Tier 4
Michael Lever et al. · PloS one · 2014
Prospective observational cohort. Higher betaine predicted more events in patients with diabetes, whereas lower betaine predicted some events in those without diabetes.
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Tier 4
Lulu Wang et al. · Journal of clinical hypertension (Greenwich, Conn.) · 2018
Cross-sectional cohort analysis. Higher circulating betaine was associated with lower ambulatory blood pressure, mainly in women.
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Tier 4
Eha Nurk et al. · The British journal of nutrition · 2013
Cross-sectional study. The clearest cognitive association concerned choline; low betaine combined with high methylmalonic acid was associated with poorer performance on one memory measure.
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Tier 4
E Cho et al. · British journal of cancer · 2010
Prospective cohort. Dietary betaine was not associated with lower breast-cancer risk.
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Tier 4
Eline H van den Berg et al. · Liver international : official journal of the International Association for the Study of the Liver · 2023
Cohort biomarker comparison. Betaine was elevated with greater cirrhosis severity and fell after transplantation; it did not independently predict waiting-list mortality.
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Tier 4
Guicun Yang et al. · Alternative therapies in health and medicine · 2025
Case-control birth study. Higher cord-blood betaine was associated with smaller birth size and small-for-gestational-age status.
Original sources: PubMed
Tier 4
Mahdieh Golzarand et al. · Food & function · 2021
Prospective cohort. Dietary betaine was not significantly associated with incident hypertension; findings for choline differed.
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Tier 4
Mahdieh Golzarand et al. · Nutrition journal · 2022
Prospective cohort. Total dietary choline and betaine were not associated with incident cardiovascular disease.
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Tier 4
Liling Xie et al. · Clinical nutrition (Edinburgh, Scotland) · 2020
Nested case-control study. Serum betaine showed a U-shaped association with first ischemic stroke, rather than a simple higher-is-better pattern.
Original sources: DOI · PubMed
Tier 4
Héctor Vázquez-Lorente et al. · The American journal of clinical nutrition · 2026
Prospective cohort analysis within PREDIMED-Plus. Higher dietary betaine was associated with modest improvements in selected cognitive domains, including language.
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Tier 4
Alexandra E Cowan-Pyle et al. · Menopause (New York, N.Y.) · 2024
Longitudinal cohort analysis. Dietary betaine had small and inconsistent associations with verbal-memory trajectories, with no clear association in premenopausal women.
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Tier 4
Aurelian Bidulescu et al. · BMC cardiovascular disorders · 2007
Prospective cohort. Higher choline-plus-betaine intake was not significantly protective against incident coronary heart disease.
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Tier 4
Chongke Zhong et al. · The American journal of clinical nutrition · 2021
Nested case-control study. Higher plasma betaine was associated with fewer recurrent cardiovascular events and strokes in this patient population.
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Tier 4
Shervin Kazeminejad et al. · The British journal of nutrition · 2025
Cross-sectional study. Betaine intake was not significantly related to depression, anxiety or psychological distress after adjustment.
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Tier 4
Peishan Tan et al. · The British journal of nutrition · 2025
Prospective cohort. Dietary betaine was not associated with all-cause mortality in either sex, despite associations for some choline measures.
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Tier 4
Monica L Bertoia et al. · Atherosclerosis · 2014
Prospective cohorts and nested case-control analyses. Dietary betaine and choline were not consistently associated with peripheral-artery disease, unlike some sex-specific homocysteine and folate findings.
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Tier 4
J Kotsopoulos et al. · European journal of clinical nutrition · 2010
Prospective cohorts. Dietary betaine and choline were not associated with epithelial ovarian-cancer risk.
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Tier 2
Tilman Kühn et al. · Clinical chemistry and laboratory medicine · 2017
Repeated biomarker study. Betaine concentrations were more stable within individuals over a year than TMAO concentrations.
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Tier 4
Cai-Xia Zhang et al. · Cancer science · 2013
Two-stage case-control study. Higher betaine and choline intake was associated with lower breast-cancer odds in this population.
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Tier 4
Michael Lever et al. · PloS one · 2011
Cross-sectional patient cohort. Lower plasma betaine correlated with less favorable lipid profiles; statin and fibrate use showed different betaine patterns.
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Tier 4
Gary M Shaw et al. · American journal of epidemiology · 2004
Case-control study. The lowest odds occurred with a dietary pattern high in choline, betaine and methionine, rather than an isolated betaine intervention.
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Tier 4
Shangling Wu et al. · Food & function · 2026
Prospective cohort. Dietary betaine was not significantly associated with diabetes incidence; the nonlinear findings concerned choline.
Original sources: DOI · PubMed
Tier 4
Xiang Gao et al. · PloS one · 2016
Cross-sectional study. Higher dietary choline and betaine were associated with more favorable body-composition measures.
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Tier 4
Erwin Garcia et al. · Journal of clinical medicine · 2019
Prospective cohort with assay validation. Higher circulating betaine was associated with lower subsequent type 2 diabetes risk after adjustment.
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Tier 4
Min-Shan Lu et al. · PloS one · 2015
Case-control study. Betaine intake was not significantly associated with colorectal-cancer odds; some choline measures showed inverse associations.
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Tier 4
Daniel T Dibaba et al. · Diabetes care · 2020
Prospective cohort. Dietary betaine was not significantly associated with type 2 diabetes incidence overall.
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Tier 4
Rui-Fen Zhou et al. · Scientific reports · 2017
Matched case-control study. Higher estimated betaine intake was associated with lower primary liver-cancer odds.
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Tier 4
Stephanie E Chiuve et al. · The American journal of clinical nutrition · 2007
Cross-sectional study. Betaine alone was not significantly associated with homocysteine; combined choline-plus-betaine intake showed an inverse trend dependent on nutritional context.
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Tier 4
Paraskevi Detopoulou et al. · The American journal of clinical nutrition · 2008
Cross-sectional study. Higher betaine intake was associated with lower homocysteine and TNF-alpha; the CRP comparison was weaker and not conventionally significant.
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Tier 4
James A Greenberg et al. · The American journal of clinical nutrition · 2021
Prospective cohort. The analysis assessed eggs and methyl-donor nutrients; its main reported diabetes associations concerned eggs, cholesterol and choline rather than a tested betaine treatment.
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Tier 4
Alireza Jafari et al. · BMC pediatrics · 2021
Cross-sectional study. Most body-size comparisons were null; selected betaine associations concerned mid-arm circumference and overweight classification.
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Tier 4
Si Liu et al. · The British journal of nutrition · 2023
Prospective patient cohort. Higher dietary betaine was associated with lower cardiovascular mortality, while the fully adjusted all-cause mortality association was not significant.
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Tier 4
Jun Ying et al. · PloS one · 2013
Case-control study. Higher betaine intake was associated with lower lung-cancer odds among current or former smokers, but not never-smokers.
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Tier 4
Peijin Han et al. · Cancer causes & control : CCC · 2019
Prospective cohort. Betaine intake was inversely associated with lethal but not total prostate cancer; findings did not show better survival after diagnosis.
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Tier 4
Carolina Moltó-Puigmartí et al. · The American journal of clinical nutrition · 2021
Prospective birth cohort. Higher late-pregnancy betaine was associated with greater early weight gain and some later overweight measures, particularly in boys.
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Tier 4
Carmen Marino et al. · npj aging · 2025
Cross-sectional metabolomics study. Higher serum betaine emerged as a possible pre-frailty signature in women.
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Chisato Nagata et al. · The Journal of nutrition · 2015
Prospective cohort. Overall there was no clear consistent link with cardiovascular mortality; selected coronary-mortality categories in men were lower without a significant dose trend.
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Tier 4
Therese Karlsson et al. · European journal of nutrition · 2024
Prospective cohort. Higher dietary betaine was associated with lower all-cause mortality in women but not men.
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Tier 4
Xiang Gao et al. · Journal of diabetes and its complications · 2019
Cross-sectional study. Higher serum betaine was associated with more favorable lipid and insulin-resistance measures, with sex-specific patterns.
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Tier 4
Xiaoting Lu et al. · Nutrients · 2022
Prospective cohort. Higher serum betaine was associated with lower diabetes risk, with exploratory interactions involving selected MTHFR variants.
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