"Exploring the Impact of Choline on Liver Function in Fetus and Infants"

Essential micronutrient

Choline is an essential micronutrient. 'Essential' meaning that the body can't make it in adequate amounts for good health and therefore must be provided by the diet, and 'micro' meaning that it is required in very small amounts. Even though choline is required in very small amounts, its impact on health can be critical.

Where does choline come from?

Produced by the liver, though not in quantities sufficient enough to meet human needs. Choline needs to also be obtained from the diet, either from some foods, such as eggs, meat, fish, quinoa, mushrooms, soy, lima and kidneys beans, cruciferous vegetables, as well as fats and oils, or as a dietary supplement.

What does choline do?

Choline is involved in human metabolism (including the metabolism and transport of lipids and cholesterol), neurotransmitter synthesis, regulating gene expression, maintaining cell structure and early brain development. Choline is particularly important during human embryogenesis, during which time it is actively transported to the fetus. Research has shown that most pregnant and lactating women are not currently consuming enough choline through their diet.

Liver function

Choline is essential for healthy liver function. Research has linked choline deficiency to fatty liver disease, which is caused by a build-up of fat in the liver, as well as liver and muscle damage.

Reviewing evidence to submit to EFSA

Working with a team of European scientists and experts Nutritional Insight collated and reviewed the evidence on whether maternal choline intake is necessary to maintain normal liver function in the fetus and breastfed infant. Publishing the results in the journal Nutrients (Paediatric Special Edition) we show that removing choline from the diet of pregnant rats can cause fatty liver disease in both the mother and fetus. The severity of fatty liver in the offspring was shown to correspond to the severity of fatty liver in the respective mothers and to the length of time a choline-deficient diet was fed to the mother.

EFSA choline evaluation

Furthermore, Nutritional Insight, with European colleagues compiled and submitted a dossier of evidence to the European Food Safety Authority (EFSA). Nutritional Insight provided scientific input, expertise and helped to compile an evidence portfolio. Based on the evidence submitted, members of the EFSA Panel concluded that 'a cause and effect relationship has been established between the intake of choline by pregnant and lactating women and contribution to normal liver function of the fetus and exclusively breastfed infants.' This is not yet a formal claim but a favourable opinion.

Further choline research

Additional evidence is needed to confirm the effects of choline intake during pregnancy and lactation on the fetus and infant. Our aim is to inform policy makers to raise awareness about the important of choline intakes, particularly across certain life stages such as pregnancy and lactation when dietary requirements increase.

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References:

Obeid R, Schön C, Derbyshire E, Jiang X, Mellott TJ, Blusztajn JK, Zeisel SH (2024) A Narrative Review on Maternal Choline Intake and Liver Function of the Fetus and the Infant; Implications for Research, Policy, and Practice. Nutrients. 2024 Jan 15;16(2):260. doi: 10.3390/nu16020260.

EFSA (2023) Choline and contribution to normal liver function of the foetus and exclusively breastfed infants: evaluation of a health claim pursuant to Article 14 of Regulation (EC) No 1924/2006. EFSA Journal. Available at: https://efsa.onlinelibrary.wiley.com/doi/abs/10.2903/j.efsa.2023.8115

Other publications related to choline by Dr Derbyshire:

Derbyshire E, Maes M (2023) The Role of Choline in Neurodevelopmental Disorders-A Narrative Review Focusing on ASC, ADHD and Dyslexia. Nutrients 15(13):2876.

Obeid R, Derbyshire E, Schön C (2022) Association between Maternal Choline, Fetal Brain Development, and Child Neurocognition: Systematic Review and Meta-Analysis of Human Studies. Adv Nutr 13(6):2445-2457.

Derbyshire E, Obeid R (2020) Choline, Neurological Development and Brain Function: A Systematic Review Focusing on the First 1000 Days. Nutrients 12(6):1731.

Derbyshire E, Obeid R, Schön C. (2021) Habitual Choline Intakes across the Childbearing Years: A Review.

Nutrients 13(12):4390.

Derbyshire E (2019) Could we be overlooking a potential choline crisis in the United Kingdom? BMJ Nutr Prev Health 2(2):86-89.

Derbyshire E (2001) Nutrition in the Childbearing Years. Wiley-Blackwell [Book].

Derbyshire E (2017) A review of maternal nutrition and fetal gene expression. Br J Nurs 16(13):820-2.