Choline Intake and Pelvic Inflammatory Disease Risk: A Cross-Sectional Study Based on NHANES 2013-2018.

Background and Aim: Pelvic inflammatory disease (PID), a chronic infection of the female upper genital tract, is a leading cause of morbidity in reproductive-aged women, often resulting in chronic pelvic pain, tubal infertility, and ectopic pregnancy. Choline, an essential nutrient, plays a critical role in various metabolic processes and is known to modulate inflammatory pathways. However, the potential link between dietary choline intake and PID remains largely unexplored. This study aimed to investigate the relationship between dietary choline consumption and PID prevalence. Methods: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2013-2018. A total of 3204 women were included in the analysis. The association between choline intake and PID was assessed using multivariable logistic regression and smooth curve fitting. Subgroup analyses were performed to explore potential effect modifiers, and threshold effect analysis was used to identify inflection points in the relationship. Results: Among the 3204 women studied, 208 had PID. In fully adjusted models, higher choline intake was significantly associated with a reduced risk of PID (OR = 0.20, 95% CI: 0.04-0.92, p = 0.038). Compared to women in the lowest quintile of choline intake, those in the highest quintile had a 45% lower risk of PID (OR = 0.55, 95% CI: 0.30-0.98, p = 0.044). Smooth curve fitting demonstrated a nonlinear association, with an inflection point at 0.41 g/day overall and at 0.29 g/day for normotensive women. Subgroup analysis suggested that blood pressure status may modify this relationship. Conclusion: Higher dietary choline intake was associated with a reduced prevalence of PID. These findings highlight the potential role of nutritional factors, particularly adequate choline intake, in reproductive health and support further prospective research to confirm causality.