When is an egg not just an egg? The importance of global food systems

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When is an egg not just an egg? The importance of global food systems

Mickey Rubin, PhD

Global Food Systems

Nutritious Dietary Patterns

As our world becomes increasingly interconnected, we each have a role to play in ensuring that food is accessible for all – while also being good for us and the planet. As dietitians and healthcare professionals, we are aware of how the foods we choose to eat not only impact our health, but also the larger food system. That’s why we’re excited to share more about important conversations taking place on the global level. In September 2021, the UN Secretary-General convened the first-ever United Nations Food Systems Summit (UNFSS) to bring widespread attention to topics such as sustainability, food systems, and global health.

Dietitians play an integral role in promoting sustainability because they are highly skilled in translating complex science to patients and harness interpersonal skills to change patient behavior. Plus, dietitians understand the importance of both healthy diets and promoting a sustainable food system.

As such, dietitians recommend certain foods to patients to promote good nutrition and other health goals. Eggs and beans have long been regarded as highly nutritious foods – both are a source of protein and key nutrients. In addition to being nutritious foods to include in the diet, the UNFSS formally recognized eggs and beans as “star ingredients” as part of World Food Day 2021. The UNFSS video, When Is An Egg Not Just An Egg?, highlights the key role that eggs play in diets around the world; they’re accessible, nutritious, and full of potential for fueling our bodies. The video The Magic of Beans highlighted beans as a versatile, affordable, and nutritious food for people around the world. These videos help promote the importance of food systems conversations and show that eggs and beans are fuel for our future.

So, what do you mean by food systems?

Food systems refer to the collective activities involved in the production, processing, transportation, consumption, and disposal of food. They encompass the physical health of people, as well as healthy environments, economies, and cultures. Registered dietitians play a critical role in food systems, helping patients build nutritious dietary patterns while considering the affordability, accessibility, and cultural context of food choices.

And, what happened at the UNFSS and why is it important?

UNFSS was convened as part of the Decade of Action on Nutrition to achieve the Sustainable Development Goals(SDGs). Promoted as a “people’s summit, UNFSS assembled key actors across global food systems, with over 51,000 attendees from 193 countries. It included five Action Tracks to draw on the expertise of different stakeholders, two of which included nutrition and sustainable consumption:

  • Action Track 1 concentrated on ensuring access to safe and nutritious food for all, with the goal of ending hunger and malnutrition in all its forms. This Action Track launched conversations on food safety, access to school meals, workforce nutrition, and more.
  • Action Track 2 covered sustainable consumption patterns, looking to build consumer demand for sustainably produced food, strengthen local value chains, improve nutrition, and promote the reuse and recycling of food resources. This Action Track examined the role of food environments, demand creation, and food loss and waste.

UNFSS was the first major global gathering around food systems. It resulted in coalition-building among stakeholders, national commitments from governments, and cross-cutting priorities for global nutrition organizations. Undoubtedly, the high-level conversations launched at UNFSS will drive nutrition commitments and food policy for decades to come.

Interested in learning how you can take action on food systems? Follow UNFSS on Twitter or Instagram for announcements of new coalitions, podcasts on global food systems, as well as opportunities for health professionals and other stakeholders to get involved.

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Choline during pregnancy: new study shows lasting cognitive benefit for children

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Choline during pregnancy: new study shows lasting cognitive benefit for children

Jen Houchins, Phd

Nutrients in Eggs

Nutritious Dietary Patterns

Getting enough choline is important throughout the lifespan, but it is especially critical during pregnancy and lactation to support the baby’s brain development.1,2  Previous research demonstrated that choline supplementation during the third trimester of pregnancy can improve an infant’s cognitive function,3 and a recently published follow-up study with this same group of children found a lasting impact into school-age years.4  While larger studies will need to confirm these human data, the current evidence demonstrates higher maternal choline intake during pregnancy can have a lasting beneficial impact on children’s brain health and development.

Previously, a randomized, double-blind, controlled feeding study found that higher maternal choline supplementation during the third trimester of pregnancy (930 vs. 480 mg/day) improved infant information processing speed (a measure of cognitive function).  Importantly, a benefit was also seen at the lower level of intake for infants born to mothers who were enrolled in the study for a greater duration of pregnancy.  The authors concluded, “even modest increases in maternal choline intake during pregnancy may produce cognitive benefits for offspring.”3

As a follow-up, the same children from this initial study were assessed at seven years old.  Children born to women who were in the 930 mg supplementation group demonstrated superior performance in sustained attention (a measure of cognitive function), compared to children in the 480 mg supplementation group.4  The long-term benefits of choline supplementation during pregnancy are hypothesized to be at least partly due to lasting changes during brain development, which would be consistent with animal studies.  While these results strongly support a beneficial impact of higher choline intake during pregnancy, the authors recommend larger studies in more diverse populations to confirm the observations.  Further, more research is needed to determine the optimal level of choline intake during pregnancy.

Most Americans, including pregnant women (average choline intake of 350 mg/day), do not meet the Adequate Intake for choline.2,4,5  With these new human data supporting the critical role of higher choline intake during early life, consuming choline-rich foods (along with a supplement if indicated), are encouraged as part of healthy dietary patterns.5,6  Importantly, one large egg provides several nutrients essential for brain growth, including 150 mg choline.7,8  A large egg also provides 252 mcg of lutein + zeaxanthin, carotenoids with emerging evidence linking to brain development and health.9  Other nutrient-rich foods that can help provide choline to the diet include meat, soybeans, poultry, fish, dairy products, potatoes with skin, wheat germ, quinoa, cruciferous vegetables, nuts, and seeds.10

“Meeting nutrient needs through foods and beverages is preferred, but women who are concerned about meeting recommendations should speak with their healthcare provider to determine whether choline supplementation is appropriate.”11  For more information about choline, see the National Institutes of Health Choline Fact Sheet for Health Professionals and Choline Throughout the Lifespan article. For recipe inspiration, check out IncredibleEgg.org.

  1. Wallace, T.C. and V.L. Fulgoni, 3rd, Assessment of Total Choline Intakes in the United States. J Am Coll Nutr, 2016. 35(2): p. 108-12.
  2. Wallace, T.C. and V.L. Fulgoni, Usual Choline Intakes Are Associated with Egg and Protein Food Consumption in the United States. Nutrients, 2017. 9(8).
  3. Caudill, M.A., 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(4): p. 2172-2180.
  4. Bahnfleth, C.L., et al., Prenatal choline supplementation improves child sustained attention: A 7-year follow-up of a randomized controlled feeding trial. Faseb j, 2022. 36(1): p. e22054.
  5. Wallace, T.C., et al., Choline: The Neurocognitive Essential Nutrient of Interest to Obstetricians and Gynecologists. J Diet Suppl, 2019: p. 1-20.
  6. Caudill, M.A., et al., Building better babies: should choline supplementation be recommended for pregnant and lactating mothers? Literature overview and expert panel consensus. Eur Gyn Obstet, 2020. 2: p. 149-61.
  7. U.S. Department of Agriculture. FoodData Central SR Legacy — Egg, whole, raw, fresh. 2019 April 1, 2019; Available from: https://fdc.nal.usda.gov/fdc-app.html#/food-details/171287/nutrients.
  8. Schwarzenberg, S.J. and M.K. Georgieff, Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health. Pediatrics, 2018. 141(2).
  9. Wallace, T.C., A Comprehensive Review of Eggs, Choline, and Lutein on Cognition Across the Life-span. J Am Coll Nutr, 2018. 37(4): p. 269-285.
  10. National Institutes of Health. Choline: Fact Sheet for Health Professionals. 2021; Available from: https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/.
  11. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2020-2025 Dietary Guidelines for Americans. 2020; Available from: https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf.

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FREE Class: First Steps to FEEDing Your Baby

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Nutrients in Eggs

To view the recorded class click here.

Handouts associated with the class can be accessed here and here

Once you have viewed the recorded class, please fill out this short survey

Do you work with new parents or caregivers looking for information on how to introduce solid foods to babies? Or maybe your family has welcomed a new addition and you’d like a refresher on “nutrition for baby” 101? Egg Enthusiasts and Registered Dietitians Sara Haas and Lara Field of FEED Nutrition Counseling discuss the basics of feeding babies in this free class. Lara breaks down the science of feeding new babies and provides expert tips on when and how to start solid foods, while Sara brings the conversation to the kitchen and shows how to put these concepts into practice.

Feel free to share this on-demand class with your clients and audiences!

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Choline, Eggs and TMAO: Recent Study Offers Important New Insight

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Choline, Eggs and TMAO:

Recent Study Offers Important New Insight

Jen Houchins, PhD & Mickey Rubin, PhD

Cardiometabolic Health

Nutrients in Eggs

Scientists have no shortage of ways to measure a person’s cardiovascular disease risk. You are likely very familiar with low-density lipoprotein cholesterol (LDL-C), blood pressure, or markers of inflammation like c-reactive protein, just to name a few. In recent years you may have also heard of another potential risk factor for cardiovascular disease: trimethylamine-N-oxide (TMAO).

TMAO can form after eating foods that contain choline, an important nutrient for brain health found in egg yolk, fish, poultry, and red meat. It can be measured in the blood but is actually produced in the gut. TMAO has been linked with atherosclerosis in animal studies, while observational studies in humans have shown that those with higher blood levels of TMAO have higher cardiovascular disease risk.1  The foods you eat may impact the amount of TMAO precursors and potentially the gut microbial composition, which in turn, could impact the development of TMAO.2  A lingering question has been to what extent is TMAO impacted by diet –  is TMAO just an indicator or are underlying disruptions in metabolism leading to the relationship with atherosclerosis?3,4

Ten years ago, researchers at The Cleveland Clinic published one of the first studies proposing a link between TMAO, dietary choline, and cardiovascular disease risk,5 but have just published a new study that offers some important new information about choline from eggs, one of the best food sources of choline available. The new study published in The American Journal of Medicine explored the difference between consuming eggs, a whole food source of choline, and taking supplemental choline on TMAO production, and concluded “… it may be more prudent to recommend natural sources of choline, like eggs, over supplements.”6

In this study of healthy adults, TMAO concentrations increased from baseline to end-of-study in the participants who consumed a choline bitartrate supplement alone or in combination with whole eggs or egg whites; however, there was no change in TMAO concentrations in the participants who consumed eggs alone or for those who took supplement of phosphatidylcholine, a form of choline found in eggs.

The results of this new study from Cleveland Clinic align with other studies in healthy, young adults that have indicated higher intake of choline from eggs (2-3 eggs/day) has no impact on blood levels of TMAO.7-9  Additionally, a recent study in postmenopausal women who were overweight found that consuming two eggs per day for four weeks did not impact TMAO concentration.10  Overall, “Most recent dietary interventions do not support significant increases in TMAO in healthy individuals or in those with a chronic condition.”3

This new study is important for eggs, as it demonstrates that food sources of choline may be viewed differently than dietary supplements. “These findings imply that the form of choline ingested may differentially influence gut-microbiota dependent TMAO generation.”6  Although the supplement data need to be replicated, these new data strongly support previous work showing eggs as a food source of choline can be an important part of heart-healthy diets.

You’ve likely heard of the benefits of choline and that it is an important nutrient for brain health throughout the lifespan. Here are some ways choline plays an essential role in overall health:

  • 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.11
  • 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.12

In fact, the 2020-2025 Dietary Guidelines for Americans recommends eggs as a notable source of choline to support brain health and development during pregnancy. Most Americans, about 90%, don’t consume enough choline. Fortunately, eggs are an excellent source. Just one large egg provides the daily choline needs for babies and toddlers, and two large eggs provide more than half of the daily choline needs for pregnant moms.

  1. Blesso, C.N. and M.L. Fernandez, Dietary Cholesterol, Serum Lipids, and Heart Disease: Are Eggs Working for or Against You? Nutrients, 2018. 10(4).
  2. Yang, J.J., et al., Circulating trimethylamine N-oxide in association with diet and cardiometabolic biomarkers: an international pooled analysis. Am J Clin Nutr, 2021.
  3. Thomas, M.S. and M.L. Fernandez, Trimethylamine N-Oxide (TMAO), Diet and Cardiovascular Disease. Curr Atheroscler Rep, 2021. 23(4): p. 12.
  4. Jia, J., et al., Assessment of Causal Direction Between Gut Microbiota-Dependent Metabolites and Cardiometabolic Health: A Bidirectional Mendelian Randomization Analysis. Diabetes, 2019. 68(9): p. 1747-1755.
  5. Wang, Z., et al., Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease. Nature, 2011. 472(7341): p. 57-63.
  6. Wilcox, J., et al., Dietary Choline Supplements, but Not Eggs, Raise Fasting TMAO Levels in Participants with Normal Renal Function: A Randomized Clinical Trial. Am J Med, 2021.
  7. Lemos, B.S., et al., Effects of Egg Consumption and Choline Supplementation on Plasma Choline and Trimethylamine-N-Oxide in a Young Population. J Am Coll Nutr, 2018: p. 1-8.
  8. DiMarco, D.M., et al., Intake of up to 3 Eggs/Day Increases HDL Cholesterol and Plasma Choline While Plasma Trimethylamine-N-oxide is Unchanged in a Healthy Population. Lipids, 2017. 52(3): p. 255-263.
  9. Missimer, A., et al., Compared to an Oatmeal Breakfast, Two Eggs/Day Increased Plasma Carotenoids and Choline without Increasing Trimethyl Amine N-Oxide Concentrations. J Am Coll Nutr, 2018. 37(2): p. 140-148.
  10. Zhu, C., et al., Whole egg consumption increases plasma choline and betaine without affecting TMAO levels or gut microbiome in overweight postmenopausal women. Nutr Res, 2020. 78: p. 36-41.
  11. 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.
  12. 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.

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5 Ways To Build An Egg Bowl

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5 Ways To Build An Egg Bowl

Nutrients in Eggs

Nutritious Dietary Patterns

Here’s a common dilemma I hear from many folks: You want to prepare and eat a nutritious meal, but picking out and cooking a recipe takes too much time and energy. Don’t reach for the take-out app just yet. If you’re overwhelmed with recipes, I have the ultimate solution for you– a no-recipe egg bowl formula. It’s a simple blueprint to help whip up a satisfying meal on the fly without any recipe reading. 

Here’s the simple formula to get you on your way to lunch or dinner success:

1 to 2 cups of veggies + ½ cup of whole grains + 1 large egg + 1 tablespoon sauce. 

The 2015-2020 Dietary Guidelines for Americans recommend eating 2½ cups of vegetables per day, and this egg bowl helps you meet those recommendations. Start by picking out your favorite veggie(s) and build the bowl from there. If you opt for more than one vegetable, try to eat different colors for a variety of nutrients. 

Next, add a whole grain. MyPlate recommends filling a quarter of your plate with a grain. Whole grains provide fiber and protein, two nutrients that contribute to satiety, as well as heart health and muscle growth. There are a ton of tasty and affordable whole grain options to choose from, such as brown rice, farro, oats, bulgur, barley and more. 

Your bowl already has some protein, vitamins and minerals, but top it with an egg to add even more nutrition. Eggs naturally provide many essential nutrients, such as Vitamin B12, biotin, iodine, selenium, choline, riboflavin, pantothenic acid and protein. Not to mention that they are one of the only foods that naturally have Vitamin D, which along with calcium, is critical for building strong bones. Eggs are also an important part of a plant-forward diet, especially since they aid in the absorption of nutrients found in plant foods, such as vitamin E and carotenoids. 

What’s more, eggs contain important nutrients for brain health, including choline and lutein. Choline is critical for brain development during pregnancy and infancy, but approximately 90% of pregnant women don’t get enough of this essential nutrient. Two large eggs supply more than half of the recommended intake for pregnant women and can help them meet their needs. Lutein has long been associated with eye health and emerging research shows lutein may also play a role in cognition too. 

Lastly, don’t forget to add a sauce to your egg bowl for flavor and even more nutrients. Opt for sauces made with healthy oils, vegetables, beans and/or legumes. If you need a little inspiration, make sure you check out the five simple egg bowl suggestions below.

  • Fall Harvest Egg Bowl: oven-roasted Brussels sprouts & cauliflower + wheatberries + over easy egg + balsamic vinaigrette
  • Pesto Egg Bowl: oven-roasted crispy broccoli & sun-dried tomatoes + farro + poached egg + pesto
  • Southwest Egg Bowl: fresh shredded purple cabbage & corn + brown rice + fried egg + salsa
  • Green Tahini Egg Bowl: fresh kale & shelled edamame + quinoa + sunny side up egg + tahini sauce (whisk together 1 tablespoon of tahini, a pinch of salt and a splash of water)
  • Mediterranean bowl: fresh cherry tomatoes & sliced cucumber & olives + lentils + hard boiled egg + hummus

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Protein Foods from a Variety of Sources Contribute to Nutrient Adequacy

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Protein Foods from a Variety of Sources Contribute to Nutrient Adequacy

Mickey Rubin, PhD

Nutrients in Eggs

Featured article in the Fall 2019 Issue of Nutrition Close-Up; written by Mickey Rubin, PhD

There has been considerable debate recently around the topic of protein quality, particularly regarding the best way to measure protein quality1 as well as the relative importance of dietary protein quality as it relates to important health outcomes, such as muscle loss with aging.2

While this discussion is important and will no doubt continue as research in this area evolves and new measures for protein quality are developed,3 less attention is often given to the important contribution of protein foods to overall nutrient adequacy. Commonly consumed protein foods contribute to nutrient intake, diet quality, and nutrient adequacy, independent from their contributions to total protein intake.4

Protein foods provide important micronutrient diversity. Foods within the protein foods group provide B vitamins (e.g., niacin, vitamin B12, vitamin B6, and riboflavin), selenium, choline, phosphorus, zinc, copper, vitamin D, and vitamin E just to name a few.5

For example, meats provide the most zinc, while poultry provides the most niacin.5 Seafood provides the omega-3’s eicosapentanoic acid (EPA) and docosahexaenoic acid (DHA). Eggs provide the most choline of any commonly consumed protein food, while nuts and seeds provide vitamin E, and soy and legumes are sources of copper, manganese and iron.5 Indeed, if we focus just on the protein that is provided by the protein foods group, we are missing the larger picture of what these foods contribute to healthy diet patterns.


Nutrient-Dense Eggs Make Important Contributions to the Diets of Americans of All Ages

Eggs are a prime example of a protein food that should be just as appreciated for their micronutrient contribution to healthy eating patterns as they are for their macronutrient contribution. Analysis of NHANES 2003-2012 reveals that in adults ≥19 years, whole egg consumption is associated with a higher likelihood of meeting or exceeding recommendations for several micronutrients, including nutrients identified by the 2015-2020 Dietary Guidelines as Nutrients of Public Health Concern such as vitamin D, calcium, and iron. Egg consumption is also associated with higher likelihood of meeting the recommendations for other underconsumed nutrients such as choline.6 Importantly, egg consumption was not associated with serum total cholesterol or LDL cholesterol in this analysis.

In fact, several lipid related risk factors were improved with higher egg consumption, including triglycerides, the triglyceride to HDL-cholesterol ratio, and the total cholesterol to HDL-C ratio.6 NHANES data in infants and toddlers ages 6-24 months revealed that those who consume eggs have greater intakes of choline, lutein + zeaxanthin, α -linolenic acid, DHA, vitamin B12, phosphorus, and selenium. Egg consuming infants and toddlers also had higher intakes of total fat, monounsaturated fat, saturated fat, and sodium, but also lower added sugar and total sugar compared to non-consumers of eggs. Importantly, egg consumption in infants was associated with longer recumbent length when compared to nonconsumers of eggs.7

Findings in children and adolescents ages 2-18 years showed a similar story, revealing those who consume eggs have greater intakes of protein, polyunsaturated, monounsaturated and total fat, α-linolenic acid, DHA, choline, lutein + zeaxanthin, vitamin D, potassium, phosphorus, and selenium compared to non-egg consumers.8


Plant vs. Animal or Plant and Animal?

Perhaps all too often the nutrition conversation regarding protein foods has turned to a debate between animal and plant protein sources. However, both animal and plant protein sources provide essential nutrients that are important for healthy dietary patterns. The emphasis away from animal source protein foods is generally evidenced by the association of some of these foods with cardiovascular risk, although randomized controlled studies show that nutrient-dense diets containing animal protein can improve cardiovascular disease risk factors,9 and animal source foods like eggs may have nutrients important for other outcomes such as neurocognitive development.10

The 2015–2020 DGA recommends adopting healthy eating patterns that contain a variety of protein foods, including seafood, lean meats and poultry, eggs, legumes, nuts, seeds, and soy products. A recent editorial by Dr. Wayne Campbell of Purdue University uniquely captured the idea that eating protein foods does not have to be an either or proposition, stating that “debates pitting meats against protein-rich plant foods seem less useful to consumers than helping both omnivores and vegetarians understand the health properties of the foods they choose to consume and educating them to include a variety of suitable protein-rich foods within healthy eating patterns.”11

  1. Katz, DL, et al., Perspective: The Public Health Case for Modernizing the Definition of Protein Quality. Adv Nutr, 2019. [Epub ahead of print].

  2. Phillips, SM, Current Concepts and Unresolved Questions in Dietary Protein Requirements and Supplements in Adults. Front Nutr, 2017. 4: p. 13.

  3. Wolfe, RR, et al., Protein quality as determined by the Digestible Indispensable Amino Acid Score: evaluation of factors underlying the calculation. Nutr Rev, 2016. 74(9): p. 584-99.

  4. Phillips, SM, et al., Commonly consumed protein foods contribute to nutrient intake, diet quality, and nutrient adequacy. Am J Clin Nutr, 2015. 101(6): p. 1346s-1352s.

  5. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans. 2015;8:[Available from: http://health.gov/dietaryguidelines/2015/guidelines/].

  6. Melough, MM, et al., Association of eggs with dietary nutrient adequacy and cardiovascular risk factors

  7. Papanikolaou Y, Fulgoni VL 3rd. Egg Consumption in Infants is Associated with Longer Recumbent Length and Greater Intake of Several Nutrients Essential in Growth and Development. Nutrients, 2018;10(6).

  8. Papanikolaou Y, Fulgoni VL 3rd. Egg Consumption in U.S. Children is Associated with Greater Daily Nutrient Intakes, including Protein, Lutein + Zeaxanthin, Choline, α-Linolenic Acid, and Docosahexanoic Acid. Nutrients. 2019;11(5).

  9. Petersen KS, et al. Healthy Dietary Patterns for Preventing Cardiometabolic Disease: The Role of Plant-Based Foods and Animal Products. Curr Dev Nutr, 2017;1(12).

  10. Wallace, TC., A Comprehensive Review of Eggs, Choline, and Lutein on Cognition Across the Life-span. J Am Coll Nutr, 2018. 37(4): p. 269-285.

  11. Campbell, WW, Animal-based and plant-based protein-rich foods and cardiovascular health: a complex conundrum. Am J Clin Nutr, 2019. [Epub ahead of print].

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Choline – The Underconsumed and Underappreciated Essential Nutrient

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Choline – The Underconsumed and Underappreciated Essential Nutrient

Taylor C. Wallace, PhD, CFS, FACN

Nutrients in Eggs

Featured article in the Winter 2019 Issue of Nutrition Close-Up; written by Taylor C. Wallace, PhD, CFS, FACN

“Recognition of the growing evidence relating inadequate intakes to health consequences coupled with evidence of suboptimal intakes in high-risk populations, warrants a need for improved public health recommendations for choline” was the consensus of more than 40 experts attending the 2018 Choline Science Summit, whose findings were summarized recently in a feature article in the journal Nutrition Today.1

Choline’s role in human health begins prenatally and extends into adulthood and old age.2 Its functions are complex and include, but are not limited to, neurotransmitter synthesis, cell membrane signaling, lipid transport and methyl group metabolism. Choline has been recognized as an essential nutrient in the U.S. and Canada since 1998; it has long been established that deficiency results in non-alcoholic fatty liver disease.

Choline’s function and recognition among health professionals regarding cogniti on across the lifespan has only recently gained momentum. Humans can produce small amounts of choline but must consume the nutrient through the diet to prevent deficiency.2
The American Academy of Pediatrics (AAP) recently affirmed choline as a key nutrient to support neurodevelopment during the first 1000 days postconception.3 Adequate maternal choline intake has been shown to help the baby’s brain and spinal cord develop properly.1 Additional research has shown that choline eases the baby’s response to stress and enhances nutrient transfer across the placenta to the developing fetus.4,5 Importantly, lactation increases the maternal choline requirement.2

Higher maternal intake of choline results in lasting beneficial cognitive effects that become more pronounced with aging in both animal and human models. Results of a recent randomized controlled trial reveal benefits of higher maternal choline intake on child attention, memory and problem solving that may last into the school-age years.1,6 Choline intake throughout adulthood may also help reduce the risk of age-related cognitive decline,7 however these findings are predominately based on observational studies or animal-models and more research is needed.

Analysis from the National Health and Nutrition Examination Survey indicates that the majority of the U.S. population is not consuming sufficient choline to meet recommended intakes. The daily value for choline is 550 mg per day, however estimated mean daily intake is approximately 319 mg per day.8 It is difficult to get enough choline without consuming eggs or taking a dietary supplement and therefore, it’s not surprising that 90% of Americans and 92% of pregnant women do not achieve current recommended intakes for choline.8,9

The bottom line – health professionals need to be aware of food sources of choline and while data indicate a need for Americans to increase plant-foods in the diet, this should not mean eliminating nutrient dense animal-derived foods such as eggs that contain higher levels of choline. Health professionals should strongly consider the recommendations from the American Medical Association (AMA) and AAP, as well as the recent scientific literature summarized in this recently published report. Dietary guidance that helps all individuals meet current choline recommendations is critical for the health and wellbeing of all individuals.

  1. Wallace, TC, et al. Choline: The Underconsumed and Underappreciated Essential Nutrient. Nutr. Today. 2018; 53: 240–253.

  2. Dietary Reference Intakes for Thiamin, Ribofl avin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. (National Academy Press, 1998).

  3. Schwarzenberg, SJ and M.K Georgieff . Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health. Pediatrics. 2018; 141: e20173716.

  4. Jiang, X, et al. Maternal choline intake alters the epigenetic state of fetal cortisol-regulating genes in humans. FASEB J.2012; 26: 3563–3574.

  5. Jiang, X, et al. Choline inadequacy impairs trophoblast function and vascularization in cultured human placental trophoblasts. J. Cell. Physiol. 2014; 229: 1016–1027.

  6. 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. Off . Publ. Fed. Am. Soc. Exp. Biol. 2018; 32: 2172-2180.

  7. Blusztajn, JK, et al. Neuroprotective Actions of Dietary Choline. Nutrients.2017; 9.

  8. Wallace, TC and V.L. Fulgoni. Usual Choline Intakes Are Associated with Eggand Protein Food Consumption in the United States. Nutrients. 2017; 9.

  9. Wallace, TC and V.L. Fulgoni, 3rd. Assessment of Total Choline Intakes in the United States. J. Am. Coll. Nutr. 2016; 35: 108–112.

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