Marie Caudill, PhD, RDElizabeth Ward, MS, RD
CHOLINE: EXPLORING THE GROWING SCIENCE ON ITS BENEFITS FOR MOMS,
DURING FETAL DEVELOPMENT AND BEYOND
Wednesday, September 12, 2018
Internationally recognized expert known for her work on folate andcholine
Research focuses primarily on choline and the level of intake required to meet metabolic requirements and improve physiological outcomes
Published more than 100 papers, reviews or chapters in this area and is an editor on the popular graduate level textbook "Biochemical, Physiological, & Molecular Aspects of Human Nutrition”
Frequently invited to speak on topics related to methyl nutrients, one- carbon metabolism and nutritional genomics
MARIE CAUDILL, PHD, RDPROFESSOR, DIVISION OF NUTRITIONAL SCIENCES AT CORNELL UNIVERSITY
2
Award-winning author, nutrition consultant and spokesperson Author/co-author of seven books including her most
recent,“Expect the Best,Your Guide to Healthy Eating Before, During and After Pregnancy, 2nd ed.”
Frequently writes for several top-tier publications and maintains a website, Betteristhenewperfect.com
Previously a spokesperson for the Academy of Nutrition and Dietetics for nine years and was a writer and contributing editor for Environmental Nutrition, and a writer for WebMD
Counseled children, and pregnant women and other adults about healthy eating and disease prevention at Harvard Vanguard Medical Associates
Expert advisor to the HP Hood company 3
ELIZABETH WARD, MS, RDCONSULTANT AND AUTHOR
WEBINAR BROUGHT TO
4
1. Recognize the critical role choline plays in supporting positive health outcomes,particularly at important life stages such as during fetal development and beyond.
2. Translate scientific evidence into meaningful dietary recommendations to help boost choline intake.
3. Recommend foods and supplements that can help infants, women and other consumers improve choline intake to achieve research-backed health benefits.
LEARNING OBJECTIVES
5
6
CHOLINE IN THE LIFE CYCLE: THE ESSENTIAL NUTRIENT MORE PEOPLE NEED TO KNOWSTATE OF THE SCIENCE
MARIE A. CAUDILL, PHD, RDDIVISION OF NUTRITIONAL SCIENCESCORNELL UNIVERSITY
Grants/Research Support NIH, USDA, Balchem Corporation, Egg Nutrition Center, National Cattlemen’s Beef
Association/Beef Checkoff Other Financial or Material Support/Honorarium
Balchem Corporation
7
DISCLOSURES
Steven H. Zeisel
1932 1990s 1998
Charles H. Best 8
HISTORICAL TIDBITS
Phosphatidylcholine (PC)
PC PC
PC
VLDL Fat ExportMembrane Biosynthesis
WHAT DOES CHOLINE DO?
9
WHAT DOES CHOLINE DO?
Acetylcholine
10
WHAT DOES CHOLINE DO?
Methyl Donor
+
DNA Methylation
Creatine Phospholipids Hormones Neurotransmitters
11
CHOLINE PLAYS A FUNDAMENTAL ROLE IN HUMAN HEALTH ACROSS THE LIFE CYCLE12
CH3
CH3CH3
Learning
Memory
Attention
Fetal Growth Brain Development
Proteins Hormone
s Metabolites
LARGE AMOUNTS OF CHOLINE ARE REQUIRED DURING PREGNANCY
Cellular Function 13
Lasting Effects on Health
N=99OR=0.66 N=98
OR=0.63
N=80 OR=0.49
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
Shaw GM, et al. Am J Epidemiol. 2004;160:102-109. Shaw GM, et al. Epidemiology. 2009;20:714-719.
<290 290-371 371-498 >498 14
Choline Intake, mg/d
Odd
s
HIGHER MATERNAL CHOLINE INTAKE REDUCES RISK OF NEURAL TUBE DEFECTS
Categor
Hypothalamus
*
Infant Plasma Cortisol
PituitaryPlacenta
Adrenal Cortex Circulation
4035302520151050
Jiang X, et al. FASEB J. 2012;26:3563-3574.
HIGHER MATERNAL CHOLINE INTAKE EASES BABY’S RESPONSE TO STRESS
g/
Hypertension Obesity Diabetes DepressionCH3 CH3 CH3
“Choline” Baby
Memory Learning Attention
16
Jiang X, et al. FASEB J. 2012;26:3563-
LOWER PRODUCTION OF CORTISOL IN “CHOLINE BABIES” MAYREDUCE RISK OF STRESS-RELATED DISEASES
3574.
In PE, placenta produces too much Preeclampsia
Placenta
+FLT1
sFLT1 + VEGFVEGF VEGF
++ VEGF
-
Impaired VEGF binding to mFLT1
17
HIGHER MATERNAL CHOLINE INTAKE LOWERS PREECLAMPSIA RISK FACTOR
Endothelial dysfunction
Jiang X, et al. FASEB J. 2013;27:1245-1253.
Maternal hypertension Maternal kidney impairment
Choline Placenta
-FLT1 - VEGF VEGF
sFLT1 VEGF
-- VEGF
VEGF +
Endothelial cells
In PE, placenta produces too much
Normal VEGF binding to mFLT1
Jiang X, et al. FASEB J. 2013;27:1245-1253.
Endothelial health
mFL
T1
In PE, placenta produces too much
18
HIGHER MATERNAL CHOLINE INTAKE LOWERS PREECLAMPSIA RISK FACTOR
19
CON = control; SUP = supplementation.Meck WH,Williams CL. Neurosci Biobehav Rev. 2003;27:385-399.
HIGHER MATERNAL CHOLINE INTAKE IMPROVES OFFSPRING COGNITIVE FUNCTIONING (ANIMALS)
Administered a visual attention task to measure eye movement reaction time to sequences ofbriefly presented visual stimuli 20
HIGHER MATERNAL CHOLINE INTAKE IMPROVES INFANT INFORMATION PROCESSING SPEED (HUMANS)
• Attention• Memory• Problem Solving
ASN 2018Abstract Submission ID: 424013Abstract Title: “Enduring benefits of prenatal choline supplementation in 7-year olds: enhanced attention task performance”Presenting Author: Charlotte BahnflethOral Session Title:“Nutritional Implications for Brain and Cognition” (Oral 11)Oral Session Date: Sunday, June 10, 2018Oral Session Time: 10:30 AM - 12:30 PM 21
COGNITIVE ASSESSMENT IN THESE CHILDREN AT AGE 7 REVEAL LASTING BENEFITS OF THE HIGHER MATERNAL CHOLINE INTAKE
Oral Session Location: Hynes Convention Center, Room 210
480 mg/d choline930 mg/d choline
Studies are being conducted in pregnant women to address this important question.
Circulating PC- DHA Non-Pregnant Women
Tota
l PC-
Fatty
Acid
s, %
by
CHOLINE-DHA SYNERGY:A WAY TO INCREASE FETAL DHA SUPPLY?
22
West AA, et al. Am J Clin Nutr. 2013;97:718-727.
Choline AI is 450 mg/d Average choline intake is
~300- 350 mg/d Common genetic
variants increase choline requirements (further increasing gap between choline needs and intake)
ONLY 10 PERCENT OF US PREGNANT WOMEN ARE MEETING THE CHOLINE AI
23
24
VERY FEW OF THE MOST RECOGNIZED PRENATAL OR MULTIVITAMINS CONTAIN THE RECOMMENDED AMOUNT OF CHOLINE
25
THE AMERICAN MEDICAL ASSOCIATION (AMA) RECENTLY ANNOUNCED IT WILL SUPPORT ACTIONS TO BOOST CHOLINE AMOUNTS IN PRENATAL VITAMINS!
THE AMERICAN ACADEMY OF PEDIATRICS RECENTLY RECOGNIZED CHOLINE AS AKEY NUTRIENT TO SUPPORT NEURODEVELOPMENT DURING THE FIRST 1,000 DAYS
26
Large amounts of choline are required for normal fetal and neonatal development.
Higher maternal choline intake will likely improve pregnancy outcomes and offspring health.
Most pregnant and lactating women need to increase dietary choline intake orconsume a choline supplement to meet recommendations.
KEY TAKEAWAYS
27
HEALTH PROFESSIONALS AND CHOLINE COMMUNICATION: WHERE DO WE STAND?ELIZABETH WARD, MS, RD
28
Other Financial or Material Support/Honorarium Balchem Corporation
29
DISCLOSURES
600
500
400
300200
550 425
450
550 Recommended (AI)
Actual Intake
200
100
0Kids Men Women Pregnancy Lactation
NHANES 2009-2014 30
Source: http://cholinecouncil.com/health_professional/
mg/
MOST AMERICANS DO NOT ACHIEVE ADEQUATE INTAKE FOR CHOLINE
CHOLINE AND THE DIETARY GUIDELINES FOR
The 2015–2020 Dietary Guidelines for Americans Advisory Committee (DGAC) identified four nutrients with an Adequate Intake (AI) - vitamin K, fiber, potassium, and choline – that are under-consumed by children and adults.
https://health.gov/dietaryguidelines/2015-scientific-report/https://health.gov/dietaryguidelines/2015/guidelines/appendix-3/ 31
CHOLINE AND THE DIETARY GUIDELINES FOR
Of the four, only fiber and potassium were called out in the DGA as nutrients of public health concern.
In addition, almost all of the USDA Healthy U.S.-Style Eating patterns included in the 2015-2020 DGA lack adequate choline. They also lack potassium, and vitamins D and E.
https://health.gov/dietaryguidelines/2015-scientific-report/https://health.gov/dietaryguidelines/2015/guidelines/appendix-3/ 32
33
CHOLINE AND THE DIETARY GUIDELINES FOR
Federal food and nutrition health policies and programs are based on the DGA. For example: The Special Supplemental Nutrition Program for
Women, Infants and Children uses DGA to determine the contents of its food packages and nutrition education program.
The USDA's National School Lunch Program and School Breakfast Program, which feeds more than 30 million children each school day, are informed by the DGA.
CHOLINE AND THE DIETARY GUIDELINES FOR https://health.gov/dietaryguidelines/2015/guidelines/introduction/dietary-guidelines-for-americans/
THE CHOLINE
Vegans Vegetarians Mainstream eaters Pregnant and breastfeeding women with
any of these eating styles Pregnant women with aversions to
foods that are rich in choline
34
SELECTED CHOLINE
35
Egg yolk, large: 147 mg Ground beef, 3 oz. cooked: 85 mg Pork tenderloin, 3 oz. cooked: 83 mg Salmon, Atlantic, farmed, 3 oz. cooked: 77 mg Chicken breast, boneless, skinless, 3 oz. cooked: 65 mg Soybeans, ¼ cup roasted: 53 mg Broccoli, 1 cup cooked: 51 mg Garbanzo beans, ½ cup cooked: 35 mg
https://ndb.nal.usda.gov/ndb/nutrients/report?nutrient1=421&nutrient2=&nutrient3=&fg=&max=25&subset=0&offset=100&sort=c&totCount=4551&measureby=m
CREATING A CHOLINE-CENTRIC MEAL
36
CREATING A CHOLINE-CENTRIC MEAL
37
FOOD SUPPLEMENTS
“Nutritional needs should be met primarily from foods. … Foods in nutrient-dense forms contain essential vitamins and minerals and also dietary fiber and other naturally occurring substances that may have positive health effects. In some cases, fortified foods and dietary supplements may be useful in providing one or more nutrients that otherwise may be consumed in less-than-recommended amounts.”
Source: 2015-2020 Dietary Guidelines for Americans
38
FINDING CHOLINE ON FOOD The FDA has set the Reference Daily
Intake (RDI) for choline at 550 mg. Food labeling of choline content is voluntary. Foods with at least 55 mg of choline per serving are
considered a “good source” of the nutrient. Helpful in educating consumers about choline, and aiding
them in selecting foods that supply it.
https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-11867.pdf
39
CHOLINE IS IN SOME MULTIVITAMINS, BUT IN SMALL
40
RECOMMENDATION FOR
Multivitamin
41
SELECTING A CHOLINE Choline upper level of tolerance = 3,500 mg/d
Only contains 13% choline based on weight
SELECTING A CHOLINE 1 capsule = 300 mg choline 1 tablet = 500 mg choline 1 softgel = 50 mg choline
SPECIAL CONSIDERATIONS FOR CHOLINE:
Mammary cells are capable of uptake of choline from the maternal blood supply for transfer to the child.
Choline levels in breast milk are highest in mature milk. Infant formula contains choline.
43
CHOLINE FOR
Encourage choline-abundant foods. Pay particular attention to pregnant/lactating patients and those with vegetarian/vegan diets.
Evaluate each person for their usual intake, and fill in the gap with supplements.
CHOLINE FOR 44
Choline is important for mom and baby, and for everyone else in the family, too, and at every age.
45
COMMUNICATING “CHOLINE FOR LIFE”
Visit: VitaCholine.com
Subscribe to VitaCholine’s quarterly46
e-newsletter – The Choline Connectionhttps://confirmsubscription.com/h/d/
FOR MORE INFORMATION ON THE BENEFITS OF CHOLINE AT ALLAGES AND STAGES OF LIFE…
7189DEE61A851D3A
47
Visit: https://www.eggnutritioncenter.org/downloads/toolkits/Choline%20facts.pdf
FOR MORE INFORMATION ON THE BENEFITS OF CHOLINE AT ALLAGES AND STAGES OF LIFE…
48
THANK YOU!49
You must complete a brief evaluation of the program in order to obtain your certificate.The evaluation will be available for 1 year; you do not have to complete it today.Credit Claiming Instructions:1. Go to www.CE.TodaysDietitian.com/Choline OR Log on to
www.CE.TodaysDietitian.com, go to “My Courses” and click on the webinar title.
2. Click “Take Course” on the webinar description page.3. Select “Start/Resume Course” on the webinar description page. Complete
and submitthe Evaluation.
4. Download and print your certificate.
CREDIT CLAIMING
Please Note: If you access the Evaluation between 3-4 pm ET on 9/12, you may50
experience a slow connection due to a high volume of users.