Choline: The Forgotten Nutrient in Eggs

Eggs are one of the top three food sources of choline.1 This essential and mostly unknown micronutrient is vital in health and wellness across all life stages. Choline plays an important role in brain and spinal cord development during pregnancy2 and may assist in preventing cognitive decline and Alzheimer’s disease in the elderly3,4.

What is choline?

Choline is a methyl donor, similar to folate, and is found in foods such as eggs, meat, fish and milk, as well as some green vegetables and wholegrains. Eggs, even when cooked, are the richest food source of choline providing more than double the amount of choline per 100g than any other commonly eaten food source5

Despite choline being one of a few essential nutrients vital for the structure and function of all cell membranes, 90% of Australians are currently consuming inadequate amounts of this essential nutrient1.

Choline content graph

Local choline recommendations

Although some choline can be synthesised in the body, the quantities are insufficient to meet all requirements. As such, sufficient dietary intake is important to maintain choline levels. The NHMRC published Australian daily nutrient reference values in 2006 (see Table).8 The values presented are adequate intake (AI) values. 


 Table: Australian NHMRC recommended daily nutrient reference values for choline and percentage of Australian population meeting AI.1,2

Age Group

Adequate Intake (AI)

Percent consuming AI

Children

 

 

7-12 months infants

150 mg

No data

1-2 years

200 mg

No data

2-3 years

200 mg

67%

4-8 years

250 mg

20%

Male

 

 

9-13 years

375 mg

7.1%

14-18 years

550 mg

2.0%

19-64 years

550 mg

3.7%

65-85 years

550 mg

1.2%

Female

 

 

9-13 years

375 mg

4.3%

14-18 years

400 mg

1.9%

19-64 years

425 mg

3.3%

65-85 years

425 mg

3.0%

Pregnancy (14-18 years)

415 mg

No data

Pregnancy (19+ years)

440 mg

<1%

Lactation (19+ years)

550 mg

<1%

Choline intake in Australia

Despite choline being one of a few essential nutrients vital for the structure and function of all cell membranes, 90% of Australians are currently consuming inadequate amounts of this essential nutrient1.

Research shows that less than 4% of the adult population in Australia are consuming the recommended Adequate Intake (AI) of choline as set by the National Health and Medical Research Council (NHMRC).1

99% of pregnant and lactating woman in Australia are not meeting the AI,whilst one third (33%) of children aged 2-3 years are falling below the AI recommendation for choline. This rises to 80% in children aged 4-8 years. 1

In both males and females, aged nine years onwards, less than 10% of the population meet AI recommendations for choline. This means that more than 90% of the population (aged nine years and over) are consuming less choline than what is currently recommended. 1

Choline across the life stages

Conception & pregnancy

Research suggests that pregnant women who have sufficient folic acid, increased intake of vitamins B6 and B12, choline, methionine and betaine may reduce the risk of neural tube defects.2 However, two of the most commonly used prenatal supplement brands in Australia do not contain choline; the supplements that do contain choline only contain very small quantities. Although choline is available as a separate supplement, purchasing and consuming an additional supplement during pregnancy may be prohibitive for some. As choline is readily available in inexpensive whole-foods such as eggs, meat and fish, this is considered the simplest and most affordable way for most people to increase their choline levels.

Infants

There is emerging evidence that adequate dietary choline may play an important role in neurodevelopment and cognitive outcomes from early life.6,7 As infants make the transition from breast or formula milk, both of which are rich sources of choline, to solid foods, it's important for parents and carers to have an awareness of choline-rich food choices as an important part of the diet.  Eggs are an inexpensive source of choline that can be easily incorporated into the diet at the appropriate age. Milk, fish and meat also contain choline.

Elderly

Choline may play a role in preventing Alzheimer’s disease and cognitive decline, although more research is needed. Choline (400mg) is a key active ingredient in a nutritional supplement which is currently undergoing clinical trials in people with Alzheimer’s with promising early findings.3 It has been reported that Alzheimer’s patients have lower levels of choline in their brain and spinal fluid.10 Choline metabolism gene polymorphisms has also been associated with Alzheimer’s disease. Eggs, as a component of a healthy diet, have been associated with improved cognitive function in the elderly.11 There is also evidence that a choline-rich diet is associated with stronger bones12 and favourable body composition (such as lower BMI and lower waist circumference).13

Choline resources:

videos:

Australian Eggs has worked in conjunction with numerous professionals in the food industry, including Food and Nutrition Australia dietitian Sharon Natoli, to analyse the positive effects choline has on health and wellbeing. In July 2019, these top food industry specialists met to discuss the results of the work that has already done and create a final position statement to help guide future research and promotion of choline as beneficial in our everyday diet. 

Click here to view a series of brief videos featuring Sharon explaining the research already done and what the future holds for choline in Australia.   

Sharon Natoli profile picFood and Nutrition Australia dietitian Sharon Natoli 
fact sheets and other documents:

Click on the documents below to download more information on how choline can benefit your health:

REFERENCES:

  1. Probst, Y, et. al. Development of a Choline Database to Estimate Australian Population Intakes. Nutrients 2019, 11, 913.
  2. Petersen JM, Parker SE, Crider KS, Tinker SC, Mitchell AA, Werler MM. One-Carbon Cofactor Intake and Risk of Neural Tube Defects Among Women Who Meet Folic Acid Recommendations: A Multicenter Case-Control Study. Am J Epidemiol 2019;188:1136-43.
  3. Dementia Australia. Souvenaid - a dietary treatment for mild Alzheimer's disease, online document [accessed 22 July 2019]. 2013 (reviewed 2019).
  4. Blusztajn, J.K., Slack, B.E. & Mellott, T.J. Neuroprotective Actions of Dietary Choline. Nutrients 9(2017).
  5. U.S. Department of Agriculture. USDA Database for the Choline Content of Common Foods Release Two, online document [Accessed 21 July 2019]. 2008.
  6. Caudill MA, Strupp BJ, Muscalu L, Nevins JEH, Canfield RL. Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study. FASEB J 2018;32:2172-80.
  7. Mun JG, Legette LL, Ikonte CJ, Mitmesser SH. Choline and DHA in Maternal and Infant Nutrition: Synergistic Implications in Brain and Eye Health. Nutrients 2019;11.
  8. National Health and Medical Research Council; Australian Government Department of Health and Ageing; New Zealand Ministry of Health. NHMRC Nutrient Reference Values for Australia and New Zealand, online document [Accessed 20 Jul 2019]. 2006 (updated 2017).
  9. Wiedeman AM, Whitfield KC, March KM, et al. Concentrations of Water-Soluble Forms of Choline in Human Milk from Lactating Women in Canada and Cambodia. Nutrients 2018;10.
  10. de Wilde MC, Vellas B, Girault E, Yavuz AC, Sijben JW. Lower brain and blood nutrient status in Alzheimer's disease: Results from meta-analyses. Alzheimers & Dementia (New York, NY) 2017;3:416-31.
  11. Chuang SY, Lo YL, Wu SY, Wang PN, Pan WH. Dietary Patterns and Foods Associated With Cognitive Function in Taiwanese Older Adults: The Cross-sectional and Longitudinal Studies. Journal of the American Medical Directors Association 2019;20:544-50.e4
  12. Oyen J, Gjesdal CG, Karlsson T, et al. Dietary Choline Intake Is Directly Associated with Bone Mineral Density in the Hordaland Health Study. The Journal of Nutrition (Norway) 2017;147:572-8.
  13. Gao X, Wang Y, Randell E, et al. Higher Dietary Choline and Betaine Intakes Are Associated with Better Body Composition in the Adult Population of Newfoundland, Canada. PloS One 2016;11:e0155403.