, "newCitedByModal": true }

Serum betaine is inversely associated with low lean mass mainly in men in a Chinese middle-aged and elderly community-dwelling population

Published online by Cambridge University Press:  15 April 2016

Bi-xia Huang
School of Public Health, Faculty of Nutrition, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, People’s Republic of China
Ying-ying Zhu
Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, People’s Republic of China
Xu-ying Tan
School of Public Health, Faculty of Nutrition, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, People’s Republic of China
Qiu-ye Lan
School of Public Health, Faculty of Nutrition, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, People’s Republic of China
Chun-lei Li
School of Public Health, Faculty of Nutrition, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, People’s Republic of China
Yu-ming Chen
Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, People’s Republic of China
Hui-lian Zhu
School of Public Health, Faculty of Nutrition, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, People’s Republic of China
Rights & Permissions[Opens in a new window]


Previous studies have demonstrated that betaine supplements increase lean body mass in livestock and improve muscle performance in human beings, but evidence for its effect on human lean mass is limited. Our study assessed the association of circulating betaine with lean mass and its composition in Chinese adults. A community-based study was conducted on 1996 Guangzhou residents (weight/mass: 1381/615) aged 50–75 years between 2008 and 2010. An interviewer-administered questionnaire was used to collect general baseline information. Fasting serum betaine was assessed using HPLC-MS. A total of 1590 participants completed the body composition analysis performed using dual-energy X-ray absorptiometry during a mean of 3·2 years of follow-up. After adjustment for age, regression analyses demonstrated a positive association of serum betaine with percentage of lean mass (LM%) of the entire body, trunk and limbs in men (all P<0·05) and LM% of the trunk in women (P=0·016). Each sd increase in serum betaine was associated with increases in LM% of 0·609 (whole body), 0·811 (trunk), 0·422 (limbs), 0·632 (arms) and 0·346 (legs) in men and 0·350 (trunk) in women. Multiple logistic regression analysis revealed that the prevalence of lower LM% decreased by 17 % (whole body) and 14 % (trunk) in women and 23 % (whole body), 28 % (trunk), 22 % (arms) and 26 % (percentage skeletal muscle index) in men with each sd increment in serum betaine. Elevated circulating betaine was associated with a higher LM% and lower prevalence of lower LM% in middle-aged and elderly Chinese adults, particularly men.

Full Papers
Copyright © The Authors 2016 

Sarcopenia is a progressive and generalised decline in muscle mass and function with age( Reference Schwartz 1 ) that is associated with increased risks of frailty fractures and mortality( Reference Bortz 2 , Reference Wannamethee, Shaper and Lennon 3 ). The prevalence of sarcopenia ranges from 5 to 13 % in 60–70-year-olds and rises to 11–50 % in people over 80 years of age( Reference Morley 4 ). Loss of muscle mass is a characteristic of ‘pre-sarcopenia’, which is the early stage of sarcopenia that does not impact muscle strength or physical performance( Reference Cruz-Jentoft, Baeyens and Bauer 5 ). Muscle mass decreases at a median annual rate of 0·37 % in women and 0·47 % in men from young (18–45 years) to old age (>65 years)( Reference Mitchell, Williams and Atherton 6 ). Notably, muscle mass exhibits a positive relationship with strength( Reference Newman, Haggerty and Goodpaster 7 ) and physical performance( Reference Buchner, Larson and Wagner 8 ). Sarcopenia-related annual healthcare expenditure is estimated at $18 billion in the USA alone( Reference Beaudart, Rizzoli and Bruyere 9 ). Effective preventive and therapeutic measures for sarcopenia, such as nutritional intervention, have become a medical and societal challenge because of the disabling complications and healthcare costs.

Betaine (trimethylglycine) acts as a methyl donor in the transmethylation of homocysteine and as an organic osmolyte, and it is abundant in spinach, beets and whole grains( Reference Craig 10 ). Betaine is commonly added to animal feeds to improve lean meat yield and quality in pigs and chickens( Reference Rojas-Cano, Lara and Lachica 11 , Reference Xing, Kang and Jiang 12 ). Previous human studies have also indicated a potential ergogenic value of betaine on athletic performance in endurance- and strength-based exercises( Reference Trepanowski, Farney and McCarthy 13 , Reference Pryor, Craig and Swensen 14 ). However, evidence of its effect on human lean mass (LM) is limited. Neither 10 d (2 g/d) nor 12 weeks (6 g/d) of betaine supplementation improved body composition or fat-free mass in thirty-four sedentary young male subjects or forty-two middle-aged subjects restricted from exercising( Reference del Favero, Roschel and Artioli 15 , Reference Schwab, Torronen and Toppinen 16 ). In contrast, a randomised-controlled trial demonstrated that a prescribed resistance training programme supplemented with betaine (2·5 g/d for 6 weeks) significantly improved body composition in twenty-three young males by increasing LM and reducing fat mass compared with placebo( Reference Cholewa, Wyszczelska-Rokiel and Glowacki 17 ). Our previous study( Reference Chen, Liu and Liu 18 ) demonstrated that higher circulating betaine is associated with better body composition by decreasing the percentage of visceral fat mass in a Chinese population. However, to our knowledge, there are no reports of an association between betaine and lean body mass in the elderly, who are at risk of sarcopenia.

The aim of this study was to investigate the association between serum betaine and lean body mass of the whole body, trunk and limbs including arms and legs in middle-aged and elderly adults in a large community-dwelling population.


Study population

Data for this analysis were collected from a community-based study, which was a cohort study investigating the determinants of cardio-metabolic outcomes and osteoporosis in Chinese adults( Reference Liu, Xu and Wen 19 ). A total of 3169 participants (50–75 years old) were recruited from July 2008 to June 2010. All participants resided in Guangzhou (South China) for at least 5 years. They were recruited through local advertisements or from referrals in the local community. Persons who were diagnosed with serious chronic diseases or were using weight-reducing aids were excluded. Trained interviewers conducted face-to-face interviews to collect information on socio-demographic characteristics, lifestyle and food consumption using structured questionnaires. A total of 1996 of the 3169 initial participants provided serum betaine baseline specimens, and 1590 completed the follow-up tests between April 2011 and January 2013 (after a mean of 3·2 years). General information, serum betaine from baseline, anthropometric measurements and dual-energy X-ray absorptiometry (DXA)-derived body composition from the follow-up tests were used for analysis in this study. The Ethics Committee of the School of Public Health at Sun Yat-sen University approved the study protocol. Written informed consent was obtained from all the participants at initial enrolment and follow-up.

Serum betaine

Fasting venous blood samples were collected at baseline. Serum was separated by centrifugation and stored at −80°C until analysis. Serum betaine was measured using HPLC-tandem MS as described previously( Reference Chen, Liu and Liu 18 , Reference Holm, Ueland and Kvalheim 20 , Reference Wang, Zhang and Zhou 21 ). In brief, 60 µl of either serum or standards was deproteinised using 100 µl acetonitrile containing 10 µm internal standards of d9-betaine, and the samples were centrifuged at 13 000 g for 10 min to precipitate the proteins. Supernatants were injected into spin columns and centrifuged at 3000 g for 2 min to filter and remove impurities. Supernatants were collected and analysed by HPLC-MS (Agilent 6400 Series Triple Quad LCMS). The CV for the between-run assays were 6·21 %.

Body composition

Weight and height were measured at baseline and follow-up while the participants were barefoot and wearing light clothes; BMI (kg/m2) was calculated. Waist circumference (WC) was measured twice, and the average value was used for subsequent analyses. LM was measured using DXA (Discovery W; Hologic Inc.) of whole-body scans. DXA results were analysed using Hologic Discovery software version 3.2. DXA measurements included LM and percentage values of the whole body, trunk and limbs (including arms and legs). Bone mineral content was subtracted from the original fat-free LM to determine non-bone LM, under the assumption that all non-fat and non-bone tissue is skeletal muscle. Percentage skeletal muscle index (SMI%) was defined as limb LM (kg)/body weight (kg)×100 %( Reference Hong, Hwang and Choi 22 ). The in vivo reproducibility values of LM in twenty-seven participants after re-positioning were 2·6, 3·2, 4·3 and 4·0 % for left arms, right arms, left legs and right legs, respectively.

Covariate assessments

An interviewer-administered questionnaire was used at baseline to ascertain the following information: socio-demographic characteristics (e.g. age, sex and occupation); lifestyle habits (e.g. consumption of tobacco, alcohol and tea); years since menopause (for women only); habitual dietary intake in the year before the interview; physical activities; and history of chronic diseases and use of medication. Participants who smoked at least 1 cigarette/d, drank alcohol once weekly for at least 6 months or drank tea at least twice weekly were defined as smokers, alcohol drinkers or tea drinkers, respectively. Menopause was defined as the natural cessation of menstrual periods for more than 12 months. Dietary intakes of energy and protein were assessed using a seventy-nine-item quantitative FFQ( Reference Zhang and Ho 23 ). Dietary intake of protein was adjusted by total energy content using the residual method proposed by Willet & Stampfer( Reference Willett and Stampfer 24 ). Daily physical activity was estimated using a nineteen-item questionnaire( Reference Ainsworth, Haskell and Herrmann 25 ), including daily occupation, leisure-time activity and household chores, and was evaluated using metabolic equivalent-h/d.

Statistical analysis

All data were analysed and reported by sex. LM was adjusted for body weight using the residual method( Reference Willett and Stampfer 24 ), and the results were used in subsequent linear regression analyses. Descriptive characteristics of the participants are presented as tertiles of serum betaine. Continuous data are reported as mean values and standard deviations or as medians and interquartile ranges in cases of non-normal distribution. Frequencies and percentages are reported for categorical data. One-way ANOVA, Kruskal–Wallis tests or χ 2 tests were used according to the above-mentioned types of data to test for overall differences between tertiles. Regression analysis adjusted for age was used to examine the linear associations between serum betaine (in Z scores) and LM indices. We further conducted subgroup analyses stratified by low- or high-level medians according to physical activities, BMI, WC, energy intake or energy-adjusted protein intake. Interactions were estimated via multiplicative interaction terms in the multivariate models. The logistic regression analysis was performed to obtain OR and 95 % CI of the presence of low lean mass (LLM) per sd of serum betaine. LLM were defined as the lowest quartile of percentage of lean mass (LM%) or SMI% of the whole body, trunk, limbs, arms or legs( Reference Rolland, Czerwinski and Abellan Van Kan 26 ). All tests were two-sided, and a P value<0·05 was considered to be statistically significant. Statistical analyses were performed using SPSS version 19.0 (SPSS Inc.).


Participant characteristics

Table 1 presents participant characteristics in serum betaine tertiles. In all, 69 % of the 1590 subjects were women. Median ages and serum betaine levels in women and men were 56·0 and 61·8 years and 45·8 and 53·5 μmol/l, respectively. Participants with higher serum betaine levels exhibited lower weight, BMI, WC and total LM but a higher total lean:fat ratio in both sexes; higher percentage of total LM was seen in men (all P<0·05).

Table 1 Association between serum betaine and characteristics and lean mass indices in women and men (Mean values and standard deviations; medians and interquartile ranges (IQR); numbers and percentages)

WC, waist circumference; SMI%, percentage skeletal muscle index, defined as limb lean mass (kg)/body weight (kg)×100 %; MET, metabolic equivalent.

Associations of serum betaine and indices of lean mass

Table 2 shows age-adjusted regression coefficients of the associations of serum betaine with weight-adjusted LM and LM%. Each sd increase in serum betaine (women: 17·2 μmol/l; men: 17·7 μmol/l) in men was associated with increases from 0·346 (legs) to 0·811 (trunk) of LM% (all P<0·05) and 0·342 of SMI% (P=0·001). Marginal significances were observed for the weight-adjusted LM of the total body, limbs and legs. The trunk exhibited the strongest association with betaine, followed by arms, and legs exhibited the weakest association. Almost no significant associations were observed in women, except at the trunk for LM% (P=0·016).

Table 2 Differences in lean mass indices per sd of serum betaine in women and menFootnote * (β-Coefficients with their standard errors)

SMI%, percentage skeletal muscle index.

* The model was adjusted for age.

Associations of serum betaine and percentage of lean mass by subgroup

We examined whether the favourable associations with LM% were modified by age, physical activity, BMI, WC, energy intake and protein intake as stratified by medians. Significant associations were observed in women with lower physical activities, higher age and higher BMI at the trunk (all P<0·05). Associations of serum betaine and LM% tended to be more pronounced in men. However, no significant interactions were found (all P interactions>0·05) (Table 3).

Table 3 Sex-specific differences in percentage of lean mass indices per sd of serum betaine stratified by sarcopenia risk factors (β-Coefficients with their standard errors)

MET, metabolic equivalent, WC, waist circumference.

* Median for women.

Median for men.

OR of low lean mass for serum betaine

Logistic regression analyses in model 1 demonstrated that higher serum betaine levels were linearly associated with a lower risk of having lower LM% in the total body and trunk in women and in the total body, trunk and arms, as well as lower SMI%, in men (all P<0·05) (Fig. 1). The OR of LLM for each sd increase in serum betaine in model 2 were 0·83 (95 % CI 0·71, 0·95) (total body) and 0·86 (95 % CI 0·74, 0·99) (trunk) in women and 0·77 (95 % CI 0·62, 0·95) (total body), 0·72 (95 % CI 0·58, 0·90) (trunk) and 0·78 (95 % CI 0·63, 0·97) (arms) in men (all P<0·05). Greater betaine was also associated with a lower risk of having lower SMI% mainly in men (OR 0·74; 95 % CI 0·60, 0·92) (Fig. 1).

Fig. 1 Sex-specific OR and 95 % CI of low lean mass per sd of serum betaine. Lower lean mass was defined as the lowest quartile of percentage of lean mass or percentage skeletal muscle index (SMI%). Model 1: adjusted for age. Model 2: model 1 further adjusted for energy intake, energy-adjusted protein intake, physical activity, alcohol consumption, smoking status, tea intake, years since menopause (women only).


This large community-based study of 50–75-year-old Chinese adults demonstrated that higher serum betaine correlated to greater levels of LM% and a lower risk of having lower LM% at all studied sites except for legs in men, and a lower risk of having lower LM% in the total body and trunk in women, after adjusting for a variety of covariates. To our knowledge, this is the first study to directly examine and report positive associations between blood betaine levels and LM in humans.

Serum betaine levels in Chinese adults

In this study population, the serum betaine concentrations were 46·1 (sd 17·2) and 53·4 (sd 17·7) μmol/l in women and men, respectively, which was lower than that (65·4 μmol/l) of 631 normal Shanghai men (China) with mean age of 56 (sd 5) years( Reference Butler, Arning and Wang 27 ), but higher than the value of 39·5 (sd 12·5) μmol/l among 7045 Norwegians aged 47–74 years( Reference Konstantinova, Tell and Vollset 28 ) and of 16·89 (5·12) μmol/l in Californian pregnancies( Reference Shaw, Yang and Carmichael 29 ). The between-study heterogeneity in serum betaine might be due to varied dietary patterns with different intakes of betaine-rich foods in different populations. The variations in the measurements and the gene polymorphisms of betaine metabolic enzymes in different ethnic groups might also partly account for the between-study differences.

Betaine and lean body mass

Previous observational human studies have demonstrated that plasma or serum betaine is inversely associated with weight, BMI, WC and body fat( Reference Konstantinova, Tell and Vollset 28 ). These are consistent with our present results, in which higher serum betaine was associated with significantly lower body weight, BMI and WC. However, the relationship between serum betaine and body LM is not well elucidated. Although weight-adjusted LM did not show a significant association with serum betaine except in limbs in men, the LM% in our study exhibited a positive relationship with serum betaine. This may indicate that betaine influences body mass by reducing the fat mass while maintaining the LM. Higher serum betaine levels were linearly associated with a lower risk of having LLM. These observations are indirectly supported by previously published human studies. Previous studies have demonstrated that circulating betaine levels were inversely related to the percentage of body fat in a health examination population( Reference Konstantinova, Tell and Vollset 28 ) and dyslipidaemia patients( Reference Lever, George and Dellow 30 ), which may be consistent with betaine being positively associated with LM%. Betaine supplementation was also shown to increase LM gain in the whole body in pigs and ham( Reference Matthews, Southern and Higbie 31 ).

Several mechanisms for the beneficial effects of betaine on lean muscle are possible. (1) Betaine performs a methionine-sparing and homocysteine antidotal effect by transmethylating homocysteine to methionine. Betaine conserves methionine for protein synthesis. Excess homocysteine generates homocysteine thiolactone (HCTL), which inhibits insulin/insulin-like growth factor (IGF-1)-mediated mRNA expression and enzyme activity involved in protein synthesis( Reference Najib and Sanchez-Margalet 32 ). Betaine may increase muscle protein by reducing HCTL. (2) Betaine may stimulate growth hormone secretion and activate the IGF-1 pathway to promote muscle fibre differentiation( Reference Cholewa, Guimarães-Ferreira and Zanchi 33 , Reference Senesi, Luzi and Montesano 34 ). (3) Betaine increases sarcoplasmic osmolality via the osmoregulated betaine/GABA transporter-1 (BTG-1), which leads to cellular swelling under conditions of metabolic and ionic stress. Cellular swelling is sensed by sarcolemma integrins that are coupled to G proteins, which initiates a series of cascades via mitogen-activated protein kinase activation that results in protein synthesis and proteolysis inhibition( Reference Haussinger 35 ). Cellular swelling also promotes protein synthesis by enhancing amino acid uptake.

Betaine on body lean mass differences in sex

The present study found that high circulating betaine was a potential protective factor to improve or maintain LM and prevent LLM. However, the OR were significant for lower LM% in the limbs and arms in men but not in women, which was consistent with the linear regression results. This sex difference has not been directly proposed in previous human studies, but in a study by Konstantinova et al. ( Reference Konstantinova, Tell and Vollset 28 ) the authors demonstrated a stronger correlation between betaine and BMI, WC and percentage of body fat in men than in women. Previous animal studies have also demonstrated that betaine may be more effective in altering body composition in barrows than in gilts( Reference Lawrence, Schinckel and Adeola 36 ). The reason for this sex difference has not been clearly clarified, but the different functions of sex hormones may partially explain the sex differences. Testosterone, but not oestradiol, exerts an assimilation function and stimulates muscle protein synthesis. Serum betaine is higher in men than in women. These differences in sex may be explained by the transcriptional regulation of human phatidylethanolamine N-methyltransferase (PEMT), which is an oestrogen-responsive gene for the endogenous synthesis of choline. Most of the women in our study were postmenopausal, who exhibit a lower capacity for de novo biosynthesis of the choline moiety( Reference Fischer, daCosta and Kwock 37 ), which may ultimately influence the endogenous generation of betaine. Therefore, the less significant association in women may also be due to the lower levels of endogenous generation and the lower concentration of betaine in blood.

Betaine and body lean mass by subgroups

We found that the betaine–LM association tended to be more pronounced in subjects with higher levels of energy intake, BMI and WC, but the biological mechanisms are not clear. Animal studies have demonstrated that betaine influenced protein synthesis, reduced lipogenesis and promoted lipolysis, which might increase the LM%( Reference Cholewa, Guimarães-Ferreira and Zanchi 33 ). Betaine supplementation significantly decreased the activity of lipogenic enzymes in the subcutaneous adipose tissue of pigs( Reference Huang, Xu and Han 38 ) and abdominal adipose tissue of broilers( Reference Xing, Kang and Jiang 12 ). Betaine supplementation also increased the activity of hepatic carnitine palmitoyltransferase 1 and promoted fatty acid oxidation( Reference Xu, Huang and Hu 39 ). These results suggest that there is more potential for betaine to decrease fat mass and increase the LM% in people with higher (v. lower) BMI and WC.

Strengths and limitations

There are several strengths to our study. First, the relatively large sample size allowed us to obtain precise results. Next, the use of DXA allowed us to more precisely determine LM measurements than bioelectrical impedance analysis or body measures. Very strong correlations were reported previously between DXA-derived total-body lean soft tissue mass and MRI-derived total-body muscle mass in adult men and women aged 18–88 years (R 2 0·96)( Reference Kim, Wang and Heymsfield 40 ) and older women with a mean age of 71 years (r 0·94)( Reference Chen, Wang and Lohman 41 ). Serum betaine was also used to assess internal exposure, which was more accurate and precise than dietary surveys alone, as the total betaine included exogenous food sources, and endogenous generation was also considered. Some limitations must be acknowledged as well. As extensively discussed in our previous article( Reference Chen, Liu and Liu 18 ), our study used a cross-sectional study design and betaine sample collection and DXA measurements occurred 3 years apart. We could not address whether there was a causal relationship between betaine and LM in our study. Another defect is that we had little information on muscle function in this population. We could not infer the relationship between serum betaine and muscle strength or performance. DXA also cannot distinguish water retention or fat tissue infiltration within muscle, which may slightly overestimate muscle thickness. Kim et al. ( Reference Kim, Heshka and Gallagher 42 ) estimated that fatty infiltration of muscle inflated skeletal muscle mass estimates from DXA by 1–8 %.


Higher serum betaine is associated with increased LM% and a lower risk of LLM mainly in men. The finding that serum betaine related to decreased fat mass and improved or nearly unchanged LM suggested a beneficial effect on obesity-related sarcopenia. Further studies, particularly interventional studies, are needed to clarify whether there is a causative relationship between betaine and LM in humans.


The authors thank the numerous individuals who participated in this study.

This study was jointly supported by the National Science Foundation of China (nos 81273050 and 81472966) and the 5010 Program for Clinical Researches by Sun Yat-sen University, Guangzhou, China (no. 2007032). The funding sources had no role in the design, analysis or writing of this article.

H.-l. Z. and Y.-m. C. designed the study; Q.-y. L., C.-l. L., X.-y. T. and Y.-y. Z. conducted the study; B.-x. H. and Y.-m. C. analysed the data; H.-l. Z. and B.-x. H. wrote the paper. H.-l. Z. had primary responsibility for the final content. All the authors read and approved the final version of the manuscript.

There are no conflicts of interest.


1. Schwartz, RS (1997) Sarcopenia and physical performance in old age: introduction. Muscle Nerve Suppl 5, S10S12.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
2. Bortz, WM 2nd (2002) A conceptual framework of frailty: a review. J Gerontol A Biol Sci Med Sci 57, M283M288.CrossRefGoogle ScholarPubMed
3. Wannamethee, SG, Shaper, AG, Lennon, L, et al. (2007) Decreased muscle mass and increased central adiposity are independently related to mortality in older men. Am J Clin Nutr 86, 13391346.Google ScholarPubMed
4. Morley, JE (2008) Sarcopenia: diagnosis and treatment. J Nutr Health Aging 12, 452456.CrossRefGoogle ScholarPubMed
5. Cruz-Jentoft, AJ, Baeyens, JP, Bauer, JM, et al. (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 39, 412423.CrossRefGoogle ScholarPubMed
6. Mitchell, WK, Williams, J, Atherton, P, et al. (2012) Sarcopenia, dynapenia, and the impact of advancing age on human skeletal muscle size and strength: a quantitative review. Front Physiol 3, 260.CrossRefGoogle ScholarPubMed
7. Newman, AB, Haggerty, CL, Goodpaster, B, et al. (2003) Strength and muscle quality in a well-functioning cohort of older adults: the Health, Aging and Body Composition Study. J Am Geriatr Soc 51, 323330.CrossRefGoogle Scholar
8. Buchner, DM, Larson, EB, Wagner, EH, et al. (1996) Evidence for a non-linear relationship between leg strength and gait speed. Age Ageing 25, 386391.CrossRefGoogle ScholarPubMed
9. Beaudart, C, Rizzoli, R, Bruyere, O, et al. (2014) Sarcopenia: burden and challenges for public health. Arch Public Health 72, 45.CrossRefGoogle ScholarPubMed
10. Craig, SA (2004) Betaine in human nutrition. Am J Clin Nutr 80, 539549.Google ScholarPubMed
11. Rojas-Cano, ML, Lara, L, Lachica, M, et al. (2011) Influence of betaine and conjugated linoleic acid on development of carcass cuts of Iberian pigs growing from 20 to 50 kg body weight. Meat Sci 88, 525530.CrossRefGoogle ScholarPubMed
12. Xing, J, Kang, L & Jiang, Y (2011) Effect of dietary betaine supplementation on lipogenesis gene expression and CpG methylation of lipoprotein lipase gene in broilers. Mol Biol Rep 38, 19751981.CrossRefGoogle ScholarPubMed
13. Trepanowski, JF, Farney, TM, McCarthy, CG, et al. (2011) The effects of chronic betaine supplementation on exercise performance, skeletal muscle oxygen saturation and associated biochemical parameters in resistance trained men. J Strength Cond Res 25, 34613471.CrossRefGoogle ScholarPubMed
14. Pryor, JL, Craig, SA & Swensen, T (2012) Effect of betaine supplementation on cycling sprint performance. J Int Soc Sports Nutr 9, 12.CrossRefGoogle ScholarPubMed
15. del Favero, S, Roschel, H, Artioli, G, et al. (2012) Creatine but not betaine supplementation increases muscle phosphorylcreatine content and strength performance. Amino Acids 42, 22992305.CrossRefGoogle Scholar
16. Schwab, U, Torronen, A, Toppinen, L, et al. (2002) Betaine supplementation decreases plasma homocysteine concentrations but does not affect body weight, body composition, or resting energy expenditure in human subjects. Am J Clin Nutr 76, 961967.Google ScholarPubMed
17. Cholewa, JM, Wyszczelska-Rokiel, M, Glowacki, R, et al. (2013) Effects of betaine on body composition, performance, and homocysteine thiolactone. J Int Soc Sports Nutr 10, 39.CrossRefGoogle ScholarPubMed
18. Chen, YM, Liu, Y, Liu, YH, et al. (2015) Higher serum concentrations of betaine rather than choline is associated with better profiles of DXA-derived body fat and fat distribution in Chinese adults. Int J Obes (Lond) 39, 465471.CrossRefGoogle ScholarPubMed
19. Liu, YH, Xu, Y, Wen, YB, et al. (2013) Association of weight-adjusted body fat and fat distribution with bone mineral density in middle-aged Chinese adults: a cross-sectional study. PLOS ONE 8, e63339.CrossRefGoogle ScholarPubMed
20. Holm, PI, Ueland, PM, Kvalheim, G, et al. (2003) Determination of choline, betaine, and dimethylglycine in plasma by a high-throughput method based on normal-phase chromatography-tandem mass spectrometry. Clin Chem 49, 286294.CrossRefGoogle ScholarPubMed
21. Wang, LJ, Zhang, HW, Zhou, JY, et al. (2014) Betaine attenuates hepatic steatosis by reducing methylation of the MTTP promoter and elevating genomic methylation in mice fed a high-fat diet. J Nutr Biochem 25, 329336.CrossRefGoogle ScholarPubMed
22. Hong, HC, Hwang, SY, Choi, HY, et al. (2014) Relationship between sarcopenia and nonalcoholic fatty liver disease: the Korean Sarcopenic Obesity Study. Hepatology 59, 17721778.CrossRefGoogle ScholarPubMed
23. Zhang, CX & Ho, SC (2009) Validity and reproducibility of a food frequency questionnaire among Chinese women in Guangdong province. Asia Pac J Clin Nutr 18, 240250.Google ScholarPubMed
24. Willett, W & Stampfer, MJ (1986) Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 124, 1727.CrossRefGoogle ScholarPubMed
25. Ainsworth, BE, Haskell, WL, Herrmann, SD, et al. (2011) 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc 43, 15751581.CrossRefGoogle ScholarPubMed
26. Rolland, Y, Czerwinski, S, Abellan Van Kan, G, et al. (2008) Sarcopenia: its assessment, etiology, pathogenesis, consequences and future perspectives. J Nutr Health Aging 12, 433450.CrossRefGoogle ScholarPubMed
27. Butler, LM, Arning, E, Wang, R, et al. (2013) Prediagnostic levels of serum one-carbon metabolites and risk of hepatocellular carcinoma. Cancer Epidemiol Biomarkers Prev 22, 18841893.CrossRefGoogle ScholarPubMed
28. Konstantinova, SV, Tell, GS, Vollset, SE, et al. (2008) Divergent associations of plasma choline and betaine with components of metabolic syndrome in middle age and elderly men and women. J Nutr 138, 914920.Google ScholarPubMed
29. Shaw, GM, Yang, W, Carmichael, SL, et al. (2014) One-carbon metabolite levels in mid-pregnancy and risks of conotruncal heart defects. Birth Defects Res A Clin Mol Teratol 100, 107115.CrossRefGoogle ScholarPubMed
30. Lever, M, George, PM, Dellow, WJ, et al. (2005) Homocysteine, glycine betaine, and N,N-dimethylglycine in patients attending a lipid clinic. Metabolism 54, 114.CrossRefGoogle Scholar
31. Matthews, J, Southern, L, Higbie, A, et al. (2001) Effects of betaine on growth, carcass characteristics, pork quality, and plasma metabolites of finishing pigs. J Anim Sci 79, 722728.CrossRefGoogle ScholarPubMed
32. Najib, S & Sanchez-Margalet, V (2005) Homocysteine thiolactone inhibits insulin-stimulated DNA and protein synthesis: possible role of mitogen-activated protein kinase (MAPK), glycogen synthase kinase-3 (GSK-3) and p70 S6K phosphorylation. J Mol Endocrinol 34, 119126.CrossRefGoogle ScholarPubMed
33. Cholewa, JM, Guimarães-Ferreira, L & Zanchi, NE (2014) Effects of betaine on performance and body composition: a review of recent findings and potential mechanisms. Amino Acids 46, 17851793.CrossRefGoogle ScholarPubMed
34. Senesi, P, Luzi, L, Montesano, A, et al. (2013) Betaine supplement enhances skeletal muscle differentiation in murine myoblasts via IGF-1 signaling activation. J Transl Med 11, 174.CrossRefGoogle ScholarPubMed
35. Haussinger, D (1996) The role of cellular hydration in the regulation of cell function. Biochem J 313, 697710.CrossRefGoogle ScholarPubMed
36. Lawrence, B, Schinckel, A, Adeola, O, et al. (2002) Impact of betaine on pig finishing performance and carcass composition. J Anim Sci 80, 475482.CrossRefGoogle ScholarPubMed
37. Fischer, LM, daCosta, KA, Kwock, L, et al. (2007) Sex and menopausal status influence human dietary requirements for the nutrient choline. Am J Clin Nutr 85, 12751285.Google ScholarPubMed
38. Huang, Q, Xu, Z, Han, X, et al. (2008) Effect of dietary betaine supplementation on lipogenic enzyme activities and fatty acid synthase mRNA expression in finishing pigs. Anim Feed Sci Technol 140, 365375.CrossRefGoogle Scholar
39. Xu, L, Huang, D, Hu, Q, et al. (2015) Betaine alleviates hepatic lipid accumulation via enhancing hepatic lipid export and fatty acid oxidation in rats fed with a high-fat diet. Br J Nutr 113, 18351843.CrossRefGoogle ScholarPubMed
40. Kim, J, Wang, Z, Heymsfield, SB, et al. (2002) Total-body skeletal muscle mass: estimation by a new dual-energy X-ray absorptiometry method. Am J Clin Nutr 76, 378383.Google ScholarPubMed
41. Chen, Z, Wang, Z, Lohman, T, et al. (2007) Dual-energy X-ray absorptiometry is a valid tool for assessing skeletal muscle mass in older women. J Nutr 137, 27752780.Google ScholarPubMed
42. Kim, J, Heshka, S, Gallagher, D, et al. (2004) Intermuscular adipose tissue-free skeletal muscle mass: estimation by dual-energy X-ray absorptiometry in adults. J Appl Physiol 97, 655660.CrossRefGoogle ScholarPubMed

Altmetric attention score

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 528
Total number of PDF views: 340 *
View data table for this chart

* Views captured on Cambridge Core between September 2016 - 7th March 2021. This data will be updated every 24 hours.


Send article to Kindle

To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Serum betaine is inversely associated with low lean mass mainly in men in a Chinese middle-aged and elderly community-dwelling population
Available formats

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Serum betaine is inversely associated with low lean mass mainly in men in a Chinese middle-aged and elderly community-dwelling population
Available formats

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Serum betaine is inversely associated with low lean mass mainly in men in a Chinese middle-aged and elderly community-dwelling population
Available formats

Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *