{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T11:53:45Z","timestamp":1780401225238,"version":"3.54.1"},"reference-count":36,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T00:00:00Z","timestamp":1752019200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical University of Silesia","award":["PCN-1-1690\/N\/2\/K"],"award-info":[{"award-number":["PCN-1-1690\/N\/2\/K"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Trimethylamine N-oxide (TMAO) is implicated in the development of atherosclerosis and cardiovascular diseases. Preventive strategies must recognize the excessive consumption of products rich in choline, carnitine, and betaine, which are substrates essential for TMAO synthesis. The aim of this study was to develop and validate a dietary questionnaire to assess the consumption of these compounds and investigate the correlation with serum TMAO levels in a Central European population. Methods: A dietary questionnaire was designed based on a literature review identifying foods high in TMAO precursors. The tool was validated in a prospective study with 94 participants. The theoretical relevance and reliability of the tool were assessed using factor analysis and statistical indices. Reproducibility was evaluated in a subgroup of 10 participants who completed the questionnaire a second time 24 h later. The results of the questionnaire helped us to determine factors contributing to serum TMAO levels. Results: The final questionnaire consisted of 15 questions, providing acceptable data quality (KMO = 0.654). Three main dietary factors were detected: (1) the consumption of fish products and legumes (SS loadings = 1.72; 10.78% variance), (2) the consumption of cereal products and root vegetables (SS loadings = 1.61; 10.05% variance), and (3) the consumption of meat (SS loadings = 1.47; 9.22% variance). Conclusions: The validated questionnaire is a useful tool for assessing the intake of TMAO-promoting foods in post-myocardial infarction patients from Central Europe. It may support dietary risk assessment and nutritional counseling in clinical practice, particularly for secondary cardiovascular prevention.<\/jats:p>","DOI":"10.3390\/nu17142263","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T09:38:27Z","timestamp":1752140307000},"page":"2263","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Assessing Choline, Carnitine, and Betaine Intake and Their Effects on Trimethylamine N-Oxide Levels: Validation of a Dietary Questionnaire in a Central European Population"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4856-8511","authenticated-orcid":false,"given":"Witold","family":"Streb","sequence":"first","affiliation":[{"name":"Department of Cardiology and Electrotherapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, ul. M. Curie-Sk\u0142odowskiej 9, 41-800 Zabrze, Poland"},{"name":"Silesian Centre for Heart Diseases in Zabrze, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Olma","sequence":"additional","affiliation":[{"name":"Silesian Centre for Heart Diseases in Zabrze, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mateusz","family":"Pajor","sequence":"additional","affiliation":[{"name":"Silesian Centre for Heart Diseases in Zabrze, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Suchodolski","sequence":"additional","affiliation":[{"name":"Silesian Centre for Heart Diseases in Zabrze, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2420-5935","authenticated-orcid":false,"given":"Wiktoria","family":"Sta\u015bkiewicz-Bartecka","sequence":"additional","affiliation":[{"name":"Department of Food Technology and Quality Assessment, School of Public Health in Bytom, Medical University of Silesia in Katowice, 41-808 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Stanjek-Cichoracka","sequence":"additional","affiliation":[{"name":"Department of Biophysics, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, 41-200 Sosnowiec, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0312-6122","authenticated-orcid":false,"given":"Katarzyna","family":"Mitr\u0119ga","sequence":"additional","affiliation":[{"name":"Silesian Centre for Heart Diseases in Zabrze, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacek","family":"Kowalczyk","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Electrotherapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, ul. M. Curie-Sk\u0142odowskiej 9, 41-800 Zabrze, Poland"},{"name":"Silesian Centre for Heart Diseases in Zabrze, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zbigniew","family":"Kalarus","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Electrotherapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, ul. M. Curie-Sk\u0142odowskiej 9, 41-800 Zabrze, Poland"},{"name":"Silesian Centre for Heart Diseases in Zabrze, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Sun, Y., Lin, X., Liu, Z., Hu, L., Sun, P., Shen, G., Fan, F., Zhang, Y., and Li, J. (2024). Association between Plasma Trimethylamine N-Oxide and Coronary Heart Disease: New Insights on Sex and Age Differences. Front. Cardiovasc. Med., 11.","DOI":"10.3389\/fcvm.2024.1397023"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Li, Z., He, X., Fang, Q., and Yin, X. (2024). Gut Microbe-Generated Metabolite Trimethylamine-N-Oxide and Ischemic Stroke. Biomolecules, 14.","DOI":"10.3390\/biom14111463"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1056\/NEJMoa1109400","article-title":"Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk","volume":"368","author":"Tang","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4204","DOI":"10.1172\/JCI72331","article-title":"The Contributory Role of Gut Microbiota in Cardiovascular Disease","volume":"124","author":"Tang","year":"2014","journal-title":"J. Clin. Investig."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1146\/annurev-nutr-071816-064732","article-title":"Trimethylamine N-Oxide, the Microbiome, and Heart and Kidney Disease","volume":"37","author":"Zeisel","year":"2017","journal-title":"Annu. Rev. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Janeiro, M., Ram\u00edrez, M., Milagro, F., Mart\u00ednez, J., and Solas, M. (2018). Implication of Trimethylamine N-Oxide (TMAO) in Disease: Potential Biomarker or New Therapeutic Target. Nutrients, 10.","DOI":"10.3390\/nu10101398"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Seldin, M.M., Meng, Y., Qi, H., Zhu, W., Wang, Z., Hazen, S.L., Lusis, A.J., and Shih, D.M. (2016). Trimethylamine N-Oxide Promotes Vascular Inflammation Through Signaling of Mitogen-Activated Protein Kinase and Nuclear Factor-\u03baB. J. Am. Heart Assoc., 5.","DOI":"10.1161\/JAHA.115.002767"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Chen, M., Zhu, X., Ran, L., Lang, H., Yi, L., and Mi, M. (2017). Trimethylamine-N-Oxide Induces Vascular Inflammation by Activating the NLRP3 Inflammasome Through the SIRT3-SOD2-mtROS Signaling Pathway. J. Am. Heart Assoc., 6.","DOI":"10.1161\/JAHA.117.006347"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.cell.2016.02.011","article-title":"Gut Microbial Metabolite TMAO Enhances Platelet Hyperreactivity and Thrombosis Risk","volume":"165","author":"Zhu","year":"2016","journal-title":"Cell"},{"key":"ref_10","unstructured":"(2025, June 28). Available online: https:\/\/ods.od.nih.gov\/factsheets\/Choline-HealthProfessional\/."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1093\/jn\/133.5.1302","article-title":"Concentrations of choline-containing compounds and betaine in common foods","volume":"133","author":"Zeisel","year":"2003","journal-title":"J. Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1038\/nature09922","article-title":"Gut Flora Metabolism of Phosphatidylcholine Promotes Cardiovascular Disease","volume":"472","author":"Wang","year":"2011","journal-title":"Nature"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1038\/nm.3145","article-title":"Intestinal Microbiota Metabolism of L-Carnitine, a Nutrient in Red Meat, Promotes Atherosclerosis","volume":"19","author":"Koeth","year":"2013","journal-title":"Nat. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1161\/CIRCRESAHA.116.305360","article-title":"Gut Microbiota-Dependent Trimethylamine N -Oxide (TMAO) Pathway Contributes to Both Development of Renal Insufficiency and Mortality Risk in Chronic Kidney Disease","volume":"116","author":"Tang","year":"2015","journal-title":"Circ. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s12603-014-0566-5","article-title":"Considerations in Selection of Diet Assessment Methods for Examining the Effect of Nutrition on Cognition","volume":"19","author":"Zuniga","year":"2015","journal-title":"J. Nutr. Health Aging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1153S","DOI":"10.1093\/ajcn\/65.4.1153S","article-title":"Insights into Dietary Recall from a Longitudinal Study: Accuracy over Four Decades","volume":"65","author":"Dwyer","year":"1997","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.jclinepi.2018.08.003","article-title":"Controversy and Debate: Memory-Based Methods Paper 1: The Fatal Flaws of Food Frequency Questionnaires and Other Memory-Based Dietary Assessment Methods","volume":"104","author":"Archer","year":"2018","journal-title":"J. Clin. Epidemiol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Ravelli, M.N., and Schoeller, D.A. (2020). Traditional Self-Reported Dietary Instruments Are Prone to Inaccuracies and New Approaches Are Needed. Front. Nutr., 7.","DOI":"10.3389\/fnut.2020.00090"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1079\/PHN2001318","article-title":"Development, Validation and Utilisation of Food-Frequency Questionnaires\u2014A Review","volume":"5","author":"Cade","year":"2002","journal-title":"Public Health Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2357","DOI":"10.1007\/s00394-022-02803-4","article-title":"Circulating Trimethylamine N-Oxide Levels Following Fish or Seafood Consumption","volume":"61","author":"Wang","year":"2022","journal-title":"Eur. J. Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/S0278-6915(99)00028-9","article-title":"Dietary Precursors of Trimethylamine in Man: A Pilot Study","volume":"37","author":"Zhang","year":"1999","journal-title":"Food Chem. Toxicol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Andraos, S., Lange, K., Clifford, S.A., Jones, B., Thorstensen, E.B., Kerr, J.A., Wake, M., Saffery, R., Burgner, D.P., and O\u2019Sullivan, J.M. (2020). Plasma Trimethylamine N-Oxide and Its Precursors: Population Epidemiology, Parent\u2013Child Concordance, and Associations with Reported Dietary Intake in 11- to 12-Year-Old Children and Their Parents. Curr. Dev. Nutr., 4.","DOI":"10.1093\/cdn\/nzaa103"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Kr\u00fcger, R., Merz, B., Rist, M.J., Ferrario, P.G., Bub, A., Kulling, S.E., and Watzl, B. (2017). Associations of Current Diet with Plasma and Urine TMAO in the KarMeN Study: Direct and Indirect Contributions. Mol. Nutr. Food Res., 61.","DOI":"10.1002\/mnfr.201700363"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Lombardo, M., Aulisa, G., Marcon, D., Rizzo, G., Tarsisano, M.G., Di Renzo, L., Federici, M., Caprio, M., and De Lorenzo, A. (2021). Association of Urinary and Plasma Levels of Trimethylamine N-Oxide (TMAO) with Foods. Nutrients, 13.","DOI":"10.3390\/nu13051426"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Li, Q., Wu, T., Liu, R., Zhang, M., and Wang, R. (2017). Soluble Dietary Fiber Reduces Trimethylamine Metabolism via Gut Microbiota and Co-Regulates Host AMPK Pathways. Mol. Nutr. Food Res., 61.","DOI":"10.1002\/mnfr.201700473"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Ferrell, M., Bazeley, P., Wang, Z., Levison, B.S., Li, X.S., Jia, X., Krauss, R.M., Knight, R., Lusis, A.J., and Garcia-Garcia, J.C. (2021). Fecal Microbiome Composition Does Not Predict Diet-Induced TMAO Production in Healthy Adults. J. Am. Heart Assoc., 10.","DOI":"10.1161\/JAHA.121.021934"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1126\/science.aba3683","article-title":"High-Fat Diet\u2013Induced Colonocyte Dysfunction Escalates Microbiota-Derived Trimethylamine N-Oxide","volume":"373","author":"Yoo","year":"2021","journal-title":"Science"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1038\/nature08821","article-title":"A human gut microbial gene catalogue established by metagenomic sequencing","volume":"464","author":"Qin","year":"2010","journal-title":"Nature"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1038\/s41588-019-0350-x","article-title":"Causal relationships among the gut microbiome, short-chain fatty acids and metabolic diseases","volume":"51","author":"Sanna","year":"2019","journal-title":"Nat. Genet."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Romano, K.A., Vivas, E.I., Amador-Noguez, D., and Rey, F.E. (2015). Intestinal microbiota composition modulates choline bioavailability from diet and accumulation of the proatherogenic metabolite trimethylamine-N-oxide. mBio, 6.","DOI":"10.1128\/mBio.02481-14"},{"key":"ref_31","first-page":"118","article-title":"Dietary assessments in the European prospective study of diet and cancer (EPIC)","volume":"6","author":"Bingham","year":"1997","journal-title":"Eur. J. Cancer Prev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1079\/PHN2002394","article-title":"European Prospective Investigation into Cancer and Nutrition (EPIC): Study populations and data collection","volume":"5","author":"Riboli","year":"2002","journal-title":"Public Health Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Dakhia, Z., Russo, M., and Merenda, M. (2025). AI-Enabled IoT for Food Computing: Challenges, Opportunities, and Future Directions. Sensors, 25.","DOI":"10.3390\/s25072147"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4018\/IJRQEH.372690","article-title":"Integrating Big Data and AI in Nutrition: Current Trends and Future Directions","volume":"14","author":"Paul","year":"2025","journal-title":"Int. J. Reliab. Qual. E-Healthc. (IJRQEH)"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Sosa-Holwerda, A., Park, O.-H., Albracht-Schulte, K., Niraula, S., Thompson, L., and Oldewage-Theron, W. (2024). The Role of Artificial Intelligence in Nutrition Research: A Scoping Review. Nutrients, 16.","DOI":"10.3390\/nu16132066"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Bailey, R.L., MacFarlane, A.J., Field, M.S., Tagkopoulos, I., Baranzini, S.E., Edwards, K.M., Rose, C.J., Schork, N.J., Singhal, A., and Wallace, B.C. (2024). Artificial intelligence in food and nutrition evidence: The challenges and opportunities. PNAS Nexus, 3.","DOI":"10.1093\/pnasnexus\/pgae461"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/14\/2263\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:06:55Z","timestamp":1760033215000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/14\/2263"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,9]]},"references-count":36,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["nu17142263"],"URL":"https:\/\/doi.org\/10.3390\/nu17142263","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,9]]}}}