From the Guidelines
Choline supplementation is recommended for patients with probable choline deficiency, with a daily dose of 500-1500 mg for adults, as stated in the ESPEN micronutrient guideline 1.
Importance of Choline
Choline is a crucial nutrient for various bodily functions, including brain development, liver function, and metabolism. It serves as a precursor to acetylcholine, a neurotransmitter essential for memory and muscle control, and is vital for cell membrane integrity and methylation processes.
Recommended Daily Intake
The recommended daily intake of choline varies, but adults should aim for approximately 425-550 mg daily, with pregnant and breastfeeding women requiring higher amounts (450-550 mg) 1.
Food Sources and Supplementation
The best food sources of choline include egg yolks, liver, meat, fish, soybeans, and cruciferous vegetables like broccoli. For individuals with restricted diets, supplementation may be necessary, with common forms including choline bitartrate, alpha-GPC, and CDP-choline (doses typically range from 250-500 mg daily).
Potential Deficiency and Toxicity
Deficiency in choline can lead to liver dysfunction, muscle damage, and cognitive issues. However, high doses of choline can cause hypotension and a fishy smell, with the upper limit (UL) for adults defined at 3.5 g/day 1.
Special Considerations
Vegans, pregnant women, and those with certain genetic variations may benefit from choline supplementation after consulting with a healthcare provider. Additionally, patients with probable choline deficiency who are tolerating enteral nutrition can safely receive choline-rich feeds or enteral choline preparations in equivalents of 500-1500 mg per day for adults, as recommended by the ESPEN micronutrient guideline 1.
From the Research
Importance of Choline
- Choline is an essential nutrient for human health, recognized by the Institute of Medicine (IOM) in 1998 2 and the Food and Nutrition Board of the National Academies of Medicine since 1998 3.
- It plays a crucial role in various bodily functions, including cell structure, neurotransmitter synthesis, liver function, and lipid metabolism 2, 4.
- Choline deficiency can lead to liver disease, atherosclerosis, and neurological disorders 2.
Dietary Sources and Intake
- Choline is found in a variety of foods, with eggs and meats being rich sources in the North American diet, providing up to 430 milligrams per 100 grams 2.
- However, mean choline intakes for older children, men, women, and pregnant women are far below the adequate intake level established by the IOM 2.
- Approximately 90% of Americans, including most pregnant and lactating women, have choline intakes below the Adequate Intake (AI) 3.
- Vegetarians and vegans may be at a greater risk for choline inadequacy due to the predominance of choline in animal-derived foods 3.
Health Effects and Requirements
- Choline has been shown to have lasting beneficial neurocognitive effects on offspring when consumed by pregnant women 3, 4.
- An individual's requirement for choline is dependent on common genetic variants in genes required for choline, folate, and one-carbon metabolism 3, 4.
- The American Medical Association and American Academy of Pediatrics have reaffirmed the importance of choline during pregnancy and lactation 3, 4.
- Choline deficiency can lead to liver dysfunction, as demonstrated in a study where healthy male volunteers developed signs of incipient liver dysfunction after consuming a choline-deficient diet for 3 weeks 5.