Choline Throughout the Life-Span

11 NC Quinoa Crust Vegetable Quiche

Choline Throughout the Life-Span

Katie Hayes, RDN

Eggs Across the Lifespan



Choline is an essential nutrient, meaning that we must consume adequate amounts in the diet to achieve optimal health. Unfortunately, most people do not consume enough choline. In fact, more than 90% of Americans (including approximately 90% of pregnant women) fail to meet the adequate intake.1 The Dietary Guidelines Advisory Committee has classified choline as a nutrient that poses special challenges for Americans due to underconsumption and encouraged eggs for pregnant women, as a complementary food for babies and toddlers, and for pre-teens and adolescents.2 Many foods offer choline in small amounts, however, only a few foods are significant choline sources.  Furthermore, most multivitamin supplements contain little, if any, choline. Fortunately, eggs are convenient, affordable, accessible, and an excellent source of choline.

Beginning in fetal development, Choline is critical to good health and remains essential throughout the lifespan. This nutrient is important in many ways.

  • During pregnancy, choline helps the baby’s brain and spinal cord develop properly and supports brain health throughout life.
  • Infants and young children need choline for continued brain development and health.
  • Choline is part of a neurotransmitter called acetylcholine, which is important for muscle control, memory and mood.3
  • Choline is also important for the support of membranes that surround your cells, the transportation of fats throughout the body and for liver health.
  • New research is exploring how choline throughout life may have lasting effects on cognition and prevention of cognitive decline.4


The amount of choline an individual needs depends on many things, including age, gender and stage of life. Table 1 lists the current Adequate Intakes (AIs) for choline.3


People of all ages need adequate choline for good health, but very few consume enough through food and supplements. While many foods contain some choline, only a handful of foods are considered good or excellent sources. Fortunately, two large eggs (about 300mg of choline) contain more than half of the recommended intake for pregnant women and can help them meet their needs. The table below lists food sources of choline.2


Choline plays a role in early brain development during pregnancy and infancy. There is evidence that infants exposed to higher levels of maternal choline (930 mg/day) during the third trimester have improved information processing speed, an indicator of cognitive function,4,5 during the first year of life.

The American Medical Association (AMA) House of Delegates recommended the addition of choline to prenatal vitamins because of its essentiality in promoting cognitive development of the offspring.6 This recommendation from AMA highlights the increased recognition of choline as a nutrient of concern. The 2015-2020 Dietary Guidelines for Americans (DGAs) also list choline as a nutrient under consumed by most Americans. The DGAs recommend individuals shift to healthier eating patterns to help meet nutrient needs, including choline.7

Interested in more information about choline?

  1. Wallace TC, Fulgoni VL III. Assessment of total choline intakes in the United States. J Am Coll Nutr 2016, 35(2), 108-112.

  2. National Institutes of Health. Fact Sheet for Health Professionals: Choline. Version current 26 September 2018. June 22, 2020.

  3. Wallace TC. A comprehensive review of eggs, choline, and lutein on cognition across the life-span. J Am Coll Nutr 2018, 37(4), 269-285.

  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;32:2172-2180.

  5. AMA Wire. AMA backs global health experts in calling infertility a disease.

  6. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at

More Articles You’ll Love

Fuel Your Brain with Nutrient Rich Eggs

Brain Health Blog Post Jessica Ivey Hero

Fuel Your Brain with Nutrient-Rich Eggs

Jessica Ivey, RDN, LDN

The Egg Nutrition Center partnered with Jessica Ivey, RDN, LDN to write this blog post.


June is Alzheimer’s & Brain Awareness Month, making it the perfect time to consider the importance of brain health. With increased concern about brain diseases, researchers in the growing field of neuronutrition are examining how foods affect the health of our brains and scientists working on the 2020 Dietary Guidelines for Americans are evaluating how nutrition impacts neurocognitive health throughout the lifespan. Eggs are a key part of this research because they contain choline and lutein, two nutrients that are important for brain development, memory and learning.

Choline plays a critical role in brain development and health during fetal development and throughout the lifespan. In utero, choline helps the baby’s brain and spinal cord develop properly. Choline is an essential nutrient, meaning that our bodies can’t produce it in sufficient amounts so we have to get it in our diets.

Approximately 90% of Americans fall short of the recommended intake of choline,1 and intake declines with age. Adults age 71 and older consume on average about half their daily requirement of choline.2 Low concentrations of free choline in the blood have been associated with poor cognitive performance in older adults,3 indicating that a focus on increasing choline intake at this stage of life could have potential benefits.

Lutein is a carotenoid and is sometimes referred to as the “eye vitamin” due to its role in eye health. In addition to being good for your vision, higher brain and serum concentrations of lutein have been associated with better cognitive function in older adults.4

Eggs have both of these nutrients, and regular consumption of eggs has been associated with improved cognitive performance in adults.5 Be sure to enjoy the whole egg, including the yolk, where choline and lutein are found. Eggs are one of the best food sources of choline, with two large eggs providing about 300 mg of choline. Pair eggs with other nutritious foods, like vegetables and whole grains, to build balanced meals to fuel your body and brain.

Try these nutrient-packed recipes:


Jessica Ivey, RDN, LDN, is a dietitian and chef with a passion for teaching people to eat healthy for a happy and delicious life. Jessica offers approachable healthy living tips, from fast recipes to meal prep guides and ways to enjoy exercise on her website, Follow her on Facebook and Instagram.

  1. Wallace, TC, Blusztajn, JK, Caudill, MA, Klatt, KC, Natker E, Zeisel, SH, and KM Zelman.  Choline The Underconsumed and Underappreciated Essential Nutrient.  Nutrition Today.  November/December 2018.

  2. Choline, Memory & Cognitive Development. The Choline Information Council website. Accessed May 23, 2019.

  3. Nurk E, Refsum H, Bjelland I, et al. Plasma free choline, betaine and cognitive performance: the Hordaland Health Study. Br J Nutr. 2013;109:511–519.

  4. Johnson EJ, Vishwanathan R, Johnson MA, et al. Relationship between Serum and Brain Carotenoids, α-Tocopherol, and Retinol Concentrations and Cognitive Performance in the Oldest Old from the Georgia Centenarian Study. J Aging Res. 2013;2013:951786.

  5. Ylilauri MPT, et al. Association of dietary cholesterol and egg intakes with the risk of incident dementia or Alzheimer disease: The Kuopio Ischaemic Heart Disease Risk Factor Study. Am J Clin Nutr. 2016;105:476-484.

More Articles You’ll Love

Lutein – The Eye’s and Brain’s Best Friend

M Lutein The Eyes And Brains Best Friend 1125x1125

Lutein – The Eye’s and Brain’s Best Friend

Jirayu Tanprasertsuk, MS and Emily Mohn, PhD


Featured article in the Fall 2018 Issue of Nutrition Close-Up; written by Jirayu Tanprasertsuk, MS and Emily Mohn, PhD

Autumn is the perfect time to observe carotenoids in nature.

Carotenoids are a group of plant pigments that are responsible for the beautiful yellow, orange, and red foliage during this season. We also find carotenoids in many of the colorful fruits and vegetables we eat. Although there are more than 600 naturally occurring carotenoids, only six of them are common in the American diet. Most of us are familiar with beta-carotene, responsible for the orange color of carrots and sweet potatoes, and lycopene, responsible for the red color of tomatoes. Lutein is a carotenoid found mostly in green leafy vegetables like kale and spinach, but is also found in eggs and avocados. The amount of lutein in selected food sources is provided in Table 1.

Because carotenoids are fat-soluble, the intestine absorbs them better when they are consumed with fat. For example, adding avocado or oil to a salad significantly increases lutein absorption. Another good example is egg yolk. Because of its fat content, egg yolk is a highly bioavailable source of lutein.

Among all major dietary carotenoids, lutein and zeaxanthin (found in the same food sources but in about 1/5 the amount as lutein) are uniquely important for visual health. Only these two carotenoids are selectively taken up into the macula – the central area at the back of the eye – where they comprise macular pigment (MP). MP provides the sharp central vision we need for activities like reading and driving.

MP is often viewed as an intrinsic pair of sunglasses that screens out damaging blue light from the sun and electronic devices. Just like UV rays damage the skin, blue light exposure over a lifetime causes damage to the macula and may lead to age-related macular degeneration (AMD) and blindness in older individuals. The density of MP reflects the amount of lutein (and zeaxanthin) in the macula. MP density can be measured simply, quickly, and non-invasively in humans. Many studies that have measured MP density have found that adults with higher MP density have a lower risk for AMD.1 For younger individuals (18-40 years old), increased MP density improves contrast sensitivity, reduces glare, and enhances visual performance during activities in low ambient illumination, like driving at night.

While lutein’s role in vision has been investigated for decades, an additional role beyond the eye has emerged in more recent years. In 2008, a clinical trial studying lutein and visual health surprisingly found that adults (60-80 years old) supplemented with lutein (with or without DHA – a fatty acid found in fatty fish like salmon) improved their cognitive performance by the end of the trial.2 This finding sparked a wave of investigations into lutein’s novel role in cognition.

Analysis of post-mortem brain samples from older adults found that lutein is the most predominant carotenoid in the brain, despite being consumed less than other carotenoids. This suggests that, like the macula, the brain preferentially takes up lutein from the diet, presumably for a specific purpose. Moreover, older individuals who are more cognitively intact tend to have higher brain lutein levels.3

Since the eyes are anatomically an extended system of the brain, researchers wondered whether MP density may be a biomarker of brain lutein levels. Indeed, an investigation into matched macula and brain tissues found that MP density was related to brain lutein concentrations.4 Many studies have since demonstrated that older individuals with higher MP density, which reflects higher brain lutein content, have better cognition across different domains like memory, language, and learning.1

Why is lutein important for cognition? The answer remains unclear, but may be related to the anti-oxidative and anti-inflammatory properties of lutein. Current studies investigating where lutein localizes in the brain may shed additional light on its mechanism of action.

Since 2008, several intervention studies using lutein-rich foods or supplements have yielded promising results for preventing or delaying cognitive decline in the elderly.5–7 An unofficial recommended intake for lutein, based on evidences regarding visual function, is currently set at 6 mg/d. However, the averaged US intake is only 1-2 mg/d.1

Advanced age is a major risk factor for both AMD and age-related cognitive impairment. As the American population ages, lutein may play a critical role in preventing both diseases at a national scale. Given that lutein can only be obtained through consumption, it is important to incorporate various sources of lutein in our diet to keep our eyes and brain healthy as we age.

Table 1. Lutein/zeaxanthin content in selected food sources1

FoodAmount (mg)/ serving unit
Avocado0.3/half fruit
Broccoli1.7/half cup
Egg, hard-boiled0.2/one large
Spinach, cooked6.7/half cup
Spinach, raw4.5/half cup
Kale, cooked10.3/half cup

Jirayu Tanprasertsuk, MS is a PhD candidate at the Friedman School of Nutrition Science and Policy and a research assistant at the USDA Human Nutrition Research Center on Aging at Tufts University. His research focuses on investigating the relationship between fat-soluble nutrients, including carotenoids, and cognitive health.

Emily Mohn, PhD is finishing her postdoctoral position at the USDA Human Nutrition Research Center on Aging at Tufts University where she studies the transport of dietary carotenoids in the circulation and their effects on cognition. Emily recently joined the RNA Therapeutics Institute at UMass Medical School as a Scientific Writer. 

  1. Johnson EJ. Role of lutein and zeaxanthin in visual and cognitive function throughout the lifespan. Nutr Rev. 2014 Sep;72(9):605–12.

  2. Johnson EJ, et al. Cognitive findings of an exploratory trial of docosahexaenoic acid and lutein supplementation in older women. Nutr Neurosci. 2008 Apr 1;11(2):75–83.

  3. Johnson EJ, et al. Relationship between serum and brain carotenoids, α-tocopherol, and retinol concentrations and cognitive performance in the oldest old from the Georgia Centenarian Study. J Aging Res. 2013;2013:1–13.

  4. Vishwanathan R, et al. Macular pigment carotenoids in the retina and occipital cortex are related in humans. Nutr Neurosci. 2016 Mar 15;19(3):95–101.

  5. Nolan JM, et al. Nutritional intervention to prevent Alzheimer’s disease: Potential benefits of xanthophyll carotenoids and omega-3 fatty acids Combined. J Alzheimers Dis. 2018 Jan 1;64(2):367–78.

  6. Hammond BR, et al. Effects of lutein/zeaxanthin supplementation on the cognitive function of community dwelling older adults: A randomized, double-masked, placebo-controlled trial. Front Aging Neurosci [Internet]. 2017 Aug 3;9.

  7. Tammy Scott, et al. Avocado consumption increases macular pigment density in older adults: A randomized, controlled trial. Nutrients. 2017 Aug 23;9(9):919.

More Articles You’ll Love