For Healthcare Professionals

Choline – A Nutrient Critical for People of all Ages

Choline’s necessity for human health is fundamental; its biochemistry underlies many important processes in human nutrition. Some of choline’s effects are direct:

  • it is a biosynthetic precursor of numerous molecules critical to diverse structural and functional purposes in the human body
  • it is a material requirement of cells for membrane structure and metabolic control
  • its presence is integral in maintaining a balance of key biochemicals needed for cell growth, function and repair
  • it is indispensable for its enabling roles in metabolism and mobilization of other micro-and macronutrients, including vitamin cofactors, amino acids and lipids.

Other effects of choline are indirect, in that it impacts the balance of and need for many other partially compensatory metabolites to which it is closely related, via its influence on the activity of certain regulatory genes or the catalytic proteins they express.

Dietary intake of choline is known to affect the availability of the nutrient to the tissues and organs whose viability depend on it. It is absolutely essential, as the body does not produce enough, even under ideal conditions. While choline exhibits nutritional synergies with vitamins involved in folate metabolism and the methionine cycle, such as B6 and B12, and nutrients such as omega-3 fatty acids, none of these substances can functionally replace it. Deficiency in these complementary nutrients elevates the need for choline in the diet.

Choline’s role in cell structure and function, phospholipid metabolism, cell signaling and epigenetic events are the basis of its contribution to the maintenance of cognitive, cardiovascular, and hepatic health. Its demographic targets are as diverse as its therapeutic targets. An important component of the nutrition of prenatal and infant patients (via pregnant and lactating mothers), children, as well as athletic and geriatric segments of the population, choline is, quite simply, Essential for Every BodyTM.

Choline Research

There are a significant number of published studies on the health benefits of choline, both in animal and in human populations. As many of the mechanisms of action within the body are not fully understood, new and emerging research is expanding the breadth of scientific study. Here is a broad sampling of the research on choline, grouped by the functional benefits to humans:

General references on choline
  • Blusztajn JK. Choline, a vital amine. Science 1998;281:794-5.
  • Institute of Medicine. Choline. In: Food and Nutrition Board NAoS, editor. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin and Choline.Washington, DC: National Academy Press; 1998. p. 390-422.
  • Zeisel SH, daCosta KA. Choline: an essential nutrient for public health. Nutr Rev 2009;67(11):615-23
Benefits of pre- and post-natal choline supplementation on cognitive development
  • Caudill MA. Pre- and post-natal health: Evidence of increased choline needs. J Am Diet Assoc 2010;110:1198-206.
  • Li Q, Guo-Ross S, Lewis DV, Turner D, White AM, Wilson WA et al. Dietary prenatal choline supplementation alters postnatal hippocampal structure and function. J Neurophysiol 2004;91:1545-55.
  • McCann JC, Hudes M, Ames BN. An overview of evidence for a causal relationship between dietary availability of choline during development and cognitive function in offspring. Neurosci Behav Rev 2006;30:696-712.
  • Meck WH, Smith RA, Williams CL. Pre- and postnatal choline supplementation produced long-term facilitation of spatial memory. Dev Psychobiol 1988;21:339-53.
  • Meck WH, Smith RA, Williams CL. Organizational changes in cholinergic activity and enhanced visuospatial memory as a function of choline administered prenatally or postnatally or both. Behav Neurosci 1989;103:1234-41.
  • Meck WH, Williams CL. Metabolic imprinting of choline by its availability during gestation: implications for memory and attentional processing across the lifespan. Neurosci Biobehav Rev 2003;27:385-99.
  • Zeisel SH. Nutritional importance of choline for brain development. J Am Coll Nutr 2004;23(6(Suppl.)):621S-6S.
  • Zeisel SH. Fetal origins of memory: The role of choline in optimal brain development. J Pediatr 2006;149:S131-S136.
Choline’s role in cognitive function and mitigating age-related decline
  • Buchman AL, Sohel M, Brown M, Jenden DJ, Ahn C, Roch M et al. Verbal and visual memory improve after choline supplementation in long-term parenteral nutrition. JPEN 2001;25(1):30-5.
  • Blusztajn JK, Wurtman RJ. Choline and cholinergic neurons. Science 1983;221:614-20.
  • Cohen BM, Renshaw PF, Stoll AL, Wurtman RJ, Yergelun-Todd D, Babb SM. Decreased brain choline uptake in older adults: An in vivo proton magnetic resonance spectroscopy study. JAMA 1995;274(11):2902-7.
  • Sitaram N, Weingartner H, Caine ED, Gillin JC. Choline: Selective enhancement of serial learning and encoding of low imagery words in man. Life Sci 1978;22(17):1555-60.
  • Wurtman RJ. Effects of dietary amino acids, carbohydrates and choline on neurotransmitter synthesis. Mt Sinai J Med 1988;55(1):75-86.
  • Zeisel SH. Choline: needed for normal development of memory. J Am Coll Nutr 2000;19(5):528S-31S.
Importance of choline in regulation of amino acid metabolism, particularly reduction of homocysteine
  • Cho E, Zeisel SH, Jacques PF, Selhub J, Dougherty L, Colditz GA. Dietary choline and betaine assessed by food-frequency questionnaire in relation to plasma total homocysteine concentration in the Framingham Offspring Study. Am J Clin Nutr 2006;83:905-11.
  • daCosta KA, Gaffney CM, Fischer LM, Zeisel SH. Choline deficiency in mice and humans is associated with increased plasma homocysteine concentration after a methionine load. Am J Clin Nutr 2005;81:440-4.
  • McCully KS. Homocysteine and vascular disease: The role of folate, choline and lipoproteins in homocysteine metabolism. In: Zeisel SH, Szuhaj BF, editors. Choline, Phospholipids, Health and Disease.Champaign, IL: AOCS Press; 1998. p. 117-30.
  • Verhoef P, de Groot LCPGM. Dietary determinants of plasma homocysteine concentrations. Seminars in Vascular Medicine 2005;5(2):110-23.
Choline’s necessity for liver function and lipid metabolism
  • Buchman AL, Ament ME, Sohel M, Dubin MD, Jenden DJ, Roch M et al. Choline deficiency causes reversible hepatic abnormalities in patients receiving parenteral nutrition: Proof of a human choline requirement: A placebo-controlled trial. JPEN 2001;25(5):260-8.
  • Ghoshal AK, Farber E. Biology of disease: Choline deficiency, lipotrope deficiency and the development of liver disease including liver cancer: A new perspective. Lab Investig 1993;68(3):255-60.
  • Tayek JA, Bistrian BR. Abnormal liver function in malnourished patients receiving total parenteral nutrition: A prospective randomized study. J Am Coll Nutr 1990;9(1):76-83.
Choline supplementation for athletic consumers
  • Buchman AL, Jenden DJ, Roch M. Plasma free, phospholipid-bound and urinary free choline all decrease during a marathon run and may be associated with impaired performance. J Am Coll Nutr 1999;18(6):598-601.
  • Conlay LA, Wurtman RJ, Blusztajn JK, Lopez-Coviella I, Maher TJ, Evoniuk GE. Decreased plasma choline concentrations in marathon runners. NEJM 1986 October 2;315:892.
  • Sandage, BW, Sabounjian, LA, Wuronen, RI. 1996. “Effects of Choline on Athletic Performance and Fatigue.” Abstract from National Institutes of Health Workshop on The Role of Dietary Supplements for Physically Active People. June 3-4, 1996, Bethesda, MD.
  • Zeisel SH. Choline: human requirements and effects on human performance. In: Marriott BM, editor. Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations.Washington, D.C.: Committee on Military Nutrition Research, Food and Nutrition Board (FNB), Institute of Medicine (IOM) – National Academy Press; 1994. p. 381-406.