What are the recommended daily intake and health benefits of choline?

Recommended Daily Intake and Health Benefits of Choline

The recommended daily intake of choline is 400-550 mg per day for adults to support optimal lipid metabolism and prevent deficiency-related complications. 1

Recommended Daily Intake

• The Institute of Medicine recognized choline as an essential nutrient in 1998, acknowledging that endogenous biosynthesis is insufficient even with adequate vitamin B12 and folate availability 1, 2
• For adults, the recommended daily intake is 400-550 mg per day to support lipid metabolism 1
• For individuals with suspected or proven deficiency (particularly those on home parenteral nutrition or with liver steatosis/steatohepatitis), higher doses of 550 mg to 2 g/day may be considered 1
• In patients with probable choline deficiency who can tolerate enteral nutrition, choline-rich feeds or enteral choline preparations can be safely provided at 500-1500 mg per day 1
• The upper limit (UL) for choline intake in adults is defined at 3.5 g/day to avoid potential toxicity 1

Health Benefits and Functions

• Choline serves as a component of structural lipoproteins, blood and membrane lipids, and as a precursor of the neurotransmitter acetylcholine 1
• It plays critical roles in central and peripheral neurotransmission and overall neurological function 1, 3
• Choline is essential for proper liver function, helping prevent non-alcoholic liver steatosis 1, 4
• It supports muscle function and prevents subclinical muscle damage 1, 3
• Choline has demonstrated anti-inflammatory properties in experimental studies 1
• Maternal choline intake during pregnancy and lactation has lasting beneficial neurocognitive effects on offspring 5, 3

Deficiency Manifestations

• Choline deficiency can lead to:
  • Non-alcoholic liver steatosis/steatohepatitis (confirmed by imaging or elevated liver enzymes) 1
  • Subclinical muscle damage (reflected by increased creatine phosphokinase levels) 1
  • Potentially impaired neurocognitive development, especially in infants 5, 3
• Deficiency signs are highly variable between individuals, partially explained by differences in age, gender, and genetic polymorphisms 1, 5

Special Populations and Considerations

• Choline depletion is common in cystic fibrosis patients despite enzyme treatment, resulting in liver, fatty acid, and muscle abnormalities 1
• Pregnant and lactating women have increased choline requirements, with recent analyses indicating approximately 90% of Americans, including most pregnant and lactating women, consume less than the adequate intake 5
• Vegetarians and vegans may have greater risk for inadequacy as choline is found predominantly in animal-derived foods 5
• Individual requirements for choline depend on common genetic variants in genes involved in choline, folate, and one-carbon metabolism, potentially increasing susceptibility to organ dysfunction in more than one-third of the population 5, 3

Potential Risks and Monitoring

• Acute ingestion of high doses of choline may provoke hypotension and a fishy body odor 1
• A concern with enteral administration of choline is its conversion into trimethylamine-N-oxide (TMAO) by gut microflora, with potential negative long-term impact on cardiovascular health 1
• There is no routinely accessible biomarker for choline status in blood, although choline and its metabolites can be measured 1
• Plasma free choline may be determined in patients on home parenteral nutrition who develop unexplained liver steatosis or subclinical muscle damage 1

Food Sources

• Eggs and meats are rich sources of choline in the North American diet, providing up to 430 milligrams per 100 grams 2
• The food patterns recommended by the 2015-2020 Dietary Guidelines for Americans were insufficient to meet the adequate intake for choline in most age-sex groups 5