Choline should be included in prenatal supplementation regimen, expert review finds

A new expert review published in the Dietary Supplement JournalCall it choline “Essential neurocognitive nutrient of interest to obstetricians and gynecologists”, And declares unequivocally that “Choline must be included in the prenatal supplementation regimen”.

But intakes remain stubbornly low: according to data from the National Health and Nutrition Survey (NHANES), 90% of children, adults and pregnant women do not consume enough. The Sufficient Intake (AI) for adults is 425 mg / day for women and 550 mg / day of choline for men.

For pregnant women, this is a very serious problem, given the importance of choline for the neurological development of the infant. (Recommendations increase to 450 mg for pregnant women and 550 mg for breastfeeding women.)

According to the new review, led by Dr Taylor Wallace of the Washington-based Think Healthy Group, choline is the last common nutrient to recommend for a healthy diet, and less than 6% of obstetricians and gynecologists are likely to recommend. foods rich in choline. to pregnant women.

Prenatal supplements

Dietary supplements may offer a way to fill this gap, but historically very few (if any) prenatal multivitamins have been formulated to contain choline.

One of the challenges has been working with choline – forms like choline bitartrate and choline citrate are hygroscopic – but the biggest obstacle to formulating with significant doses of choline is finding room in a tablet format that contains a wide range of nutrients all competing for space, explained Tom Druke, director of VitaCholineBrand development, Balchem ​​Human Nutrition and Pharma.

“Choline bitartrate contains around 40% choline cations by weight, which means adding a significant amount of choline can be a challenge in a single dose. ” he explained. To help meet this challenge, many companies are formulating a single-ingredient tablet with choline – this approach allows for a standard prenatal multivitamin plus choline in a separate dose, much like the industry has done with the DHA. “

The American Medical Association (AMA) recognized the essential role of choline in pregnancy a few years ago and proactively recommended that choline be included in all prenatal multivitamins.

A 2016 study found that only eight of the top 25 prenatal vitamins contain choline and none provide more than 55 mg per daily dose, or just 12% of the RDA for pregnant women, he said. declared.

Fortunately, this is changing.

“It usually takes a little while for brands to reformulate vitamins, but we’ve heard from several that have completed reformulations or are actively working on them.”Druke said. MegaFoods introduced a baby and me 2 prenatalFormulated by Dr Tierona Low Dog with 300 mg of choline. As well, Nature Made has launched a new SKU of prenatal gelatin with choline, and SmartyPants increased choline levels in its gummy range Also.”

There is also a recovery in the dairy space, he said, with the launch of Brainiac Fortified Yogurt for Kids earlier in the year with choline, DHA and probiotics for brain health. . Clover Sonoma Dairy Farm announced to Expo West that they will be launching a new organic milk fortified with 50 mg of DHA and 100 mg of choline.

“Obviously, manufacturers are starting to recognize the potential of choline, not only for infant development, but also for cognition throughout life,” Druke said.

Advocacy

Data from a 2018 study published in the FASEB Journal indicated that infants of mothers receiving 930 mg of choline per day, more than double the current daily recommendations, experienced greater cognitive benefits than infants of women consuming 480 mg per day. Image: Smart Infant Infant © Getty Images / CreativaImages

Raising awareness of choline and educating the healthcare professional community is an important issue here.

“Advocacy for raising awareness of choline levels in the medical community intensified in early 2018 with an important policy statement from the American Academy of Pediatrics published in the journal Pediatrics emphasizing the importance of good nutrition during the first 1000 days of life “, Druke said. “Choline has been noted as one of the many substances that this leading medical institution has specifically called ‘nutrients for brain building’.”

Druke noted that government agencies are taking steps to improve choline’s position in nutrition.

Choline is the latest nutrient to receive a Reference Daily Intake (RDI) and the 2015 Scientific Report of the Committee on Dietary Guidelines for Americans (DGAC) called choline one of the four ‘missing nutrients’ along with insufficient intakes in all adult diets, ” he said.

“As part of recent reviews of nutrition labeling, the United States Food and Drug Administration (FDA) established 550 mg as the RDI for choline for adults, providing an associated percentage of daily value (% DV) on Nutrition Facts signs and supplements as part of nutrition labeling revisions.

“We believe that DGA 2020 offers the opportunity to introduce choline to Americans as an under-consumed but important nutrient.”

Test

It may also be easier for people to check their choline levels, Druke added, noting that a large grant was made to the UNC Nutrition Research Institute in 2018 to develop and validate laboratory tests capable of evaluating. the status of choline in humans.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), one of the National Institutes of Health, awarded UNC Director Steven Zeisel, MD, PhD [one of the authors on the new review] a grant of $ 2.6 million over four years after demonstrating that studies were feasible and likely to succeed based on proof of concept data in a pilot study funded by Balchem ​​Corporation ”, Druke said.

Source: Dietary Supplement Journal
Published online ahead of print, doi: 10.1080 / 19390211.2019.1639875
“Choline: the essential neurocognitive nutrient of interest to obstetricians and gynecologists”
Authors: TC Wallace et al.

Patricia J. Callender