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Relationship Between Dietary Choline Intake and Cognitive Function in the United States: A Cross-Sectional Study of

Yu-Hang Chen¹, Ting-Ting Liu², Li-Ming Chen³

¹Department of Operations Management Chongqing Mental Health Center Chongqing Chongqing China.

Food Science & Nutrition

|April 22, 2026

Abstract

Background:

Current evidence on the correlation between dietary choline intake and Cognitive function is inconsistent. Therefore, this study examines the relationship between dietary choline intake and Cognitive function among noninstitutionalized older adults in the United States based on individuals in the National Health and Nutrition Examination Survey (NHANES) database.

Methods:

This cross-sectional analysis used data from the NHANES conducted from 2011 to 2014. Two 24-h dietary recalls were used to measure choline intake, which was then weighted. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) test, the Digit Symbol Substitution Test (DSST), and the Animal Fluency Test (AFT) were used to evaluate cognitive function. People were considered to have low cognitive function if their scores on each cognitive test fell below the lowest quartile for their respective age group. The association between choline intake and cognitive function was evaluated using restricted cubic splines (RCS) and binary logistic regression.

Results:

In the fully corrected model, the odds ratio (OR) and 95% confidence intervals (CI) of CERAD-WL test scores, CERAD-DR test scores, AFT scores, and DSST scores for the highest quartile of dietary choline intake were 0.61 (0.46 ~ 0.81), 0.66 (0.51 ~ 0.85), 0.66 (0.50 ~ 0.88), and 0.58 (0.42 ~ 0.80); the OR and 95% CI of CERAD-WL test scores, CERAD-DR test scores, AFT scores, and DSST scores for the highest quartile of total choline intake were 0.62 (0.47 ~ 0.83), 0.68 (0.53 ~ 0.88), 0.65 (0.49 ~ 0.86), and 0.57 (0.42 ~ 0.79). Subgroup analysis suggests that the interaction between gender, hypertension status, and choline intake has some impact on the relationship model. In dose-response relationship studies, dietary choline intake and total choline intake are both U-shaped correlated with DSST scores.

Conclusion:

Choline intake can improve cognitive function scores, and a nonlinear relationship exists between the two.

Keywords:

NHANES choline cognitive function dietary elderly regression analysis

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