Choline deficiency
Vitamins

Choline: Reference and Dietary Sources

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Abstract

In this article, we describe:

  • the major purposes of this specific nutrient in the human body, 
  • its experimentally confirmed health uses, 
  • conventional ways to estimate nutrient status,
  • nutrient’s toxicities and deficiencies,
  • experimentally confirmed and approved levels of the nutrient intake for different demographics,
  • dietary sources of the nutrient.

Introduction

All plant and animal cells need choline, an essential nutrient, to preserve their structural integrity. Choline also provides methyl groups needed for many steps in metabolism. In addition, choline is needed to produce acetylcholine, an important neurotransmitter for memory, mood, muscle control, and other brain and nervous system functions. Choline also plays important roles in modulating gene expression, cell membrane signaling, lipid transport and metabolism, and early brain development.

Humans can produce choline endogenously in the liver, but in amounts not sufficient to meet body needs. As a result, some choline should come from the diet. When a diet is deficient in folate, the need for dietary choline rises because choline becomes the primary methyl donor.

Choline is absorbed in the small intestine, enter the portal circulation, and is stored in the liver and secreted into the lymphatic circulation.

In healthy adults, the concentration of choline in plasma ranges from 7 to 20 mcmol/L. Plasma choline levels do not decline below 50% of normal, even in individuals who have not eaten for more than a week. This may be due to the hydrolysis of membrane phospholipids, a source of choline, to maintain plasma choline concentrations above this minimal level, or to endogenous synthesis.

Frank choline deficiency in healthy, nonpregnant individuals is very rare, possibly because of the contribution of choline that the body synthesizes endogenously. Choline deficiency can cause muscle damage, liver damage, and nonalcoholic fatty liver disease (NAFLD or hepatosteatosis).

The following groups are among those most likely to have inadequate choline status: pregnant women; people with genetic alterations; patients requiring total parenteral nutrition; nonalcoholic fatty liver disease sufferers.

Despite the hypothesis that choline might affect heart health, several large observational studies have found no significant associations between choline intakes and cardiovascular or peripheral artery disease risk. However, a more recent analysis found an increased risk of mortality in those consuming higher levels of choline. People with Alzheimer’s disease have lower levels of the enzyme that converts choline into acetylcholine in the brain.

Above-required choline consumption has been shown to increase production of TMAO, a substance that has been linked to a higher risk of cardiovascular disease, in a dose-dependent manner in adults.

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Adequate Intakes of Choline

The Adequate Intakes of Choline for all ages are established based on the prevention of liver damage as measured by serum alanine aminostransferase levels.

AgeMaleFemalePregnancyLactation
Birth to 6 months125 mg/day125 mg/day
7–12 months150 mg/day150 mg/day
1–3 years200 mg/day200 mg/day
4–8 years250 mg/day250 mg/day
9–13 years375 mg/day375 mg/day
14–18 years550 mg/day400 mg/day450 mg/day550 mg/day
19+ years550 mg/day425 mg/day450 mg/day550 mg/day

Food Sources of Choline

The main dietary sources of choline are meat, poultry, fish, dairy products, and eggs. Cruciferous vegetables and certain beans are also rich in choline, and other dietary sources of choline include nuts, seeds, and whole grains.

Many foods also contain lecithin, a substance rich in phosphatidylcholine that is prepared during commercial purification of phospholipids; lecithin is a common food additive used as an emulsifying agent in processed foods, such as gravies, salad dressings, and margarine. Choline is also present in breast milk and is added to most commercial infant formulas. Precise estimates of the percentage absorption of the different forms of dietary choline in humans are not available.

Selected Food Sources of Choline

FoodMilligrams
(mg) per
serving		Percent
DV*
Pan fried beef liver, 3 ounces35665
Hard boiled egg, 1 large14727
Braised beef top round, 3 ounces11721
Roasted soybeans, ½ cup10719
Roasted chicken breast, 3 ounces7213
Ground beef, broiled, 3 ounces7213
Cooked cod fish, 3 ounces7113
Shiitake mushrooms, cooked, ½ cup pieces5811
Baked red potatoes, 1 large potato5710
Wheat germ, toasted, 1 ounce519
Canned kidney beans, ½ cup458
Cooked quinoa, 1 cup438
Milk, 1% fat, 1 cup438
Nonfat vanilla yogurt, 1 cup387
Brussels sprouts, boiled, ½ cup326
Boiled and drained broccoli, ½ cup316
Cottage cheese, nonfat, 1 cup265
Canned in water white tuna, 3 ounces255
Dry roasted peanuts, ¼ cup244
Boiled cauliflower, ½ cup244
Boiled green peas, ½ cup244
Sunflower seeds, oil roasted, ¼ cup193
Brown rice, long-grain, cooked, 1 cup193
Pita bread, whole wheat, 1 large (6½ inch diameter)173
Boiled cabbage, ½ cup153
Tangerine sections, ½ cup102
Raw snap beans, ½ cup81
Kiwifruit, ½ cup sliced71
Raw carrots, chopped, ½ cup61
Raw apples, with skin, chopped, ½ cup20
  • *DV = Daily Value.
  • The DV for choline is 550 mg for adults and children age 4 years and older.
  • Foods providing 20% or more of the DV are considered to be high sources of a nutrient, but foods providing lower percentages of the DV also contribute to a healthful diet.

References

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