Studies conducted in Europe and the Americas show that there is a tendency for average daily choline intakes to fall below the AI. Common genetic variants (such as those found in the PEMT and methylenetetrahydrofolate dehydrogenase (MTHFD1) genes) can also interact with choline metabolism and can impact on choline requirements. For exclusive lactation, an intake of 520 mg/day have been set by EFSA, which provides an additional 120 mg/day on top of adult recommendations, that is, the estimated average amount of choline secreted in human milk daily. Nevertheless, during pregnancy, the AI rises to 480 mg/day to account for increased gestational body weight. Ideally, a revision of reference intakes to include an estimated average requirement would significantly advance the field and better facilitate the understanding of dietary inadequacies. The AI is a recommended average daily intake based on observed estimations of nutrient intakes in healthy groups people. Present dietary guidance by the European Food Safety Authority (EFSA) advises an adequate intake (AI) of 400 mg/day for adults based on observed choline intakes in healthy populations. Several leading organizations, including the American Medical Association and the Committee on Nutrition and the American Academy of Pediatrics now recognize that choline is a crucial nutrient during pregnancy and early childhood. Subsequently, failure to provide choline during the first 1000 days could result in lifelong deficits in brain function. Impairments resulting from choline deficits can be irreversible. Inadequate choline supplies could potentially perturb fetal progenitor cell migration, proliferation, apoptosis, and differentiation, thereby adversely modifying brain development. Over the last few million years, the hominin brain has tripled in size and has vast nutritional needs, which includes a suitable choline supply. The fetus and neonate have particularly high choline demands that participate in normal development. However, most individuals need to consume choline from dietary sources to augment the choline that is produced endogenously and prevent deficiency. Choline is an ‘essential’ nutrient, and humans can produce choline in small amounts through the hepatic phosphatidylethanolamine N-methyltransferase (PEMT) pathway. The first 1000 days (2 years) are life are fundamental as the foundations of neurodevelopment are laid down and an adequate supply of nutrients, particularly folic acid, iron, iodine, and choline, amongst others are crucial in achieving this. Health policies and guidelines should consider re-evaluation to help communicate and impart potential choline benefits through diet and/or supplementation approaches across this critical life stage. Overall, most offspring would benefit from increased choline supply during the first 1000 days of life, particularly in relation to helping facilitate normal brain development. Findings suggest that supplementing the maternal or child’s diet with choline over the first 1000 days of life could subsequently: (1) support normal brain development (animal and human evidence), (2) protect against neural and metabolic insults, particularly when the fetus is exposed to alcohol (animal and human evidence), and (3) improve neural and cognitive functioning (animal evidence). In total, 813 publications were subject to the title/abstract review, and 38 animal and 16 human studies were included after evaluation. The database PubMed was used, and reference lists were searched. Therefore, a systematic review was performed to identify the animal and human studies looking at inter-relationships between choline, neurological development, and brain function during the first 1000 days of life. Of these, evidence for choline has been building but has not been widely collated using systematic approaches. During this period an adequate supply of nutrients are essential for proper neurodevelopment and lifelong brain function.
The foundations of neurodevelopment across an individual’s lifespan are established in the first 1000 days of life (2 years).
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