Health Professional – General Backgrounder

Choline may well represent one of the largest untapped nutritional opportunities of recent times.

Rarely, has a nutrient recognized by the Institute of Medicine (IOM) as essential – and with such a widespread deficiency in the U.S. population - gone virtually unnoticed by the public and nutrition communities.

Dietary Intake: 90% Deficiency in the U.S.

• In 1998, the IOM recognized choline as an essential nutrient needed by humans, and critical for fetal and proper child development. The adequate intake (AI) recommendation and FDA's Daily Value (DV) for choline is 550 mg/day for men and 425 mg/day for women.
• About 90% of the U.S. population is not consuming enough choline. Data from the 2007-2008 NHANES Evaluation showed that only 10% or fewer had usual intakes at or above the AI; only young children typically consumed the AI.
• Data from the 2007-2008 NHANES Evaluation showed that mean intakes of choline are far below the AI. 10% or fewer had usual intakes at or above the AI, meaning about 90% of the U.S. population is not consuming enough choline. Only young children typically consumed the AI.
• Data from 2007-2008 NHANES Evaluation showed a mean choline intake for the population of 302 mg/day. The mean for men over 20 years of age (396 mg) and women (260 mg) were well below their recommended intake; pregnant women consumed on average 337 mg/day according to the 2005-2006 NHANES Evaluation.
• Choline intake also decreased with age, with those over age 71, averaging 264 mg/day, or about half of their requirement. Dietary intakes in pregnant women ranged from > 300 mg to over 550 mg/day.
• Choline deficiency is associated with cognitive function, including development of the memory center in infants and toddlers; non-alcoholic fatty liver in adults; heart health; sports performance; and prevention of neural tube defects in pregnant women.
• Liver, eggs, egg yolks and a variety of meats are the richest sources of choline, but their consumption has decreased in recent years. Supplementation of the diet with choline is almost essential in order to ensure adequate consumption for optimal health.

Choline Content of Specific Common Foods (IOM,1998)

Lack of Recognition

• There appears to be a paradoxical lack of health professional and media attention to this vital nutrient, which is clearly linked to fetal/infant brain development, enhanced memory/cognition, heart health, and liver function for all ages.
• Choline has been effectively sidelined as a nutrient of key importance for no apparent reason. For example, the 2010 Dietary Guidelines called out choline as a nutrient that is currently under-consumed and has significant health effects. However, the final recommendations did not include choline.
• Awareness of choline's health benefits among the professional community is so low that relatively few choline supplements exist, although it is added to some B-complex vitamin formulas.
• Major trackers of supplement sales have not yet begun to monitor the sales of choline supplements. Only Nielsen/ SPINS reported on choline sales in 2012, and only in combination with inositol. Sales in combined natural/mass channels reached $428,000, far from the million-dollar threshold.
• Similarly, choline's role in pregnant and lactating women has a parallel impact similar to folate - for which a national campaign was launched to include folic acid in food fortification with the objective to prevent neural tube defects by adequate consumption of the nutrient in pregnant women. Yet, choline has not received similar attention.
• The European Food Safety Authority's Panel on Dietetic Products, Nutrition and Allergies approved a health claim related to supplemental folate intake and the reduced risk of neural tube defects on July 26, 2013, but not for choline.

The opportunity exists to promote better health for all ages – children, pregnant and lactating women, adult men and women – by promoting the increased consumption of choline, including supplementation.