Abstract
Background:
Choline is a dietary precursor to the gut microbial generation of the pro-thrombotic and pro-atherogenic metabolite trimethylamine-N-oxide (TMAO). Eggs are rich in choline, yet the impact of habitual egg consumption on TMAO levels and platelet function in human subjects remains unclear.
Methods:
Healthy volunteers (41% male, 81% Caucasian, median age 28) with normal renal function (eGFR>60) were recruited and assigned to one of five daily interventions for four weeks: (i) hardboiled eggs (N=18); (ii) choline bitartrate supplements (N=20); (iii) hardboiled eggs + choline bitartrate supplements (N=16); (iv) egg whites + choline bitartrate supplements (N=18); (v) phosphatidylcholine supplements (N=10). Fasting blood and urine samples were collected for quantification of TMAO, its precursors, and platelet aggregometry.
Results:
Participant's plasma TMAO levels increased significantly in all three intervention arms containing choline bitartrate (all P<0.0001), but daily ingestion of four large eggs (P=0.28) or phosphatidylcholine supplements (P=0.27) failed to increase plasma TMAO levels. Platelet reactivity also significantly increased in the three intervention arms containing choline bitartrate (all P<0.01), but not with eggs (P=0.10) or phosphatidylcholine supplements (P=0.79).
Conclusions:
Despite high choline content in egg yolks, healthy participants consuming four eggs daily showed no significant increase in TMAO or platelet reactivity. However, choline bitartrate supplements providing comparable total choline raised both TMAO and platelet reactivity, demonstrating that the form and source of dietary choline differentially contributes to systemic TMAO levels and platelet responsiveness.
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