90% of Americans don't get enough choline. So why isn't it higher up the food policy agenda?
Written by Editor   
Monday, October 27, 2014 03:23 PM

As the 2015 Dietary Guidelines for Americans are developed, there has been a lot of heated debate about saturated fat and protein. But what about choline?

In 1998, the Institute of Medicine (IOM) recognized choline - found naturally in beef and chicken liver, egg yolk, salmon, milk, and soybeans among other things - as an essential nutrient and set an adequate intake at 550 mg/day for men and 425 mg/day for women (rising to 450 mg for pregnant women and 550 mg for breastfeeding women). Yet according to National Health and Nutrition Examination Survey (NHANES) data, while American infants are doing OK, a whopping 90% of children, adults and pregnant women are not getting enough.

But while the 2010 DG advisory committee identified choline as a "shortfall nutrient”, it did not make any particular recommendations about the importance of increasing intake.  “In pregnancy we know that low choline diets are associated with increased rates of birth defects. And we know that low choline diets in adults present with fatty liver and sometimes muscle damage that is reversed when choline restored.  Given the importance of choline in making a healthy baby, pregnant women should be the target. As more data develops, fatty liver in older men and women may develop as a second important target for increasing choline.”

And given that 50% of the population has genetic variations that make it necessary to consume choline at levels even greater than the AI, there is an immediate need to increase awareness of the critical role it plays throughout life, he said, noting that only a fraction of doctors are likely to recommend foods containing choline for healthy pregnant women.

As for adults, “25% of the US population has fatty liver,” he added.“[But as] we do not know if we have fatty liver without special testing, most people do not realize they have it. Probably this is why there is less pressure to set policy on choline.”

“Given the strength of the body of scientific literature, this nutrient begs for a champion.  It really is unusual for such a widespread deficiency of a nutrient to go unaddressed by the nutraceutical and functional food industries for so long”.  But how do we get more choline? And are supplements or fortified products advisable for some groups?

Eggs are one of the richest dietary sources of choline, with an average whole large egg containing approximately 147 mg choline."

Raising awareness about choline could also serve as a reminder that the new wave of plant-based egg replacers might be able to replace the functionality of eggs, but do not always match the nutritional benefits, particularly when it comes to choline.  There was a national program for folate fortification. What are we doing about choline?

Choline could and should become the next folate: “The effect of choline deficiency in pregnant women is similar to that of folate; and there was a national program that included folate fortification of bread and cereals to correct it. What are we doing about choline?

“Choline has been effectively sidelined as a nutrient of key importance for no apparent reason.”

Source:  http://www.foodnavigator-usa.com/R-D/Time-for-the-DGAC-to-look-again-at-choline