The study, published on Aug. 5 2017 in the journal Nutrients, looked at data from the National Health and Nutrition Examination Survey (NHANES) in the 2009-2014 period. Data for pregnant women were assessed from the 2005-2014 time frame.
Very few in population get enough
The study found that suboptimal intakes of choline were present across many gender and life-stage subpopulations. Only 8% of adults met the adequate intake (AI) level for this nutrient, and, more critically, only 8.5% of pregnant women achieved this level, though the error margin for that data point was greater (± 2.89%). Children were more likely to meet the AI for this nutrient, and for adults, more of those who regularly consume eggs met this level. Still, only slightly more than half of egg consumers (57.3%) met the AI for choline, as compared to almost none (2.4%) for those who ate no eggs. According to the data evaluated in this study, no one is getting too much of this nutrient.
Those who regularly consume foods like meat, poultry and seafood did get more choline in the diet, but consumption of these foods did not have a statistically significant effect on the number of consumers who met the AI. Thus, the authors concluded: “This research illustrates that it is extremely difficult to achieve the AI for choline without consuming eggs or taking a dietary supplement.”
Choline has been known for years to health professionals as a vital nutrient. The ingredient has been recognized for its role in liver health, and more recently it has been shown to play a vital role in the proper development of the nervous systems of fetuses, but those facts have been slow to be recognized by consumers or by product formulators.
AMA recommends higher dosages
Earlier this year, the American Medical Association (AMA) supported an increase of choline in all prenatal vitamins to 450 mg/day, according to a resolution passed by delegates at the 2017 AMA Annual Meeting in Chicago.
“Adequate levels of choline—an important nutrient that helps a baby’s brain and spinal cord to develop properly—are necessary to maintain normal pregnancy including neural development of the fetus and reducing the incidence of birth defects,” wrote Sara Berg, a staff writer for AMA’s communications site AMA Wire, reporting on the association’s annual meeting.
As of 2016, none of the top 25 prenatal multivitamins contains the scientifically backed choline dose for pregnant women (450 mg per day), according to a study published in 2016 by researchers at the University of Illinois at Chicago.
This recommended dosage was first established in 1998 by the Institute of Medicine, which recognized choline—found naturally in beef and chicken liver, egg yolk, salmon, milk, and soybeans—as an essential nutrient.
Tom Druke, director of VitaCholine brand development for Balchem Human Nutrition and Pharma, said research done at Duke University by Warren Meck, PhD, a professor of psychology and neuroscience, showed the effects of choline supplementation and deprivation during pregnancy.
“Using animal models, Professor Meck demonstrated that increased availability of choline led to improved neural communication and brain development. By comparing offspring born of supplemented pregnancies against those without additional choline, Meck showed improved cognitive performance, particularly related to visuo-spatial memory (the kind of memory you use to remember where you parked your car). Later, research conducted by Marie Caudill of Cornell University has demonstrated similar and additional benefits for choline supplementation in pregnant women,” Druke said.
Druke went on to say that work done by Cornell University by Marie Caudill, PhD, showed that adequate prenatal levels of choline improved the function of the placenta and helped lessen the risk of pre-eclampsia.
The authors of the Nutrients study said far more needs to be done to raise awareness of the importance of this nutrient.
Lack of EAR for choline seen as hurdle
“There is a clear need to increase awareness among health professionals, policy makers, and consumers regarding the large portion of individuals and subpopulations who do not currently achieve the AI for choline in the United States. It is necessary for the National Academy of Medicine, Food and Nutrition Board to update Dietary Reference Intakes (DRIs) for choline so that we may more accurately assess the magnitude of concern about potential population inadequacies for any nutrient with an assigned AI. Lack of an Estimated Average Requirement (EAR) severely limits the interpretation of the population intake data because it is difficult to assess whether intake below the AI results in suboptimal health status (e.g., impaired liver function, cognition, etc.),” they wrote.
Could single-ingredient supplements be the answer?
They also implied that single-ingredient supplements might be the way to go, despite the AMA recommendation about increasing choline levels in multivitamins. It appears that recommendation may well have been made in ignorance of certain dosage hurdles. There is not enough data at the moment on the effects of single-ingredient supplements to draw a conclusion, however.
“Multivitamins and other dietary multi-nutrient supplements contain only minimal amounts of choline, since choline salts are bulky and vastly increase the size of [the] supplement product. Only minuscule portions of the US population, including pregnant women, consume choline as a single-nutrient supplement, making it impossible to assess their impact on usual choline intakes from a population level,”they wrote.
Published online ahead of print, 9(8), 839; doi:10.3390/nu9080839
“Usual Choline Intakes Are Associated with Egg and Protein Food Consumption in the United States"
Authors: Taylor C. Wallace, Victor L. Fulgoni