CHICAGO – Based on current knowledge of the role foods play in nourishing the body, it’s hard to believe it was only a century ago when scientists started identifying vitamins and discovering their biological role in humans. Advancements in nutritional science continue to identify essential nutrients vital to the human body, allowing food formulators to develop more nutritionally rounded products to ensure human health and wellness.

During the past two decades, the nutrition and scientific communities have focused on a relatively short list of nutrients that are deficient in most Americans’ diets. The list includes calcium, dietary fiber, potassium and vitamin D — the four nutrients of concern identified in the 2010 Dietary Guidelines for Americans.

Rich food sources of choline


Right before the turn of the century, folic acid, also known as vitamin B9, was a nutrient of concern, as its deficiency in pregnant women is associated with miscarriage and neural tube defects in infants. According to the Centers for Disease Control and Prevention, Atlanta, every year in the United States, an estimated 1,000 more babies are born healthy since mandatory folic acid fortification of enriched cereal grain products went into effect in January 1998.

The same year folic acid enrichment became mandatory in the United States, The Institute of Medicine (I.O.M.) — the public health arm of the National Academy of Sciences — acknowledged choline as an essential nutrient needed by humans, and critical for fetal and proper child development. The I.O.M. set a recommended Adequate Intake (A.I.) level of 425 mg per day for women and 550 mg per day for men.

Interestingly, the 2010 Dietary Guidelines for Americans highlighted choline as a nutrient that is under-consumed and has significant health effects; however, the final recommendations did not include choline. This baffles many in the nutrition and medical communities, which developed and recently organized The Choline Information Council. 

“Few Americans are aware of choline, even though it offers crucial health benefits at every phase of life,” explained Dr. Elizabeth Sloan at the recent SupplySide West expo, when we sat down and talked about the formation of The Choline Information Council, for which she is a spokesperson. “Choline may be one of today’s most under-publicized and overlooked nutrients, and this concerns the nutritional community.”

Choline requirements by age


According to 2013 Gallup research, just 15% of Americans are aware of choline. In addition, data from the 2007 to 2008 National Health and Nutrition Examination Survey determined that 90% of the U.S. population currently does not consume adequate amounts.

“Choline may well represent one of the largest untapped nutritional opportunities of recent times,” Dr. Sloan said. “Rarely, has a nutrient recognized by I.O.M. as essential, and with such a widespread deficiency in the U.S. population, gone unaddressed by the nutraceutical and functional food industries.”

Choline has a variety of functions. For example, it is an essential nutrient for fetal development. Unfortunately, pregnant women often consume inadequate amounts, and many multi-vitamins and prenatal supplements do not contain choline. The Nurses’ Health Study, reported in 2010, found that 95% of pregnant women consumed less than 411 mg of choline per day, below the recommended 450 mg. The average consumption was 337 mg per day. Pregnant women whose choline consumption levels are at the lower end of the 300-to-550 mg range also face a deficiency that increases the risk of neural tube birth defects affecting the brain, spine and spinal canal.

The nutrient also is critical to cognitive functions throughout life. It is clearly linked to fetal and infant brain development and enhanced memory and cognition. Choline may support the brain during aging and helps prevent changes in brain chemistry that result in cognitive decline and failure.

Choline promotes heart health. The No. 1 cause of death in the U.S. is heart disease. Choline helps prevent blood plaque formation, which in turn, prevents clots that cause heart attacks and strokes. It is also instrumental in supporting the nerve impulse systems that ensure a regular heartbeat and a strong heart muscle.

Choline promotes liver health. According to the American Liver Foundation, nonalcoholic fatty liver disease (N.A.F.L.D.) may affect up to 25% of the U.S. population, including 6 million children, and the incidence is on the rise. The incidence of N.A.F.L.D. has more than doubled in the past 20 years. As the body’s second largest organ — second only to the skin — the liver performs more than 500 critical body functions. Choline supports normal liver function and helps prevent N.A.F.L.D. A healthy liver helps fight infection, provides detoxification by removing harmful substances from the blood and helps process the food and drinks we consume to store energy, vitamins and minerals for future use.

Finally, choline helps optimize sports performance. It benefits athletes in several ways, including enhancing muscle performance during exercise, improving stamina, supporting communication with muscle fibers and promoting muscle recovery following repetitive motion. However, when athletes are deficient in choline — and when sources of choline are exhausted in the body — the body takes choline away from other key systems and organs.

Many in the nutritional community want to see choline recognized as a nutrient of concern so efforts may be made to bridge the gap between actual and recommended intakes. Although choline may be produced within the body, the amount is not adequate to meet human needs over the life cycle. Therefore, choline must be obtained through the diet.

One reason for the current deficiency is consumption of foods providing the richest sources of choline — including liver, eggs and various meats — has decreased in recent years. This is why it is almost always necessary today to supplement the diet with choline in order to attain recommended intake levels.

The U.S. Food and Drug Administration recently proposed to set a Reference Daily Intake of 550 mg, which would thereby allow choline to be listed voluntarily on the Nutrition Facts panel on food labels. The F.D.A. mandates choline as an ingredient in infant formula.

In 2008, the American Egg Board, Park Ridge, Ill., began efforts to promote the choline content of eggs and egg products, as whole eggs are one of the richest sources of choline, containing approximately 230 mg. Specifically, choline is found in the egg’s lipid portion, which is found primarily in the yolk.

SensoryEffects has formulated a peach smoothie with 6 grams of protein and 110 mg of choline per serving.


Formulating prepared foods with whole egg or egg yolk product is an easy way for the food industry to help Americans get more choline in the diet. Another is to fortify foods with an isolated choline ingredient.

For example, at SupplySide West, SensoryEffects, Bridgeton, Mo., sampled a peaches and cream beverage that provided 6 grams of protein and 110 mg of choline per 8-fluid-oz serving. Foods that contain at least 110 mg of choline per serving may be labeled as an “excellent source of choline.” Foods containing at least 55 mg of choline per serving would be a “good source of choline.”

There are a number of F.D.A.-reviewed structure-function claims associated with choline-fortified foods, encouraging creative product development for demographic-specific formulations. This list includes:

•   May help memory problems associated with aging.

•   Prenatal use may lead to lifelong improvement of visuospatial memory in children both of the pregnancy.

•   Supplementation during infancy and childhood may lead to improved lifelong memory.

•   May reduce fatigue and increase vigor during strenuous exercise.

•   May help reduce levels of plasma homocysteine.

•   May promote health liver function.

“Choline is currently a missed opportunity and marketers should have choline-containing supplements and fortified foods in the marketplace,” Dr. Sloan said. “They should initiate an extensive public relations effort.”

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