Choline for toddler and children’s nutrition

Good nutrition is essential to health and well-being, and one of the most critical times to focus on nutrition is early in life. Ensuring adequate intake of key nutrients during these fundamental stages is critical—think of the important role calcium and vitamin D play in building strong bones. The scientific community supports the daily intake of these nutrients in guidance literature such as the Institute of Medicine’s (IOM) “Dietary Reference Intakes for Calcium and Vitamin D” and “Scientific Report of the 2015 Dietary Guidelines Advisory Committee” from USDA’s Department of Health and Human Services (HHS).

Minerals like zinc, iron and selenium work hand in hand with antioxidants like vitamins A, C and E to help build and maintain a strong immune system, noted the “Immunity in Brief” section of the Micronutrient Information Center on Oregon State University’s Linus Pauling Institute website.

Folic acid, DHA and iodine all support the development of the brain, eyes and nervous system during pregnancy¹ and continue to be particularly important during the first 1,000 days of life.² Many of these nutrients are easily recognized, but an essential nutrient critical to good health from the moment of conception up through the later years of life may not be as readily known.

Choline was first recognized as an essential nutrient by the Institute of Medicine (IOM) in 1998 because of the key role it plays in fat metabolism in the liver. Little was known about choline status in humans until 2008, when USDA—in conjunction with researchers at the University of North Carolina—released a database of the choline content of common foods. Not long after, researchers examining dietary intake data from the CDC’s National Health and Nutrition Examination Survey (NHANES) found about 90% of Americans were not getting enough choline in their diet. These low dietary intakes persist, presenting an important and unique opportunity for manufacturers to fill this nutrient gap via fortified foods and supplements.³

As more researchers examined choline, the scientific community began to realize the complex and critical role it plays in human health. As phosphatidylcholine (PC), choline is part of every cell membrane, so it is needed in vast quantities to support the explosive growth that comes early in life. As a building block of sphingomyelin, choline helps form the myelin sheath that insulates the axons in the brain for improved signaling. As acetylcholine, a primary neurotransmitter, choline helps activate synapses which transmit messages from the brain through the nervous system to the neuromuscular junction. More recently, researchers at Cornell University examined the role of choline during pregnancy and discovered babies born to moms who received supplemental choline had improved infant processing speeds.⁴ Babies continue to receive choline from their moms via breastfeeding, and these critical roles in neurodevelopment support inclusion of the nutrient as a required component of infant formula.

Choline remains important throughout the early stages of life as the brain continues to develop, a process extending into the early-20s. By providing key building blocks for the ongoing brain expansion, choline supports young minds as children grow and learn. The impact of maternal choline intake throughout a child’s life was reaffirmed in a study published in the American Journal of Epidemiology.⁵ Researchers analyzed choline intakes of mothers participating in the Project Viva study and concluded that higher gestational choline intake was associated with improved child visual memory at age 7. And a study published in The FASEB Journal examined choline levels among Swedish teens and discovered plasma choline concentrations were significantly and positively associated with academic achievement independent of other socioeconomic factors.⁶

The important role of choline in everyday brain function was also the focus of a 2015 study, where researchers found young adult participants who took choline prior to performing an “aim and click” task on a computer had significantly improved targeting and accuracy measures vs. the placebo group.⁷ This body of research points to choline’s important role in building the brain early in life and then helping to maintain and preserve neurotransmission and normal brain function later in life.

Manufacturers have taken notice and are launching innovative new food products, particularly in the dairy sector. Both Horizon Organic milk and Clover Sonoma dairy recently launched new fortified milks with added choline, while newcomer Brainiac Kids created a line of yogurt and applesauce products for young children with the “BrainPack”—a combination of choline and omega-3 docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) to help support brain health.⁸

The American Medical Association (AMA), American Academy of Pediatrics (AAP) and, most recently, the Scientific Report of the 2020 Dietary Guidelines Advisory Committee have all issued policy statements that support the critical role of choline as a brain-building nutrient. Given that the leading sources of choline—liver, egg yolks and fish—may not be featured, let alone prominently, in the diets of many young children, manufacturers have a unique opportunity to fortify products with choline to help build a brighter future for children.

To read related content, download the Food & Beverage Insider Children and toddler nutrition: Winning strategies to feed the future – digital magazine. 

Tom Druke is the marketing director for human minerals and nutrients at Balchem. He currently leads the development and execution of market analytics and insights, brand positioning, product innovation and advertising and promotion for the Albion chelated minerals and VitaCholine choline salts product lines.

References

1 Morse NL. “Benefits of docosahexaenoic acid, folic acid, vitamin D and iodine on foetal and infant brain development and function following maternal supplementation during pregnancy and lactation.” Nutrients. 2012;4(7):799-840.

2 Beluska-Turkan K et al. “Nutritional Gaps and Supplementation in the First 1000 Days.” Nutrients. 2019;11(12):2891.

3 Wallace TC, Fulgoni VL. “Usual choline intakes are associated with egg and protein food consumption in the United States.” Nutrients. 2017;9:839.

4 Caudill MA et al. “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(4):2172-2180.

5 Boeke CE et al. “Choline Intake During Pregnancy and Child Cognition at Age 7 Years.” Am J Epidemiol. 2013;177(12):1338-1347.

6 Nilsson TK et al. “Plasma 1-carbon metabolites and academic achievement in 15-yr-old adolescents.” FASEB J. 2016;30(4):1683-1688.

7 Naber M, Hommel B, Colzato LS. “Improved human visuomotor performance and pupil constriction after choline supplementation in a placebo-controlled double-blind study.” Sci Rep. 2015;5:13188.

8 Swanson D, Block R, Mousa SA. “Omega-3 Fatty Acids EPA and DHA: Health Benefits Throughout Life.” Advances in Nutrition. 2012;3(1):1-7.