The investigation drew upon the epidemiological cross-sectional Latin American Study of Nutrition and Health (ELANS), extracting data for 3,704 women between the ages of 15 and 49 years from Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela.
A team of Latin American university researchers set out to assess both choline and essential fatty acid (EFA) intake by identifying food sources, the presence of supplements containing these nutrients and what potential policies would be adequate to address the deficiencies.
“Choline intake is inadequate for most ELANS women,” the study reported. “Achieving the recommended intake through diet alone is challenging, especially when diets are not as diverse as they should be or meet the required quantities. Regarding EFA, the results show adequate and even excessive intakes for the studied population; however, the sources are different from those shown over other regions of the world.”
The choline inadequacy
In addition to promoting overall maternal health, choline is vital for fetal brain development and a range of other baby making processes from building cellular membranes to engaging in epigenetic marks through the DNA methylation processes, synthesis and repair. It has even been found to offer protective effects against alcohol consumption during pregnancy.
Commenting independently on the study findings, Steven Zeisel, MD, PhD, choline expert and professor emeritus of nutrition and pediatrics at the University of North Carolina, Chapel Hill, said that the data from the well-constructed study looked very similar to the data in the United States collected by the Centers for Disease Control’s National Health and Nutrition Examination Survey (NHANES).
“In the current study, Latin American women of childbearing age are ingesting around 305 mg of choline a day, and the recommended intake in the United States is 450 mg for pregnant women,” he said. “And that is probably light in that there are studies in children where approximately twice that much had positive effects on cognitive development.”
He also noted evidence that choline intake during pregnancy reduces low birth weight in premature infants, where low birth weight is a primary cause for hospitalization and a burden on the healthcare system. In the United States, Colorado recently became the first state to approve coverage of choline supplements for eligible Medicaid members.
For their study, the Latin American researchers used the reference of 425 mg for non-pregnant women of childbearing age stipulated by the U.S. Institute of Medicine (IOM) Dietary Reference Intakes (DRI) standards.
They reported that close to 80% of the cohort considered was deficient in choline consumption across all countries. Chile had the lowest intake of 238.6 mg/day and the highest proportion of deficient consumption (95.4%). Colombia had the highest intake of 373.1 mg/day and the highest proportion of excessive intake (19%); however more than half of the Colombian women (55.2%) had deficient intake.
There were no significant differences in choline consumption parameters observed between age groups, socioeconomic status, educational level and marital status.
Considering consumption patterns, enhancing choline intake
The researchers highlighted the importance of diet diversity and adequacy of micronutrients in childbearing-age women but noted that 42.3% of women consumed from one to four food groups (e.g., non-diverse diet), and 30.4% consumed from five food groups (e.g., acceptable diet).
According to the ELANS analysis, the most consumed foods in the region were starchy staples (99.4%) and meat (84.2%). Eggs—a significant source of choline with one egg equivalent to about 200 mg—accounted for 35.6%. The least consumed foods were green leafy vegetables (6.8%) and nuts and seeds (2.8%).
Results indicated that some countries had more inadequate choline intake than others and that consuming a larger quantity of eggs helped reduce choline inadequacy, as did including eggs and fish in the diet. There were more consistent levels of choline intake from poultry across the countries studied, while choline consumption from fish and pork was more variable.
An analysis of most used prenatal multivitamin–mineral–nutrient supplements available in the eight ELANS countries revealed that none of the products in Argentina, Brazil, Chile, Colombia, Costa Rica, Peru or Venezuela contain choline or omega-6. At least one brand in each country declared the presence of omega-3 in their supplements.
Given the prevalence of deficiency and to guarantee the health of future generations in Latin America, the researchers called for regional policies and programs to enhance adequate choline and EFA intake during the pre-conceptional period through aid programs and education campaigns for women and healthcare providers.
“As reported in other studies, choline intake is largely deficient in pregnant women, which has deleterious effects on fetal brain development and the ability to concentrate and visual memory for school-age children,” they wrote. “Also, because of this poor choline intake pattern during pre-conceptional years, one can easily understand that when these women eventually become pregnant, they will likely continue these eating habits unless an intervention is strategically planned.”
Source: Nutrients
doi: 10.3390/nu16183150
“Inadequate Intake of Choline and Essential Fatty Acids in Latin American Childbearing-Age Women as a Regional Pre-Conceptional Disadvantage: ELANS Results”
Authors: Marianella Herrera-Cuenca et al.