The Case for Establishing Choline Intake Recommendations Throughout Europe—A Narrative Review on the Importance of Choline for the European Population

Choline is an essential nutrient whose physiological importance has not yet been sufficiently recognized by many European nutrition authorities. Despite convincing evidence of its crucial role in liver lipid export, one-carbon metabolism, cell membrane integrity, and nervous system development, explicit dietary recommendations for choline are still lacking in most European countries. In contrast, its importance has long been recognized in the national guidelines of the United States, Australia, China, and other regions. The current and rapidly spreading dietary shifts toward plant-based and vegan diets—characterized by a lower proportion of animal foods, the main sources of choline—increase the risk of suboptimal intake in broad segments of the population. Given the considerable interindividual differences in endogenous choline biosynthesis, which are influenced by sex hormones, physical activity, nutrient interactions, and genetic polymorphisms, adequate dietary intake is essential to meet physiological needs, especially during periods of increased demand such as pregnancy, lactation, and high-performance sports. This narrative review summarizes the evidence for the essentiality of choline, outlines the rationale for deriving intake recommendations for different life stages, and identifies an urgent need for coordinated action by European nutrition societies to address the growing risk of population-wide undersupply.