Dietary choline is inversely associated with depressive symptoms: a cross-sectional study of the National Health and Nutrition Examination Survey (NHANES) 2011 to 2018

Background Dietary choline has neuroprotective actions. However, the relationship between dietary choline and depression has been little studied. Methods We conducted a cross-sectional study to explore the association between dietary choline and depressive symptoms in US adults, using data from the 2011 to 2018 National Health and Nutrition Examination Survey (NHANES). 12,906 individuals age ≥20 who had valid information on dietary choline and depressive symptoms were chosen. Depressive symptoms were defined as the score ≥10 of the Patient Health Questionnaire-9 (PHQ-9). Multivariable logistic regression and the restricted cubic splines were used in analyses. Results In three models, compared with the bottom quintile, each quintile of dietary choline was significantly associated with a lower risk of depressive symptoms. After adjusted all selected confounding factors and covariates, the odds ratio with the 95% confidence interval of depressive symptoms was 0.57 (95% CI:0.38-0.85) for the highest quintile versus the lowest quintile of dietary choline intake. Statistical significance was also maintained in gender and age stratification studies. In the study of the dose-response relationship, an L-shaped relationship between dietary choline and depressive symptoms was found. Limitations Causality cannot be inferred in a cross-sectional study. Conclusion In this analysis of US adults, dietary choline intake is inversely associated with the risk of depressive symptoms. An L-shape dose-response relationship between those two was found. Further studies are needed to confirm our results.