Choline

Abstract

Choline has been recognized as an essential nutrient by the Food and Nutrition Board of the National Academies of Medicine since 1998. Its metabolites have structural, metabolic, and regulatory roles within the body. Humans can endogenously produce small amounts of choline via the hepatic phosphatidylethanolamine N -methyltransferase pathway. However, the nutrient must be consumed exogenously to prevent signs of deficiency. The Adequate Intake (AI) for choline was calculated at a time when dietary intakes across the population were unknown for the nutrient. Unlike the traditional National Academy of Medicine approach of calculating an AI based on observed or experimentally determined approximations or estimates of intake by a group (or groups) of healthy individuals, calculation of the AI for choline was informed in part by a depletion-repletion study in adult men who, upon becoming deficient, developed signs of liver damage. The AI for other gender and life-stage groups was calculated based on standard reference weights, except for infants 0 to 6 months, whose AI reflects the observed mean intake from consuming human breast milk. Recent analyses indicate that large portions of the population (ie, approximately 90% of Americans), including most pregnant and lactating women, are well below the AI for choline. Moreover, the food patterns recommended by the 2015–2020 Dietary Guidelines for Americans are currently insufficient to meet the AI for choline in most age-sex groups. An individual’s requirement for choline is dependent on common genetic variants in genes required for choline, folate, and 1-carbon metabolism, potentially increasing more than one-third of the population’s susceptibly to organ dysfunction. The American Medical Association and American Academy of Pediatrics have both recently reaffirmed the importance of choline during pregnancy and lactation. New and emerging evidence suggests that maternal choline intake during pregnancy, and possibly lactation, has lasting beneficial neurocognitive effects on the offspring. Because choline is found predominantly in animal-derived foods, vegetarians and vegans may have a greater risk for inadequacy. With the 2020–2025 Dietary Guidelines for Americans recommending expansion of dietary information for pregnant women, and the inclusion of recommendations for infants and toddlers 0 to 2 years, better communication of the role that choline plays, particularly in the area of neurocognitive development, is critical. This narrative review summarizes the peer-reviewed literature and discussions from the 2018 Choline Science Summit, held in Washington, DC, in February 2018.

Nutritional Gaps and Supplementation in the First 1000 Days

“…A lack of choline in the maternal diet during critical periods of fetal development may cause lifelong changes in a child's brain structure and function, including the hippocampus. New evidence also suggests that sufficient maternal choline intake during pregnancy and lactation can have long-lasting beneficial neurocognitive effects on the offspring [29].…”

Urinary TMAO Levels Are Associated with the Taxonomic Composition of the Gut Microbiota and with the Choline TMA-Lyase Gene (cutC) Harbored by Enterobacteriaceae

“…The main dietary sources of the choline moiety, which is mostly present in food as lecithin (i.e., phosphatidylcholine), were reported to be eggs, liver, soybeans, and pork [11]. Although they are also present in numerous other foods [12], recent surveys in the USA indicated that choline may be underconsumed in specific populations (e.g., pregnant women and vegans) [13]. Based on the average observed choline intake in healthy European populations, a panel of the European Food Safety Authority set the adequate intake of choline at 400 mg/day [14].…”

Neuroprotective Effects of Choline and Other Methyl Donors

“…The American Academy of Pediatrics identified several nutrients as essential for brain growth and development including choline, VitB6, and VitB12. The US Food and Drug Administration recommended 7 mg of choline per 100 Kcal as an optimal value for infants [32]. Despite this recommendation, some individuals do not meet their daily choline requirement and other individuals increase their intake above the recommended value.…”

“…AI varies from one individual to another and this variation is influenced by several factors such as age, sex, genetic and environmental factors [33][34][35]. For example, an elevated intake of choline is required for pregnant women to support fetal growth and development and improve neurocognitive functions of offspring later in life [12,32]. Premenopausal women require less intake of choline compared to postmenopausal women.…”

“…Choline importance in health and the necessity of increasing awareness about its intake in several populations was discussed at the 2018 Choline Science Summit. We refer the readers to an excellent current review about the outcomes of this Summit discussions for further information [32].…”