Popularity of vegan diets may contribute to choline deficiency, report says
Writing in the British Medical Journal, Dr Emma Derbyshire speaks of the ‘unintended consequences’ of switching to a meat-free diet that may leave followers deficient in the vitamin-like nutrient choline.
“The mounting evidence of choline’s importance makes it essential that it does not continue to be overlooked in the UK,” she says.
“This is now more important than ever given that accelerated food trends towards plant-based diets/veganism could have further ramifications on choline intake/status.
“Government bodies and organisations should look to extended datasets to include this essential nutrient.”
Choline is present in foods such as meat, eggs, poultry, fish, and dairy products but is also found in foods like potatoes, Brussels sprouts, broccoli, and cauliflower.
The nutrient is important for the brain and nervous system, where it plays a role in regulating memory, mood and muscle control.
Choline also plays a role in forming the membranes surrounding the body’s cells. While the liver produces a small amount of choline, most of the nutrient comes from consumed food.
The European Food Safety Authority (EFSA) recognise that choline plays an important role in the human body and have established dietary reference values.
Here, the Authority recommends that for all adults, an Adequate Intake (AI) of 400 milligrams per day (mg/day) is adequate.
Dr Derbyshire points to current trends that veer towards meat reduction and plant-based diets, referencing the 2019 EAT-Lancet publication that describes a healthy food plan based on promoting environmental sustainability.
However, the restriction of foods such as whole milk, eggs and animal protein could impact on choline intakes and status, where Dr Derbyshire urges further study to ascertain its impact on health.
The emphasis in the report is the need for more research in the UK, which the country does not include choline in food composition databases, main nutrition surveys nor official recommendations.
Given the important physiological roles of choline and authorisation of certain health claims it is questionable why choline has been overlooked for so long in the UK, the report states.
In contrast, Australia has expanded its AUSNUT 2011–13 database to include Australian choline values.
Here, composite foods, and ‘not further-specified foods’, were developed using the Food Standards Australia New Zealand (FSANZ) recipe files.
When applied it was discovered that less than 10% of the population achieved the AI for choline, where eggs again were identified as the top choline contributor.
McCance & Widdowson database
The report also describes similar approaches that the UK could adopt. The McCance and Widdowson database is one example having been updated in 2019, where choline was not included.
“These data could be embedded, used to quantify habitual intakes in the UK, and be reported alongside other B vitamins such as folate in the National Diet and Nutrition Survey,” suggests Dr Derbyshire.
“Likewise, now the time may also be right for a Scientific Advisory Committee on Nutrition call, relating to the inclusion of choline as part of UK Dietary Guidelines.”
She concludes her report with a series of recommendations that point to a long-term study of choline intake using food frequency questionnaires rather than 24-hour recalls.
Dr Derbyshire also stated the need to do more to educate health care professionals and consumers about the importance of a choline-rich diet and how to achieve this.
“If choline is not obtained in the levels needed from dietary sources per se then supplementation strategies will be required,” she says.
“This is especially in relation to key stages of the life-cycle such as pregnancy, when choline intakes are critical to infant development.”
Source: BMJ Nutrition, Prevention & Health
Published online: doi: 10.1136/bmjnph-2019-000037
“Could we be overlooking a potential choline crisis in the United Kingdom?”
Authors: Emma Derbyshire