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BACKGROUND: Choline and betaine intake have been related to cardiovascular health. OBJECTIVE: We aimed to explore the relationship between 1-year changes in dietary intake of choline or betaine and 1-year changes in cardiometabolic and renal function traits within the frame of the PREDIMED-Plus trial. DESIGN: We used baseline and 1 year follow-up data from 5,613 participants (48.2% female and 51.8% male, mean age 65.01 ± 4.91) to assess cardiometabolic traits, and 3,367 participants to assess renal function, of the Spanish PREDIMED-Plus ("PREvention with MEDiterranean DIet") trial. Participants met at least three criteria of metabolic syndrome (MetS) and had overweight or obesity (BMI =27 and =40kg/m2). These criteria were similar to those of the PREDIMED parent study. Dietary intake of choline and betaine was estimated from the Food Frequency Questionnaire (FFQ). RESULTS: The greatest one-year increase in dietary choline or betaine intake (Q4) was associated with improved serum glucose (-3.39 and -2.72 mg/dL for choline or betaine, respectively) and glycated hemoglobin levels (-0.10% for Q4 of either choline or betaine intake increase). Other significant changes associated with the greatest increase in choline or betaine intake were: reduced body weight (-2.93 and -2.78 Kg, respectively), BMI (-1.05 and -0.99 Kg/m2, respectively), waist circumference (-3.37 and -3.26 cm, respectively), total cholesterol (-4.74 and -4.52 mg/dL, respectively) and LDL cholesterol (-4.30 and -4.16 mg/dL, respectively). Urine creatinine was reduced in Q4 of one-year increase in choline or betaine intake (-5.42 and -5.74 mg/dL, respectively). CONCLUSIONS: Increase in dietary choline or betaine intake were longitudinally related to improvements in cardiometabolic parameters. Markers of renal function were also slightly improved, and they required further investigation.