Choline – The Underconsumed and Underappreciated Essential Nutrient

Featured article in the Winter 2019 Issue of Nutrition Close-Up; written by Taylor C. Wallace, PhD, CFS, FACN

“Recognition of the growing evidence relating inadequate intakes to health consequences coupled with evidence of suboptimal intakes in high-risk populations, warrants a need for improved public health recommendations for choline” was the consensus of more than 40 experts attending the 2018 Choline Science Summit, whose findings were summarized recently in a feature article in the journal Nutrition Today.1

Choline’s role in human health begins prenatally and extends into adulthood and old age.2 Its functions are complex and include, but are not limited to, neurotransmitter synthesis, cell membrane signaling, lipid transport and methyl group metabolism. Choline has been recognized as an essential nutrient in the U.S. and Canada since 1998; it has long been established that deficiency results in non-alcoholic fatty liver disease.

Choline’s function and recognition among health professionals regarding cogniti on across the lifespan has only recently gained momentum. Humans can produce small amounts of choline but must consume the nutrient through the diet to prevent deficiency.2
The American Academy of Pediatrics (AAP) recently affirmed choline as a key nutrient to support neurodevelopment during the first 1000 days postconception.3 Adequate maternal choline intake has been shown to help the baby’s brain and spinal cord develop properly.1 Additional research has shown that choline eases the baby’s response to stress and enhances nutrient transfer across the placenta to the developing fetus.4,5 Importantly, lactation increases the maternal choline requirement.2

Higher maternal intake of choline results in lasting beneficial cognitive effects that become more pronounced with aging in both animal and human models. Results of a recent randomized controlled trial reveal benefits of higher maternal choline intake on child attention, memory and problem solving that may last into the school-age years.1,6 Choline intake throughout adulthood may also help reduce the risk of age-related cognitive decline,7 however these findings are predominately based on observational studies or animal-models and more research is needed.

Analysis from the National Health and Nutrition Examination Survey indicates that the majority of the U.S. population is not consuming sufficient choline to meet recommended intakes. The daily value for choline is 550 mg per day, however estimated mean daily intake is approximately 319 mg per day.8 It is difficult to get enough choline without consuming eggs or taking a dietary supplement and therefore, it’s not surprising that 90% of Americans and 92% of pregnant women do not achieve current recommended intakes for choline.8,9

The bottom line – health professionals need to be aware of food sources of choline and while data indicate a need for Americans to increase plant-foods in the diet, this should not mean eliminating nutrient dense animal-derived foods such as eggs that contain higher levels of choline. Health professionals should strongly consider the recommendations from the American Medical Association (AMA) and AAP, as well as the recent scientific literature summarized in this recently published report. Dietary guidance that helps all individuals meet current choline recommendations is critical for the health and wellbeing of all individuals.

 

References
1. Wallace, TC, et al. Choline: The Underconsumed and Underappreciated Essential Nutrient. Nutr. Today. 2018; 53: 240–253.
2. Dietary Reference Intakes for Thiamin, Ribofl avin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. (National Academy Press, 1998).
3. Schwarzenberg, SJ and M.K Georgieff . Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health. Pediatrics. 2018; 141: e20173716.
4. Jiang, X, et al. Maternal choline intake alters the epigenetic state of fetal cortisol-regulating genes in humans. FASEB J.2012; 26: 3563–3574.
5. Jiang, X, et al. Choline inadequacy impairs trophoblast function and vascularization in cultured human placental trophoblasts. J. Cell. Physiol. 2014; 229: 1016–1027.
6. Caudill, MA, et al. Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study. FASEB J. Off . Publ. Fed. Am. Soc. Exp. Biol. 2018; 32: 2172-2180.
7. Blusztajn, JK, et al. Neuroprotective Actions of Dietary Choline. Nutrients.2017; 9.
8. Wallace, TC and V.L. Fulgoni. Usual Choline Intakes Are Associated with Eggand Protein Food Consumption in the United States. Nutrients. 2017; 9.
9. Wallace, TC and V.L. Fulgoni, 3rd. Assessment of Total Choline Intakes in the United States. J. Am. Coll. Nutr. 2016; 35: 108–112.