(OR12-06-24) Comparing the Trimethylamine N-oxide (TMAO) Dietary Pattern to the 2020 Healthy Eating Index in Relation to Cardiovascular Disease Risk Factors

Objectives: TMAO is an atherosclerotic metabolite that can be produced in part by the metabolism of choline. We previously developed a TMAO Dietary Pattern (TMAO-DP) which predicts plasma TMAO and choline concentrations. We evaluated how the TMAO-DP compares to the 2020 Healthy Eating Index (HEI) in relation to cardiovascular disease (CVD) risk factors.

Methods: This cross-sectional analysis used baseline data (1993-1998) of 1116 women from an ancillary study of the Women's Health Initiative Hormone Trials. Dietary, demographic, and health data were collected via questionnaire. Waist circumference was measured at study visits. Metabolites were measured in plasma samples using liquid chromatography-tandem mass spectrometry. Associations between quartiles (Q) of the diet patterns with CVD risk factors were evaluated using ANOVA and chi-squared tests. Associations between the continuous diet patterns with plasma TMAO and choline were evaluated using adjusted linear regression.

Results: Higher TMAO-DP scores represent a more atherogenic (unhealthy) diet and higher HEI scores represent a healthier diet. Those with higher (vs. lower) TMAO-DP scores, or lower (vs. higher) HEI scores, were more likely to have larger waist circumferences, be smokers, and be less physically active. The TMAO-DP was not associated with cholesterol medication use, but those with a higher (vs. lower) HEI scores were more likely to be using cholesterol medication (Q4: 21.2%, Q1: 11.5%, p< 0.05). Those with a higher TMAO-DP or a  higher HEI were more likely to use diabetes medications: (Q1: 9.3%, Q4: 12.5%; p< 0.05) and (Q1: 6.1%, Q4: 9.3%; p< 0.10), respectively. Higher adherence to the TMAO-DP was associated with higher diastolic (p < 0.05), but not systolic, blood pressure. The HEI was not associated with blood pressure. Both diet patterns were associated with the metabolites TMAO [TMAO-DP: B (SE): 0.054 (0.019); HEI: -0.003 (0.002)] and choline [TMAO-DP: 0.009 (0.007); HEI: -0.001 (0.001)].

Conclusions: The TMAO-DP was associated with CVD risk factors to an equal or greater extent as the HEI. The postive associations between HEI and medication use may reflect healthy dietary changes following diagnosis.

Funding Sources: National Institutes of Health (NHLBI, NCI)