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Health Significance of Insufficient Dietary Choline During the Human Lifecycle

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Micronutrients and Human Health".

Deadline for manuscript submissions: 25 September 2025 | Viewed by 349

Special Issue Editor


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Guest Editor
Department of Neonatology, University Children’s Hospital, 72076 Tübingen, Germany
Interests: critical nutrients; choline; essential fatty acids; lipid metabolism; cystic fibrosis; preterm infant nutrition; stable isotope labeling in vivo
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Choline has been approved as an essential nutrient, particularly important to liver development and function, in 1998, 2016, and 2023 by the Institute of Medicine (IOM) and the European Food Safety Authority (EFSA), respectively. For decades, researchers and clinicians have defined the roles of choline in development, homeostasis, and health care. Compared to veterinary medicine and animal breeding, where choline is intensely investigated and applied to promote the growth and health of farm animals, the findings on choline’s universal relevance have so far had no impact on clinical medicine. This means choline’s relevance to (1) parenchymal growth and maintenance, (2) one-carbon metabolism including epigenetics, and (3) its interrelation with vitamins (folate and cobalamin) and polyunsaturated fatty acids (arachidonic and docosahexaenoic acid) has not gained broad attention. Hence, larger clinical trials are still missing. This applies to (1) preterm infant development; disturbed enterohepatic cycles of bile (phosphatidyl)choline (2) in patients with exocrine pancreatic insufficient cystic fibrosis or (3) short bowel disease and small intestinal bacterial overgrowth; and (4) total parenteral nutrition (TPN) receiving regimens devoid of free choline. Additionally, (5) choline deficiency due to inferior nutrition habits and (6) genetic heterogeneity in endogenous choline synthesis by phosphatidylethanolamine-N-methyl transferase (PEMT) may impact clinical medicine. In this Special Issue, the (potential or verified) critical role of choline will be evaluated, with special focus on preterm infants, cystic fibrosis, TPN, and short bowel disease.

Dr. Wolfgang Bernhard
Guest Editor

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Keywords

  • pregnancy
  • preterm infants
  • fetal development
  • cystic fibrosis
  • short bowel disease
  • genetic variability
  • choline deficiency
  • hepatosteatosis

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Published Papers (1 paper)

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Research

21 pages, 2606 KiB  
Article
Choline in Pediatric Nutrition: Assessing Formula, Fortifiers and Supplements Across Age Groups and Clinical Indications
by Wolfgang Bernhard, Anna Shunova, Ute Graepler-Mainka, Johannes Hilberath, Cornelia Wiechers, Christian F. Poets and Axel R. Franz
Nutrients 2025, 17(10), 1632; https://doi.org/10.3390/nu17101632 - 9 May 2025
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Abstract
Background: Sufficient choline supply is essential for tissue functions via phosphatidylcholine and sphingomyelin within membranes and secretions like bile, lipoproteins and surfactant, and in one-carbon metabolism via betaine. Choline requirements are linked to age and genetics, folate and cobalamin via betaine, and [...] Read more.
Background: Sufficient choline supply is essential for tissue functions via phosphatidylcholine and sphingomyelin within membranes and secretions like bile, lipoproteins and surfactant, and in one-carbon metabolism via betaine. Choline requirements are linked to age and genetics, folate and cobalamin via betaine, and arachidonic (ARA) and docosahexaenoic (DHA) acid transport via the phosphatidylcholine moiety of lipoproteins. Groups at risk of choline deficiency include preterm infants, children with cystic fibrosis (CF) and patients dependent on parenteral nutrition. Fortifiers, formula and supplements may differently impact their choline supply. Objective: To evaluate added amounts of choline, folate, cobalamin, ARA and DHA in fortifiers, supplements and formula used in pediatric care from product files. Methods: Nutrient contents from commonly used products, categorized by age and patient groups, were obtained from public sources. Data are shown as medians and interquartile ranges. Results: 105 nutritional products including fortifiers, formula and products for special indications were analyzed. Choline concentrations were comparable in preterm and term infant formulas (≤6 months) (31.9 [27.6–33.3] vs. 33.3 [30.8–35.2] mg/100 kcal). Products for toddlers, and patients with CF, kidney or Crohn’s disease showed Choline levels from 0 to 39 mg/100 kcal. Several products contain milk components and lecithin-based emulsifiers potentially increasing choline content beyond indicated amounts. Conclusions: Choline addition is standardized in formula for term and preterm infants up to 6 months, but not in other products. Choline content may be higher in several products due to non-declared sources. The potential impact of insufficient choline supply in patients at risk for choline deficiency suggests the need for biochemical analysis of products. Full article
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