Choline

ARTICLE

by Jack Norris, Registered Dietitian

Contents

• Introduction
• Summary and Recommendations
• Functions of Choline
• Choline Requirements
  • Choline and Heart Disease
  • Choline and Cancer
  • Choline and Chronic Disease
• Choline in Pregnancy and Infancy
  • Birth Defects
  • Child Cognitive Development
  • Breast Milk
• Choline and Cognitive Function in Adults
• Average U.S. Choline Intakes
• Sources of Choline for Vegans
• Choline in a 2,000-Calorie Vegan Menu
• Conclusion
• Bibliography

Introduction

Choline is an essential nutrient required for brain function, fat metabolism, and cell membrane health.

Humans make small amounts of choline in their liver but it’s not enough to meet needs and most choline comes from the diet. Foods contain choline in a number of different forms which include free choline, lecithin (also called phosphatidylcholine), sphingomyelin, glycerophosphocholine, and phosphocholine.

Although plant foods are generally lower in choline than animal foods, it’s found in small amounts in a wide range of plant foods. A vegan diet that emphasizes whole foods can provide enough choline.

Summary and Recommendations

Based on the limited research, 300 mg per day of choline, which should be typical on a vegan diet, may be adequate for most adults. But given the uncertainty, we recommend intakes that come closer to meeting the AI for this nutrient, especially for pregnant and nursing women. Many prenatal vitamins contain low amounts of choline and it may be necessary to supplement with additional choline in order to meet the DRI.

Because choline is toxic at very high intakes, and even moderately high intakes may be linked to cardiovascular disease, if you choose to take choline supplements stick with a low dose and aim to get most of your choline from food.

Functions of Choline

Choline is involved in metabolic processes and in maintaining the structure of cells.

• Most choline is used for synthesis of phospholipids which are an essential component of all cell membranes.
• Like the B vitamins folate and vitamin B12, choline functions as a methyl donor. These compounds are important in many steps of metabolism.
• Choline is needed to synthesize the lipoproteins involved in fat transport.
• Choline is needed to synthesize acetylcholine, a neurotransmitter involved in mood, memory, and muscle control.

Choline Requirements

The requirement for choline was discovered in the 1990s among people receiving total parenteral nutrition (TPN), which delivers nutrition directly into the bloodstream, bypassing digestion. Patients who were on TPN for long periods of time developed nonalcoholic fatty liver disease, which resolved when choline was added to their feeding regimen (Buchman1995; Buchman, 1992; Buchman, 2001). Without choline, the patients were unable to synthesize phosphatidylcholine, a compound needed for fat metabolism and transport (Hollenbeck, 2010).

The recommendation for choline is specified as an Adequate Intake (AI), which means there is insufficient information to establish an RDA. The AI for choline is 550 mg/day for men and 425 mg/day for women, but these numbers are based on very limited data. They are derived from a 1991 study at the University of North Carolina at Chapel Hill (Zeisel, 1991). When subjects consumed 50 mg or less of choline per day, they experienced markers of deficiency such as increased liver enzymes, a fatty liver, or elevated creatine phosphokinase (CPK) which indicates muscle deterioration. The deficiency symptoms resolved when the subjects were given supplements providing 500 mg of choline per day. The study didn’t look at the effects of choline intakes between 50 and 500 mg.

Since this study was published, five more studies on choline deficiency have been conducted at UNC Chapel Hill (da Costa, 2004; Fischer, 2007; da Costa, 2006; Fischer, 2010; Kohlmeier, 2005). In all these studies, deficiency was induced with diets that provided about 50 mg or less of choline. A large proportion of subjects developed markers of dysfunction within six weeks, indicating that few people can stay healthy on less than 50 mg/day of choline.

In one of these studies, just 138 mg of choline per 170 pounds of body weight was enough to return CPK function to normal, but the study involved a very small number of subjects, all of whom were men. And the study did not look at liver function (da Costa, 2004). In contrast, another study reported that 825 mg per 170 pounds of body weight was required to normalize liver function (Fischer, 2007). These differences may reflect the presence of genetic variants that increase or decrease the need for choline.

Premenopausal women were much less likely to develop choline deficiency-associated organ dysfunction. This might be explained by the fact that estrogen protects against the effects of a genetic mutation that raises choline requirements (da Costa, 2006; Fischer, 2010).

Choline can also be turned into betaine, another compound that acts as a methyl donor. Betaine can also be obtained directly from the diet, and it may somewhat reduce the need for dietary choline.

Vitamin B12 deficiency can interfere with production of choline and choline-containing phospholipids (Cherqaoui, 2013).

 

Table 1. DRI for CholineA
Age	Female (mg)	Male (mg)
0-6 mos	125	125
7-12 mos	150	150
1-3 yrs	200	200
4-8 yrs	250	250
9-13 yrs	375	375
14-18 yrs	400	550
≥ 19 yrs	425	550
Pregnant	450
Breastfeeding	550
A. DRIs, 1998.

Excessive choline intake is associated with fishy body odor, nausea, low blood pressure, and liver toxicity. The safe upper limit for choline intake is 3,500 mg per day.

Choline and Chronic Disease

Although recommendations for choline intake were established to protect against liver dysfunction, there has been a considerable amount of research looking at possible effects of choline on risk for cardiovascular disease, cancer, and dementia.

Choline and Heart Disease

Researchers have proposed that choline may protect against heart disease based on its functions in lipid metabolism and as a methyl donor. Methyl donors like choline, vitamin B12, and folate help lower homocysteine levels. Elevated homocysteine may be a risk factor for heart disease.

In the Framingham Offspring Study of 920 men and 1,040 women, higher intakes of choline (above 339 mg/day vs an average intake of 313 mg/day) were significantly associated with slightly lower homocysteine levels (Cho, 2006). And in a cross-sectional study from Greece, subjects with choline intakes above 310 mg had lower markers of inflammation (C-reactive protein, interleukin-6, and tumor necrosis factor), than those consuming less than 250 mg (Detopoulou, 2008). Betaine intakes above 350 mg resulted in lower homocysteine and tumor necrosis factor compared to intakes below 260 mg.

In the Dutch arm of the European Prospective Investigation into Cancer and Nutrition (EPIC), higher choline (365 mg versus 239 mg/day) and folate intakes, but not betaine intake, were associated with modestly lower homocysteine levels. But they weren’t associated with the incidence of cardiovascular disease (Dalmeijer, 2008).

There was no relationship between higher intakes of choline (which ranged from 300 to 500 mg per day) and heart disease events in the Atherosclerosis Risk in Communities study, which followed more than 14,000 adult subjects for 14 years (Bidulescu, 2007). Finally, an analysis of 72,348 women in the Nurses’ Health Study and 44,504 men in the Health Professionals Follow-up Study found no association between choline intake and peripheral artery disease (Bertoia, 2014).

Despite its effects on homocysteine levels and possibly on inflammatory markers, there is little evidence to suggest a protective effect of choline against cardiovascular disease.

Choline as a Risk Factor for Heart Disease

While most research has focused on potential impacts of inadequate choline, it’s also been suggested that high intakes of choline could raise the risk for heart disease through its conversion to trimethylamine N-oxide (TMAO). Choline is converted to trimethylamine (TMA) by intestinal bacteria and this in turn is absorbed and converted by the liver to TMAO. Some research has linked TMAO to risk for cardiovascular disease (Zheng, 2016; Zeisel, 2017; Cho, 2017).

Researchers from the Cleveland Clinic and University of California at Los Angeles (Wang, 2011) compared compounds in plasma taken from people who experienced death or a heart attack or stroke in the three years following an elective heart evaluation. They compared it to the compounds in plasma taken from age- and gender-matched subjects who did not experience these events. There were 18 compounds that were higher in plasma from the first group, including choline, betaine, and TMAO.

The researchers reported that all three of these compounds showed a dose-dependent association with cardiovascular disease in a large clinical study, the Learning and Validation Cohorts. Further research found that lecithin from eggs increased TMAO production and that higher TMAO blood levels were associated with an increase in major adverse cardiac events (Tang, 2013).

In contrast, a 2017 meta-analysis of six prospective studies did not find an association between choline or betaine intake and cardiovascular disease (Meyer, 2017). Since the relationship of TMAO to cardiovascular disease risk isn’t yet completely clear, it’s too soon to draw any conclusions about high intake of choline as a risk factor (Cho, 2017).

Choline and Cancer

Numerous studies have looked for correlations between choline and various cancers but nothing can be concluded without significantly more evidence (Cho & Holmes, 2007; Cho & Willett, 2007; Johansson, 2009; Lee, 2010; Xu, 2009; Xu, 2008).

Choline in Pregnancy and Infancy

Note: I used AI for the literature review, data analysis, claim verification, and editing of this section. Last updated: June 2026.

Choline is required for the development of the central nervous system and plays other important roles in pregnancy (Korsmo, 2019). Because of choline’s importance, the American Medical Association recommends that prenatal supplements should include choline.

Birth Defects

Dietary Intake Studies. Several studies have examined periconceptional dietary choline intake and NTD risk, with inconsistent results, largely explained by whether they were conducted in a region with our without folic acid food fortification which reduces neural tube defects (see Folic acid reduces neural tube defects). One pre-fortification study found a protective association at high choline intakes (Shaw, 2004), while two post-fortification studies found no significant association (Carmichael, 2010; Petersen, 2023). One study found an association between higher choline intake and reduced risk of cleft lip (Shaw, 2006), though choline intakes across all quartiles were well below the current pregnancy AI. Details of these studies are provided in the Bibliography.

Serum Choline Studies. One study found an association between lower serum choline in pregnant mothers and NTDs (Shaw, 2009), while another found no correlation between plasma choline and NTDs (Mills, 2014). Because blood choline isn’t necessarily a direct measure of choline intake, we won’t analyze these studies in detail here, though more details are provided in the Bibliography.

Child Cognitive Development

A systematic review by Gould et al. (2025) identified four RCTs and five observational studies of prenatal choline and child neurodevelopment. Most outcomes across both study types were null. The trials reporting a benefit each tested multiple outcomes, most of which showed no group differences between the treatment and control groups. The reviewers cited small sample sizes, high attrition, experimental (non-validated) outcome measures, and selective reporting as limitations that undermine confidence in the positive findings. The review was partially funded by Australian Eggs Ltd, although the authors declared no conflict of interest.

One study included in the review by Gould et al. is worth mentioning: a small RCT found that children whose mothers consumed 930 mg/d of choline (approximately twice the AI and well above typical intakes) during the third trimester performed better on a sustained attention task at age 7 than children whose mothers consumed approximately the AI (Bahnfleth, 2022).

Breast Milk

Although a woman’s choline intake may affect levels in breast milk (Davenport2015), a study of 74 healthy lactating women found no difference in levels of water-soluble choline (the predominant form of choline in breast milk) among women following vegan, vegetarian, and non-vegetarian diets (Perrin, 2019).

Choline Cognitive Function in Adults

In the Framingham Offspring Study, higher intakes of choline were associated with better verbal and visual memory among adults (Poly, 2011). But a 2015 systematic review of 13 studies found no improvements in cognitive function among healthy adults who took choline supplements (Leermakers, 2015). In addition, a 2004 Cochrane review of clinical studies that looked at lecithin supplementation in people with memory loss, Alzheimer’s Disease, or Parkinson dementia found no clear benefits (Higgins, 2004).

At this time, there is no evidence to suggest that lower choline intakes are a risk for dementia or that supplements of lecithin or other choline compounds are useful for preventing dementia.

Average U.S. Choline Intakes

Estimates of choline intakes are based on a USDA database that includes more than 630 food items. Based on food intake data from the National Health and Nutrition Examination Survey (NHANES), estimated usual choline intakes among non-pregnant, non-lactating adults is found to be just over 300 mg of choline per day (Wallace, 2016). The findings indicate that only 10% of Americans and 8% of pregnant women meet choline recommendations.

An older study by researchers from the University of North Carolina at Chapel Hill found much higher intakes (Fischer, 2005). In their small study of 32 adults, the average choline intake was close to the recommended intake for women and exceeded the recommendations for men.

No studies have looked at choline intake of vegetarians or vegans.

Sources of Choline for Vegans

While we don’t have studies of choline intake among vegans, we do know that a vegan diet can provide adequate choline. The USDA database of the choline content of foods shows small but consistent amounts across a range of plant foods. Plant foods that are especially rich in choline include tofu, soynuts, soymilk, cruciferous vegetables, cooked dried beans, quinoa, peanuts, and peanut butter. It’s unclear how much choline is in more processed vegan foods because it hasn’t been measured. See a list of vegan foods and their choline content in Table 2, as well as a sample vegan menu in Table 3.

In addition, plant foods can be good sources of betaine, a compound that can serve as a methyl donor in place of choline in some cases. Betaine is named after beets, and supplements of this compound are often a byproduct of sugar beet processing. Quinoa, spinach, sweet potatoes, beets, and wheat-based breads, crackers, breakfast cereals, and pasta appear to be much higher in betaine than other plant foods.

Note that the USDA database shows the amount of choline per 100 g of food, which may not always reflect a typical serving size. For example, 100 g of wheat germ provides 180 mg of choline. But that would be more than 3/4 cup of wheat germ. A more usual 2-tablespoon serving of wheat germ provides around 27 mg of choline.

Despite the lower choline content of plant foods overall, it is possible to meet the DRI by eating several servings of legumes, including soyfoods and peanuts, and plenty of cruciferous vegetables. Depending on dietary intake, some vegans may need to take a choline supplement to reach the DRI.

 

Table 2. Food Sources of CholineA
Food	Choline (mg)
Soymilk, original and vanilla, unfortified, 1 cup	57.3
Potatoes, red, baked, flesh and skin, 1 large	56.5
Roasted soynuts, ¼ cup	53
Kidney beans, canned, ½ cup	45
Quinoa, cooked, 1 cup	43
Navy beans, cooked, boiled, ½ cup	40.7
Collards, cooked, boiled, ½ cup	36.5
Tofu, firm, prepared with calcium sulfate and magnesium chloride (nigari), ½ cup	35.4
Chickpeas, cooked, boiled, ½ cup	35.1
Lentils, cooked, boiled, ½ cup	32.4
Brussels sprouts, boiled, ½ cup	32
Broccoli, boiled, ½ cup	31.3
Pinto beans, cooked, ½ cup	30.2
Black beans, cooked, boiled, ½ cup	28.1
Shiitake mushrooms, cooked, ½ cup	26.7
Wheat germ, 2 tbsp	25.3
Soy protein powder, 1 oz	24
Peanuts, dry roasted, ¼ cup	24
Cauliflower, boiled, ½ cup	24
Peas, boiled, ½ cup	24
Peanut butter, smooth, 2 tbsp	20
Orange, 1 large	15.5
Almonds, dry roasted, 1 oz	15
Tomato sauce, ½ cup	12.2
Carrot juice, canned, ½ cup	11.7
Banana, raw, 1 medium	11.6
Oatmeal, instant, fortified, plain, prepared with water, 1 cup	11
Walnuts, English, 1 oz	11
Potatoes, boiled, with skin, ½ cup	10.5
Dates, medjool, 4	9.5
Bread, whole-wheat, commercially prepared, 1 slice	8.7
Zucchini, boiled, ½ cup	8.5
Spaghetti, cooked, enriched, 1 cup	8
Apples, raw, with skin, 1 large	7.6
Tahini, 2 tbsp	7.6
Lettuce, cos or romaine, 1 ½ cups	7
Avocado, ¼ cup cubes	5.4
A. USDA, 2019.

 

 

Table 3. Choline in a 2,000-Calorie Vegan MenuA
Breakfast	Choline (mg)	Calories
1 cup oatmeal, cooked in water	17.3	166
2 tablespoons chopped English walnuts	5.8	96
1 tablespoon wheat germ	25.3	54
1 banana	11.6	105
1 cup soy milk	57	104
Total	117	525
Snack
1 navel orange	11.8	69
1/4 cup dry-roasted almonds	18	206
Total	29.8	275
Lunch
2 corn tortillas	6.4	104
1 cup pinto beans	60.4	245
1/2 cup cooked sliced portobello mushrooms	19.9	18
1/4 cup sliced avocado	5.2	59
1/4 cup sliced tomatoes	3	8
Total	94.9	434
Snack
1/2 cup raw sliced carrots	5.35	25
1/2 cup raw cauliflower florets	23.7	13
1/4 cup hummus	17.1	109
Total	46.15	147
Dinner
1 cup cooked quinoa	42.6	222
1 cup cooked broccoli	62.6	55
1 cup tofu	71.4	188
1/4 cup peanut sauce (includes 2 tablespoons peanut butter)	20.2	191
Total	196.8	656
Daily Total	485	2,037
A. USDA, 2019.

Conclusion

Given the small amount of evidence on which the DRI for choline is based and that most people don’t meet the DRI for choline, we believe it’s probably unnecessary for vegans to worry about meeting the DRI for choline as long as you’re eating a few servings of higher choline foods each day. People who might become pregnant should probably take a modest choline supplement just to be absolutely sure they’re getting enough. Although studies have not assessed choline status in vegan babies, there have been no reports of choline deficiency symptoms in infants in vegan families.

Bibliography

Bahnfleth CL, Strupp BJ, Caudill MA, Canfield RL. Prenatal choline supplementation improves child sustained attention: A 7-year follow-up of a randomized controlled feeding trial. FASEB J. 2022 Jan;36(1):e22054. | Bahnfleth et al. (2022, United States) assessed the sustained attention task (SAT) ability in 20 children aged 7 years whose mothers had participated in an RCT from week 27 of pregnancy to delivery. Both the treatment and control groups received a controlled diet of ~380 mg choline/d. The control group also received a supplement of 100 mg of choline to approximately match the Adequate Intake of 480 mg, while the treatment group received a supplement of 550 mg, for a total of 930 mg/day. The primary outcome, SAT, differed between the control and treatment groups (0.56 vs. 0.71; p=.02). This dose of choline is well above typical dietary intake. First author, CL Bahnfleth, received a Young Investigator Research Award from the Egg Nutrition Center (which doesn’t negate the findings but should be noted). A 14-year follow-up of the same cohort completed data collection; results were to be submitted in the fall of 2025 but, as of June 2026, had yet to be published (Roth, 2025).

Bertoia ML, Pai JK, Cooke JP, Joosten MM, Mittleman MA, Rimm EB, Mukamal KJ. Plasma homocysteine, dietary B vitamins, betaine, and choline and risk of peripheral artery disease. Atherosclerosis. 2014 July ; 235(1): 94–101.

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Carmichael SL, Yang W, Shaw GM. Periconceptional nutrient intakes and risks of neural tube defects in California. Birth Defects Res A Clin Mol Teratol 2010;88:670-8. | Carmichael et al. (2010) found that in a post-fortification California population, dietary choline intake across the full observed range showed no significant association with NTD risk in either direction (the 25th–75th percentile range was 293–506 mg/d; mean values within categories weren’t reported). The study can’t tell us where any meaningful threshold might be, or whether one exists at all in a folate-replete population.

Caudill MA. Pre- and postnatal health: evidence of increased choline needs. J Am Diet Assoc. 2010 Aug;110(8):1198-206. | Not cited.

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Cho CE, Caudill MA. Trimethylamine-N-Oxide: Friend, Foe, or Simply Caught in the Cross-Fire? Trends Endocrinol Metab 2017;28:121-130.

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Leermakers ET, Moreira EM, Kiefte-de Jong JC, Darweesh SK, Visser T, Voortman T, Bautista PK, Chowdhury R, Gorman D, Bramer WM, et al. Effects of choline on health across the life course: a systematic review. Nutr Rev 2015;73:500-22

Meyer KA, Shea JW. Dietary Choline and Betaine and Risk of CVD: A Systematic Review and Meta-Analysis of Prospective Studies. Nutrients 2017;9.

Mills JL, Fan R, Brody LC, Liu A, Ueland PM, Wang Y, Kirke PN, Shane B, Molloy AM. Maternal choline concentrations during pregnancy and choline-related genetic variants as risk factors for neural tube defects. Am J Clin Nutr 2014;100:1069-74. | Found no association between maternal choline status and risk of a neural tube defect, though this study measured mid-pregnancy plasma choline rather than periconceptional dietary intake, which is the more relevant exposure.

Perrin MT, Pawlak R, Allen LH, Hampel D. Total water-soluble choline concentration does not differ in milk from vegan, vegetarian, and nonvegetarian lactating women. J Nutr 2019;000:1–6.

Petersen JM, Smith-Webb RS, Shaw GM, et al.; National Birth Defects Prevention Study. Periconceptional intakes of methyl donors and other micronutrients involved in one-carbon metabolism may further reduce the risk of neural tube defects in offspring: a United States population-based case-control study of women meeting the folic acid recommendations. Am J Clin Nutr. 2023 Sep;118(3):720-728. | Petersen et al. (2023) used data from the National Birth Defects Prevention Study to examine whether periconceptional intakes of eight one-carbon metabolism micronutrients — including choline, betaine, vitamins B6 and B12, methionine, riboflavin, thiamine, and zinc — were associated with NTD risk in women already meeting folic acid recommendations. Although choline intake wasn’t associated with NTD risk, roughly 95% of participants consumed at least 200 mg/day, leaving a very small lower-intake reference group and making it difficult to draw meaningful conclusions about choline’s role.

Poly C, Massaro JM, Seshadri S, Wolf PA, Cho E, Krall E, Jacques PF, Au R. The relation of dietary choline to cognitive performance and white-matter hyperintensity in the Framingham Offspring Cohort. Am J Clin Nutr 2011;94:1584-91.

Roth SA, Lam AE, Strupp BJ, Canfield RL, Larson EA. The Effect of Maternal Choline Intake on Offspring Cognition in Adolescence: Protocol for a 14-year Follow-Up of a Randomized Controlled Feeding Trial. JMIR Res Protoc. 2025 Jul 11;14:e73508.

Savendahl L, Mar MH, Underwood LE, Zeisel SH. Prolonged fasting in humans results in diminished plasma choline concentrations but does not cause liver dysfunction. Am J Clin Nutr. 1997 Sep;66(3):622-5. | Not cited.

Shaw GM, Carmichael SL, Yang W, Selvin S, Schaffer DM. Periconceptional dietary intake of choline and betaine and neural tube defects in offspring. Am J Epidemiol. 2004 Jul 15;160(2):102-9. | Shaw et al. (2004) used data from a California case-control study of births from 1989–1991, prior to mandatory folic acid fortification, to examine whether periconceptional dietary intake of choline and betaine was associated with NTD risk. Women in the highest quartile of choline intake (>498 mg/d) had roughly half the odds of an NTD-affected pregnancy compared to those in the lowest quartile of < 290 mg/d (0.49, 0.27–0.90). However, the continuous measure of choline intake was not statistically significant, suggesting the relationship may not be linear and that the finding is driven by contrasts between intake extremes. The pre-fortification context limits the relevance of these findings to modern populations, in which folic acid-sensitive NTDs have already been substantially reduced. No multiplicity correction was applied across the multiple outcomes and nutrients tested.

Shaw GM, Carmichael SL, Laurent C, Rasmussen SA. Maternal nutrient intakes and risk of orofacial clefts. Epidemiology 2006;17:285-91. | Shaw et al. (2006) used data from the National Birth Defects Prevention Study to examine whether periconceptional dietary intake of choline and several other nutrients was associated with risk of cleft lip with or without cleft palate (CLP) or cleft palate alone (CP) in offspring. Women in the highest quartile of choline intake (>265 mg/d) had a lower risk of having a child with CLP than those in the lowest quartile (< 141 mg/d; 0.57, 0.42–0.77). No significant association was found for CP. However, many nutrients were tested, and no multiplicity correction was applied. Choline intakes across all quartiles were well below the current pregnancy AI of 450 mg/d, preventing us from assessing whether intakes greater than 450 mg/d would be preventative.

Shaw GM, Finnell RH, Blom HJ, Carmichael SL, Vollset SE, Yang W, Ueland PM. Choline and risk of neural tube defects in a folate-fortified population. Epidemiology. 2009 Sep;20(5):714-9. | Shaw et al. (2009) measured mid-pregnancy serum total choline in 80 NTD-affected pregnancies and 409 controls drawn from a California serum bank of over 180,000 pregnant women (2003–2005), making it the first study to directly assess serum choline in NTD-affected pregnancies. Women in the lowest quartile of serum choline had nearly twice the odds of an NTD-affected pregnancy compared to the middle group (OR 1.8, 95% CI 1.1–3.0), while those in the highest quartile had roughly half the odds (OR 0.4, 95% CI 0.2–0.9), with a highly significant linear trend (p=0.0006; not FDR-corrected, but should easily survive). Notably, no other analyte — including folate, B12, and homocysteine — was significantly associated with NTD risk, consistent with a post-fortification population. The critical limitation is that serum was collected at 15–18 weeks gestation, approximately 12 weeks after neural tube closure, so mid-pregnancy choline levels may not accurately reflect periconceptional status, which is the biologically relevant exposure window.

Tang WHW, Wang Z, Levison BS, Koeth RA, Britt EB, Fu X, Wu Y, Hazen SL. Intestinal Microbial Metabolism of Phosphatidylcholine and Cardiovascular Risk. N Engl J Med 2013(April 25, 2013);368:1575-1584.

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Wallace TC, Blusztajn JK, Caudill MA, Klatt KC, Natker E, Zeisel SH, Zelman KM. Choline: The Underconsumed and Underappreciated Essential Nutrient. Nutr Today 2018;53:240-253. | Not cited.

Wallace TC, Fulgoni VL, 3rd. Assessment of Total Choline Intakes in the United States. J Am Coll Nutr 2016;35:108-12.

Wang Z, Klipfell E, Bennett BJ, Koeth R, Levison BS, Dugar B, Feldstein AE, Britt EB, Fu X, Chung YM, Wu Y, Schauer P, Smith JD, Allayee H, Tang WH, DiDonato JA, Lusis AJ, Hazen SL. Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease. Nature. 2011 Apr 7;472(7341):57-63.

Wiedeman AM, Barr SI, Green TJ, Xu Z, Innis SM, Kitts DD. Dietary Choline Intake: Current State of Knowledge Across the Life Cycle. Nutrients 2018;10. | Not cited.

Wu BT, Dyer RA, King DJ, Richardson KJ, Innis SM. Early second trimester maternal plasma choline and betaine are related to measures of early cognitive development in term infants. PLoS One 2012;7:e43448.

Xu X, Gammon MD, Zeisel SH, Lee YL, Wetmur JG, Teitelbaum SL, Bradshaw PT, Neugut AI, Santella RM, Chen J. Choline metabolism and risk of breast cancer in a population-based study. FASEB J. 2008 Jun;22(6):2045-52. Epub 2008 Jan 29.

Xu X, Gammon MD, Zeisel SH, Bradshaw PT, Wetmur JG, Teitelbaum SL, Neugut AI, Santella RM, Chen J. High intakes of choline and betaine reduce breast cancer mortality in a population-based study. FASEB J. 2009 Nov;23(11):4022-8. Epub 2009 Jul 27.

Zheng Y, Li Y, Rimm EB, Hu FB, Albert CM, Rexrode KM, Manson JE, Qi L. Dietary phosphatidylcholine and risk of all-cause and cardiovascular-specific mortality among US women and men. Am J Clin Nutr 2016;104:173-80.

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