• Jennifer Wilcox, Sarah M Skye, Brett Graham, Allyson Zabell, Xinmin S Li, Lin Li, Shamanthika Shelkay, Xiaoming Fu, Sarah Neale, Cathy O'Laughlin, Kimberly Peterson, Stanley L Hazen, and TangW H WilsonWHWDepartment of Cardiovascular and Metabolic Sciences, Lerner Research Institute; Center for Microbiome and Human Health; Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Ohio. Electronic address: tangw.
• Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute; Center for Microbiome and Human Health.
• Am. J. Med. 2021 Sep 1; 134 (9): 1160-1169.e3.

BackgroundCholine is a dietary precursor to the gut microbial generation of the prothrombotic and proatherogenic 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.MethodsHealthy volunteers (41% male, 81% Caucasian, median age 28 years) with normal renal function (estimated glomerular filtration rate >60) were recruited and assigned to 1 of 5 daily interventions for 4 weeks: 1) hardboiled eggs (n = 18); 2) choline bitartrate supplements (n = 20); 3) hardboiled eggs + choline bitartrate supplements (n = 16); 4) egg whites + choline bitartrate supplements (n = 18); 5) phosphatidylcholine supplements (n = 10). Fasting blood and urine samples were collected for quantification of TMAO, its precursors, and platelet aggregometry.ResultsParticipants' plasma TMAO levels increased significantly in all 3 intervention arms containing choline bitartrate (all P < .0001), but daily ingestion of 4 large eggs (P = .28) or phosphatidylcholine supplements (P = .27) failed to increase plasma TMAO levels. Platelet reactivity also significantly increased in the 3 intervention arms containing choline bitartrate (all P < .01), but not with eggs (P = .10) or phosphatidylcholine supplements (P = .79).ConclusionsDespite high choline content in egg yolks, healthy participants consuming 4 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.Copyright © 2021 Elsevier Inc. All rights reserved.

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