Q I am pregnant with my third child and take nutrition during this time very seriously. This is the first time anyone has mentioned choline to me. Can you tell me more? FJ, Winterville

A Our understanding of nutrition continues to evolve. Choline is now recognized as a very important nutrient for pregnant women to consume to support the growth and development of the baby’s brain and reduce the risk of neural tube defect. The 2020-25 Dietary Guidelines for Americans talks about choline in pregnancy and other life stages. Getting enough is important for everyone. Leah Grace Hamilton, a senior ECU dietetic student, will tell you more.

It was not until 1998 that the Food and Nutrition Board of the Institute of Medicine recognized choline as an essential nutrient and established dietary recommendations. And it was only in 2017 that the American Medical Association encouraged those manufacturing prenatal vitamins to put choline in them. Given that choline helps to maintain healthy cells inside the body and proper nervous system function, this was an important recognition. The nervous system works to control memory, mood, muscle control and other important bodily functions. The body produces some of the necessary choline in the liver, but this is not enough required for optimal functioning. The remainder must come from diet.

For optimal health, the daily amount of choline recommended by the Institute of Medicine is slightly different across gender and age groups. For example, it is recommended that the average male 20 years or older consume approximately 550mg a day but females a little less at 425mg a day. The recommended amount increases for females while pregnant and breastfeeding, with 450mg a day recommended while pregnant and 550 mg a day while breastfeeding. In addition to the brain, it plays an important role in helping mothers’ immune function. The shortfall seems to be around 200-400 milligrams for pregnant women and 300-600 milligrams for breastfeeding ladies.

Choline most commonly is consumed through food, but also can be taken as a supplement. The foods with the highest amount of choline per serving include beef livers, chicken breast, tofu, eggs, shrimp, low-fat milk, peas, broccoli, mushrooms and beans. Many people do not meet the recommended daily serving of the nutrient. One study conducted by the National Health and Nutrition Examination Survey found that only 1 in 10 adults in the United States were consuming enough in their diets.

The side effects from not getting enough choline can be severe. When levels of choline get too low in the body, the liver and muscle cells can break down. Low levels of choline in the diet also can lead to a buildup of fat deposits in the liver, causing a severe condition known as nonalcoholic fatty liver disease. Said another way, choline helps remove fat from the liver. This disease affects approximately 1 in 4 people in the United States and is more likely to develop in individuals with diabetes or who are overweight. While symptoms can include fatigue, weight loss, abdominal pain, yellowing of the skin and swelling, many people do not experience symptoms. Because of this, it is easy for people to be unaware of the damage occurring in their bodies. Left untreated, this can lead to liver failure and cancers. The best way to prevent this disease is to maintain a healthy weight with a balanced diet to include choline, lower alcohol intake and exercise.

Professor emeritus Kathy Kolasa, a registered dietitian nutritionist and Ph.D., is an affiliate professor in the Brody School of Medicine at ECU. Contact her at kolasaka@ecu.edu.