Circulating choline pathway nutrients and depression after ischemic stroke

• Published in: European journal of neurology Vol. 29; no. 2; pp. 459 - 468
• Main Authors: Miao, Mengyuan, Du, Jigang, Che, Bizhong, Guo, Yufei, Zhang, Jintao, Ju, Zhong, Xu, Tan, Zhong, Xiaoyan, Zhang, Yonghong, Zhong, Chongke
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.02.2022
• Subjects: Antidepressants; Antihypertensives; Betaine; Calibration; Choline; Depression - etiology; Humans; Ischemia; Ischemic Stroke; Mental depression; Nutrients; poststroke depression; Reclassification; Regression analysis; Regression models; Risk analysis; Risk Factors; Stroke; Stroke - complications; choline; betaine; ischemic stroke; poststroke depression
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/ene.15133

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. Patients with higher choline and betaine levels had lower risk of depression after ischemic stroke, suggesting the protective roles of choline pathway nutrients for depression after ischemic stroke. In addition, both choline and betaine provided incremental prognostic information for poststroke depression over conventional risk factors. Our study has important clinical implications for the early prevention and intervention of poststroke depression.