# Higher dietary choline and betaine intakes are associated with lower likelihood of central nervous system demyelination in Australian women

## TL;DR

Higher dietary choline and betaine intake in Australian women is linked to a lower chance of central nervous system demyelination, possibly related to multiple sclerosis.

## Contribution

This study is the first to show that dietary choline and betaine may reduce the risk of central nervous system demyelination in women.

## Key findings

- Higher choline intake was associated with lower likelihood of central nervous system demyelination in women.
- Combined choline and betaine intake showed a significant protective effect in females.
- No significant associations were found in males due to a smaller sample size.

## Abstract

Choline and betaine may be neuroprotective; however, the role of choline and betaine obtained from food in multiple sclerosis (MS) onset in humans is unclear. We aimed to test associations between intake of choline and betaine from food and likelihood of a first clinical diagnosis of central nervous system demyelination (FCD).

We used data from the Ausimmune Study, a large, multi-centre case–control study conducted in four latitudinally diverse regions of Australia. Choline and betaine intakes were derived from food composition data sourced globally and dietary intake data collected using a self-administered, semiquantitative food frequency questionnaire. We used the alternate Mediterranean diet score (aMED) as a measure of diet quality. We applied logistic regression with full propensity score matching (264 cases, 474 controls) and stratified by sex (females: 205 cases/368 controls; males 59 cases/106 controls) to test associations between dietary choline and betaine intakes (per 50 mg/day) and likelihood of an FCD. Models were adjusted for age, region, education, smoking history, history of infectious mononucleosis, deseasonalised serum 25-hydroxyvitamin D concentration, total energy intake, dietary misreporting and aMED, and bootstrapped (500 replicates).

Independent of an overall healthy diet, higher choline intake (OR = 0.91; 95%CI 0.84–1.00; p = 0.05) and higher combined choline + betaine intake (OR = 0.92; 95%CI 0.86–0.99; p = 0.03) were significantly associated with lower likelihood of FCD in females only. We found no statistically significant associations in males (small sample).

Given the potential beneficial role of choline and betaine in MS, investigation of associations and any diet- or sex-specific influences in other populations is warranted.

The online version contains supplementary material available at 10.1007/s00394-026-03915-x.