Choline: The Neurocognitive Essential Nutrient of Interest to Obstetricians and Gynecologists

Abstract

Choline is an essential nutrient for proper liver, muscle, and brain functions as well as for lipid metabolism and cellular membrane composition and repair. Humans can produce small amounts of choline via the hepatic phosphatidylethanolamine N-methyltransferase pathway; however, most individuals must consume this vitamin through the diet to prevent deficiency. An individual’s dietary requirement for choline is dependent on common genetic variants in genes required for choline, folate, and one-carbon metabolism. Both the American Academy of Pediatrics and American Medical Association have recently reinforced the importance of maternal choline intake during pregnancy and lactation and recognize that failure to provide choline and other key essential nutrients during the first 1,000 days postconception may result in lifelong deficits in brain function despite subsequent nutrient repletion. Given that dietary intake for the majority of the US population, including subpopulations such as pregnant women, women of childbearing age, and vegetarians, falls well below the current adequate intake, there is a need to develop better policies and improve consumer education around the importance of this essential nutrient for human health. This comprehensive expert review summarizes the current scientific evidence on choline and health in relation to interests of obstetricians and gynecologists.

KEY MESSAGES

There is compelling evidence that demonstrates obtaining the current adequate intake (AI) for choline is problematic for the majority of the US population; excessive intakes above the tolerable upper intake level (UL) are absent.

The dietary requirement for choline is dependent on common genetic variants in genes required for choline, folate, and one-carbon metabolism. Continuing education is needed for health professionals on the importance of choline-rich foods in the diet. Choline must be integrated into the prenatal supplement regimen.

Research suggests not achieving the AI is likely detrimental to cognitive function in the developing fetus and infant. Adverse neurological consequences due to suboptimal maternal intakes are likely to be identified in future clinical research.

Keywords:

• brain
• choline
• cognition
• dietary guidelines
• placenta
• shortfall nutrient

Acknowledgments

The authors thank Ms. Christina West for her assistance in formatting and copyediting the manuscript.

Declaration of interest

TCW, JKB, MAC, and SHZ disclose research grant funding, scientific consulting or writing fees, travel reimbursement, and speaker honoraria from various food companies and commodity boards with an interest in choline. KCK is a graduate research assistant to MAC and has no direct conflict of interest to disclose.

Additional information

Notes on contributors

Taylor C. Wallace

Taylor C. Wallace, PhD, CFS, FACN is the principal and CEO at the Think Healthy Group, Inc. and is an adjunct professor in the Department of Nutrition and Food Studies at George Mason University.

Jan Krzysztof Blusztajn

Jan Krzysztof Blusztajn, PhD is a professor in the Department of Pathology and Laboratory Medicine at Boston University School of Medicine.

Marie A. Caudill

Marie A. Caudill, PhD, RD is a professor in the Division of Nutritional Sciences at Cornell University.

Kevin C. Klatt

Kevin C. Klatt, PhD is a postdoctoral associate at the Baylor College of Medicine Children’s Nutrition Research Center.

Steven H. Zeisel

Steven H. Zeisel, MD, PhD is the director of the University of North Carolina Nutrition Research Institute, the director of the University of North Carolina Obesity Research Center, and a professor in the Department of Nutrition at the University of North Carolina.