Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-24T20:10:56.746Z Has data issue: false hasContentIssue false
  • English
  • Français

Dietary betaine intake and risk of mortality in patients with coronary artery disease: the prospective Guangdong Coronary Artery Disease Cohort

Published online by Cambridge University Press:  09 November 2022

Si Liu ,
Dongjin Wang ,
Bo Li ,
Kai Li ,
Xin Dai ,
Lokyu Cheng ,
Jing Wang ,
Ting Huang ,
Yue Tang  and
Yunjun Xiao Open the ORCID record for Yunjun Xiao [Opens in a new window]
Si Liu
Affiliation:
Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, People’s Republic of China
Dongjin Wang
Affiliation:
Cardiothoracic surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China
Bo Li
Affiliation:
Cardiovascular Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, People’s Republic of China
Kai Li
Affiliation:
Cardiothoracic surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China
Xin Dai
Affiliation:
Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, People’s Republic of China
Lokyu Cheng
Affiliation:
Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, People’s Republic of China
Jing Wang
Affiliation:
Department of Neurology, Sun Yat-sen memorial hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
Ting Huang
Affiliation:
Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, People’s Republic of China
Yue Tang*
Affiliation:
Cardiovascular Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, People’s Republic of China
Yunjun Xiao*
Affiliation:
Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, People’s Republic of China
*
*Corresponding author: Yunjun Xiao, email xiaoyj27@mail.sysu.edu.cn, or Yue Tang, email tangy97@mail.sysu.edu.cn
*Corresponding author: Yunjun Xiao, email xiaoyj27@mail.sysu.edu.cn, or Yue Tang, email tangy97@mail.sysu.edu.cn
Get access Rights & Permissions [Opens in a new window]

Abstract

This study is designed to explore the association between dietary betaine intake and risk of all-cause and cardiovascular death in patients with coronary artery diseases (CAD). In this cohort study, 1292 patients with CAD were followed up for a median of 9·2 years. Baseline dietary betaine intake was collected using a paper-based semi-quantitative FFQ and assessed according to the US Department of Agriculture (USDA) database and the data of betaine in common foods. Cox proportional hazards regression models were used to analyse the association between dietary betaine intake and risks of all-cause and cardiovascular mortality. During the follow-up periods, 259 deaths recorded in 1292 participants, of which 167 died of CVD. Patients in the highest tertile of dietary betaine intake had a lower risk of all-cause (P = 0·007) and cardiovascular death (P < 0·001) than those in the lowest tertile after adjusting for age and sex, traditional cardiovascular risk factors and other potential confounders. After further adjusting for plasma methionine metabolites and vitamins, hazard ratio across tertiles of dietary betaine intake were 1·00, 0·84 and 0·72 for all-cause mortality (P for trend = 0·124), and 1·00, 0·77 and 0·55 for cardiovascular mortality (P for trend = 0·021). Higher dietary betaine intake was associated with a decreased risk of cardiovascular death after fully adjustment for cardiovascular risk factors, other potential confounders and plasma methionine metabolites and vitamins. However, the association between dietary betaine intake and risk of all-cause mortality was not statistically significant after further adjusting for plasma methionine metabolites and vitamins.

Keywords

Dietary betaineCoronary artery diseaseCardiovascularMortality
Type
Research Article
Information
British Journal of Nutrition , Volume 130 , Issue 1 , 14 July 2023 , pp. 10 - 19
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Nutrition Society

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

†

These authors contributed equally to this work

References

Moran, AE, Forouzanfar, MH, Roth, GA, et al. (2014) The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of Disease 2010 study. Circulation 129, 1493–1501.CrossRefGoogle ScholarPubMed
Roth, GA, Mensah, GA, Johnson, CO, et al. (2020) Global burden of cardiovascular diseases and risk factors, 1990–2019: update from the GBD 2019 study. J Am Coll Cardiol 76, 2982–3021.CrossRefGoogle ScholarPubMed
Thomas, H, Diamond, J, Vieco, A, et al. (2018) Global atlas of cardiovascular disease 2000–2016: the path to prevention and control. Glob Heart 13, 143–163.CrossRefGoogle ScholarPubMed
Mortality GBD & Causes of Death C (2015) Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 385, 117–171.CrossRefGoogle Scholar
Steg, PG & Ducrocq, G (2016) Future of the prevention and treatment of coronary artery disease. Circ J 80, 1067–1072.CrossRefGoogle ScholarPubMed
McGill, HC Jr, McMahan, CA & Gidding, SS (2008) Preventing heart disease in the 21st century: implications of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study. Circulation 117, 1216–1227.CrossRefGoogle ScholarPubMed
Brosnan, JT & Brosnan, ME (2006) The sulfur-containing amino acids: an overview. J Nutr 136, 1636S–1640S.CrossRefGoogle ScholarPubMed
Stipanuk, MH (2004) Sulfur amino acid metabolism: pathways for production and removal of homocysteine and cysteine. Annu Rev Nutr 24, 539–577.CrossRefGoogle ScholarPubMed
Parkhitko, AA, Jouandin, P, Mohr, SE, et al. (2019) Methionine metabolism and methyltransferases in the regulation of aging and lifespan extension across species. Aging Cell 18, e13034.CrossRefGoogle ScholarPubMed
Martinez, Y, Li, X, Liu, G, et al. (2017) The role of methionine on metabolism, oxidative stress, and diseases. Amino Acid 49, 2091–2098.CrossRefGoogle ScholarPubMed
Ravanel, S, Gakiere, B, Job, D, et al. (1998) The specific features of methionine biosynthesis and metabolism in plants. Proc Natl Acad Sci USA 95, 7805–7812.CrossRefGoogle ScholarPubMed
Plaisance, EP, Greenway, FL, Boudreau, A, et al. (2011) Dietary methionine restriction increases fat oxidation in obese adults with metabolic syndrome. J Clin Endocrinol Metab 96, E836–E840.CrossRefGoogle ScholarPubMed
Cavuoto, P & Fenech, MF (2012) A review of methionine dependency and the role of methionine restriction in cancer growth control and life-span extension. Cancer Treat Rev 38, 726–736.CrossRefGoogle ScholarPubMed
Ostrakhovitch, EA & Tabibzadeh, S (2019) Homocysteine and age-associated disorders. Ageing Res Rev 49, 144–164.CrossRefGoogle ScholarPubMed
Chiang, PK, Gordon, RK, Tal, J, et al. (1996) S-adenosylmethionine and methylation. FASEB J 10, 471–480.CrossRefGoogle ScholarPubMed
Craig, SA (2004) Betaine in human nutrition. Am J Clin Nutr 80, 539–549.CrossRefGoogle ScholarPubMed
Zeisel, SH, Mar, MH, Howe, JC, et al. (2003) Concentrations of choline-containing compounds and betaine in common foods. J Nutr 133, 1302–1307.CrossRefGoogle ScholarPubMed
Ueland, PM (2011) Choline and betaine in health and disease. J Inherit Metab Dis 34, 3–15.CrossRefGoogle ScholarPubMed
Barak, AJ, Beckenhauer, HC, Badakhsh, S, et al. (1997) The effect of betaine in reversing alcoholic steatosis. Alcohol: Clin Exp Res 21, 1100–1102.CrossRefGoogle ScholarPubMed
Mar, MH & Zeisel, SH (1999) Betaine in wine: answer to the French paradox? Med Hypotheses 53, 383–385.CrossRefGoogle Scholar
Vos, E (2000) Whole grains and coronary heart disease. Am J Clin Nutr 71, 1009.CrossRefGoogle ScholarPubMed
Tang, WH, Wang, Z, Levison, BS, et al. (2013) Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. N Engl J Med 368, 1575–1584.CrossRefGoogle ScholarPubMed
Senthong, V, Li, XS, Hudec, T, et al. (2016) Plasma trimethylamine N-oxide, a gut microbe-generated phosphatidylcholine metabolite, is associated with atherosclerotic burden. J Am Coll Cardiol 67, 2620–2628.CrossRefGoogle ScholarPubMed
Xiao, Y, Zhang, Y, Wang, M, et al. (2013) Plasma S-adenosylhomocysteine is associated with the risk of cardiovascular events in patients undergoing coronary angiography: a cohort study. Am J Clin Nutr 98, 1162–1169.CrossRefGoogle ScholarPubMed
Ding, D, Qiu, J, Li, X, et al. (2014) Hyperglycemia and mortality among patients with coronary artery disease. Diabetes Care 37, 546–554.CrossRefGoogle ScholarPubMed
Liu, Y, Chen, H, Mu, D, et al. (2016) Association of serum retinoic acid with risk of mortality in patients with coronary artery disease. Circ Res 119, 557–563.CrossRefGoogle ScholarPubMed
Song, J, Wang, D, Chen, H, et al. (2017) Association of plasma 7-ketocholesterol with cardiovascular outcomes and total mortality in patients with coronary artery disease. Circ Res 120, 1622–1631.CrossRefGoogle ScholarPubMed
Yu, C, Xue, H, Wang, L, et al. (2018) Serum bioavailable and free 25-hydroxyvitamin D levels, but not its total level, are associated with the risk of mortality in patients with coronary artery disease. Circ Res 123, 996–1007.CrossRefGoogle Scholar
Fihn, SD, Gardin, JM, Abrams, J, et al. (2012) 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 60, e44–e164.CrossRefGoogle Scholar
Sullivan, DR, Marwick, TH & Freedman, SB (1990) A new method of scoring coronary angiograms to reflect extent of coronary atherosclerosis and improve correlation with major risk factors. Am Heart J 119, 1262–1267.CrossRefGoogle ScholarPubMed
Liu, S, Liao, R, Dai, X, et al. (2021) Association between plasma S-adenosylmethionine and risk of mortality in patients with coronary artery disease: a cohort study. Am J Clin Nutr 114, 1360–1370.CrossRefGoogle ScholarPubMed
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, 240–250.Google ScholarPubMed
Yang, Y, Wang, G & Pan, X (2002) China Food Composition Table (2002 No. 1). (Chinese edition). Beijing: Beijing Medical University Press.Google Scholar
Rouge, B (2007) The PLANTS Database. US Department of Agriculture. Los Angeles: National Plant Data Center.Google Scholar
Willett, W & Stampfer, MJ (1986) Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 124, 17–27.CrossRefGoogle ScholarPubMed
Kim, EY, Chang, Y, Ahn, J, et al. (2020) Mammographic breast density, its changes, and breast cancer risk in premenopausal and postmenopausal women. Cancer 126, 4687–4696.CrossRefGoogle ScholarPubMed
Gellekink, H, van Oppenraaij-Emmerzaal, D, van Rooij, A, et al. (2005) Stable-isotope dilution liquid chromatography-electrospray injection tandem mass spectrometry method for fast, selective measurement of S-adenosylmethionine and S-adenosylhomocysteine in plasma. Clin Chem 51, 1487–1492.CrossRefGoogle ScholarPubMed
Hamlin, JC, Pauly, M, Melnyk, S, et al. (2013) Dietary intake and plasma levels of choline and betaine in children with autism spectrum disorders. Autism Res Treat 2013, 578429.Google ScholarPubMed
GRFC (2018) Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392, 1923–1994.CrossRefGoogle Scholar
Kjeldsen, SE (2018) Hypertension and cardiovascular risk: general aspects. Pharmacol Res 129, 95–99.CrossRefGoogle ScholarPubMed
Lawes, CM, Vander Hoorn, S & Rodgers, A (2008) Global burden of blood-pressure-related disease, 2001. Lancet 371, 1513–1518.CrossRefGoogle ScholarPubMed
Yang, JM, Zhou, R, Zhang, M, et al. (2018) Betaine attenuates monocrotaline-induced pulmonary arterial hypertension in rats via inhibiting inflammatory response. Molecule 23, 1274.CrossRefGoogle ScholarPubMed
Wang, L, Zhao, M, Liu, W, et al. (2018) Association of betaine with blood pressure in dialysis patients. J Clin Hypertens 20, 388–393.CrossRefGoogle ScholarPubMed
Wu, C-Y, Hu, H-Y, Chou, Y-J, et al. (2015) High blood pressure and all-cause and cardiovascular disease mortalities in community-dwelling older adults. Medicine 94, e2160.CrossRefGoogle ScholarPubMed
Gu, D, Kelly, TN, Wu, X, et al. (2008) Blood pressure and risk of cardiovascular disease in Chinese men and women. Am J Hypertens 21, 265–272.CrossRefGoogle ScholarPubMed
Stalenhoef, AF & de Graaf, J (2008) Association of fasting and nonfasting serum triglycerides with cardiovascular disease and the role of remnant-like lipoproteins and small dense LDL. Curr Opin lipidol 19, 355–361.CrossRefGoogle ScholarPubMed
Ye, X, Kong, W, Zafar, MI, et al. (2019) Serum triglycerides as a risk factor for cardiovascular diseases in type 2 diabetes mellitus: a systematic review and meta-analysis of prospective studies. Cardiovasc Diabetol 18, 48.CrossRefGoogle ScholarPubMed
Kim, MK, Ahn, CW, Kang, S, et al. (2017) Relationship between the triglyceride glucose index and coronary artery calcification in Korean adults. Cardiovasc Diabetol 16, 108.CrossRefGoogle ScholarPubMed
Austin, MA, Hokanson, JE & Edwards, KL (1998) Hypertriglyceridemia as a cardiovascular risk factor. Am J Cardiol 81, 7b–12b.CrossRefGoogle ScholarPubMed
Miller, M, Stone, NJ, Ballantyne, C, et al. (2011) Triglycerides and cardiovascular disease. Circulation 123, 2292–2333.CrossRefGoogle ScholarPubMed
Liu, J, Zeng, F-F, Liu, Z-M, et al. (2013) Effects of blood triglycerides on cardiovascular and all-cause mortality: a systematic review and meta-analysis of 61 prospective studies. Lipids Health Dis 12, 159.CrossRefGoogle ScholarPubMed
Barak, AJ, Beckenhauer, HC, Mailliard, ME, et al. (2003) Betaine lowers elevated s-adenosylhomocysteine levels in hepatocytes from ethanol-fed rats. J Nutr 133, 2845–2848.CrossRefGoogle ScholarPubMed
Refsum, H, Ueland, PM, Nygård, O, et al. (1998) Homocysteine and cardiovascular disease. Ann Rev Med 49, 31–62.CrossRefGoogle ScholarPubMed
Bostrom, B, Sweta, B & James, SJ (2015) Betaine for patients with acute lymphoblastic leukemia intolerant of maintenance chemotherapy due deficiency of S-adenosyl methionine. Blood 126, 1296–1296.CrossRefGoogle Scholar
Imbard, A, Smulders, YM, Barto, R, et al. (2013) Plasma choline and betaine correlate with serum folate, plasma S-adenosyl-methionine and S-adenosyl-homocysteine in healthy volunteers. Clin Chem Lab Med 51, 683–692.CrossRefGoogle ScholarPubMed
Lim, S, Moon, MK, Shin, H, et al. (2011) Effect of S-adenosylmethionine on neointimal formation after balloon injury in obese diabetic rats. Cardiovasc Res 90, 383–393.CrossRefGoogle ScholarPubMed
Kim, SY, Hong, SW, Kim, MO, et al. (2013) S-adenosyl methionine prevents endothelial dysfunction by inducing heme oxygenase-1 in vascular endothelial cells. Mol cells 36, 376–384.CrossRefGoogle ScholarPubMed
Mirbahai, L, Southam, AD, Sommer, U, et al. (2013) Disruption of DNA methylation via S-adenosylhomocysteine is a key process in high incidence liver carcinogenesis in fish. J Proteome Res 12, 2895–2904.CrossRefGoogle ScholarPubMed
Xiao, Y, Xia, J, Cheng, J, et al. (2019) Inhibition of S-adenosylhomocysteine hydrolase induces endothelial dysfunction via epigenetic regulation of p66shc-mediated oxidative stress pathway. Circulation 139, 2260–2277.CrossRefGoogle ScholarPubMed
Luo, X, Xiao, Y, Song, F, et al. (2012) Increased plasma S-adenosyl-homocysteine levels induce the proliferation and migration of VSMCs through an oxidative stress-ERK1/2 pathway in apoE(-/-) mice. Cardiovasc Res 95, 241–250.CrossRefGoogle ScholarPubMed
Xiao, Y, Huang, W, Zhang, J, et al. (2015) Increased plasma S-adenosylhomocysteine-accelerated atherosclerosis is associated with epigenetic regulation of endoplasmic reticulum stress in apoE-/- mice. Arteriosclerosis, Thrombosis, Vascular Biol 35, 60–70.CrossRefGoogle ScholarPubMed
Kharbanda, KK, Rogers, DD II, Mailliard, ME, et al. (2005) A comparison of the effects of betaine and S-adenosylmethionine on ethanol-induced changes in methionine metabolism and steatosis in rat hepatocytes. J Nutr 135, 519–524.CrossRefGoogle ScholarPubMed
Turunen, MP, Aavik, E & Yla-Herttuala, S (2009) Epigenetics and atherosclerosis. Biochim Biophys Acta 1790, 886–891.CrossRefGoogle ScholarPubMed
Ribo, S, Sanchez-Infantes, D, Martinez-Guino, L, et al. (2021) Increasing breast milk betaine modulates Akkermansia abundance in mammalian neonates and improves long-term metabolic health. Sci Transl Med 13, eabb0322.CrossRefGoogle ScholarPubMed
Nagata, C, Wada, K, Tamura, T, et al. (2015) Choline and betaine intakes are not associated with cardiovascular disease mortality risk in Japanese men and women. J Nutr 145, 1787–1792.CrossRefGoogle Scholar
Xu, X, Gammon, MD, Zeisel, SH, et al. (2009) High intakes of choline and betaine reduce breast cancer mortality in a population-based study. FASEB J 23, 4022–4028.CrossRefGoogle ScholarPubMed
Golzarand, M, Mirmiran, P & Azizi, F (2021) Association between dietary choline and betaine intake and 10·6-year cardiovascular disease outcomes and mortality in adults. Nutr J 21, 1–11.CrossRefGoogle Scholar
Yang, S, Li, X, Yang, F, et al. (2019) Gut microbiota-dependent marker TMAO in promoting cardiovascular disease: inflammation mechanism, clinical prognostic, and potential as a therapeutic target. Front Pharmacol 10, 1360.CrossRefGoogle ScholarPubMed
Niswah, I, Rah, JH & Roshita, A (2021) The association of body image perception with dietary and physical activity behaviors among adolescents in Indonesia. Food Nutr Bull 42, S109–S121.CrossRefGoogle ScholarPubMed
Machek, SB, Zawieja, EE, Heileson, JL, et al. (2022) Human serum betaine and associated biomarker concentrations following a 14 d supplemental betaine loading protocol and during a 28 d washout period: a pilot investigation. Nutrients 14, 498.CrossRefGoogle Scholar
Zeisel, SH, Growdon, JH, Wurtman, RJ, et al. (1980) Normal plasma choline responses to ingested lecithin. Neurology 30, 1226–1229.CrossRefGoogle ScholarPubMed
Supplementary material: File

Liu et al. supplementary material

Figure S1 and Tables S1-S2

Download Liu et al. supplementary material(File)
File 33.1 KB