Featured article | July 2026
Future Directions in Choline: From Neurodevelopment to Cardiometabolic Health
Paules, E.M., et al. (2025). Nutrients, 17(22), 3618.
This review article explores the role of choline in human health summarizig current knowledge about choline’s biochemical functions, its importance throughout the lifespan, and emerging evidence in neurodevelopment and cardiometabolic health.
Discussed in the article:
Choline serves as the building block for acetylcholine
- Choline is converted into the neurotransmitter acetylcholine.
- Acetylcholine is essential for memory, learning, attention, muscle contraction, and autonomic nervous system function.
Choline builds and maintains cell membranes
- Choline is required to produce phosphatidylcholine, one of the body’s major membrane phospholipids.
- Phosphatidylcholine supports membrane structure, fluidity, repair, and cell signaling.
Choline supplies methyl groups for one-carbon metabolism
- Choline is converted into betaine, an important methyl donor.
- Betaine supports the conversion of homocysteine to methionine.
- This pathway contributes to the production of S-adenosylmethionine (SAM), the body’s primary methyl donor.
- Methylation reactions influence many metabolic processes.
Choline helps regulate gene expression
- Choline contributes to DNA methylation and epigenetic regulation.
- Epigenetic changes influence gene expression without altering DNA sequence.
- These mechanisms are particularly important during fetal development.
Choline supports fetal brain development
- Choline supports neuronal growth, membrane formation, and synapse development.
- Certain phosphatidylcholine molecules carry docosahexaenoic acid (DHA), a long-chain omega-3) in the bloodstream.
- These DHA-containing phosphatidylcholine molecules are preferentially transported across the placenta, delivering DHA to the developing fetal brain where it is incorporated into neuronal cell membranes.
- Clinical studies have demonstrated improvements in several measures of offspring cognitive function.
- Pregnancy remains the strongest evidence-based application for choline.
Choline protects the liver by exporting fat
- Phosphatidylcholine is required to assemble very-low-density lipoproteins (VLDL).
- VLDL transports triglycerides from the liver into circulation.
- Inadequate choline intake can contribute to fat accumulation in the liver.
Choline requirements may increase in obesity
- Obesity alters lipid metabolism and one-carbon metabolism (the interconnected pathways that support methylation reactions and phosphatidylcholine synthesis).
- These metabolic changes may increase physiological choline requirements.
- Current Adequate Intake values may not fully reflect these altered needs.
Adequate intakes for choline
Amounts established by the U.S. National Academies to provide sufficient choline to maintain normal physiological function and prevent signs of deficiency.
Adult men 550 mg/day
Adult women 425 mg/day
Pregnancy 450 mg/day
Lactation 550 mg/day
Most adults fail to achieve the Adequate Intake for choline, with inadequate intake being particularly common during pregnancy.
Why it matters
This review reinforces that choline is a fundamental nutrient involved in several core biochemical pathways. For clinicians and nutrition professionals, choline should be viewed as a systems-level nutrient whose physiological effects extend across multiple organ systems.
“There are windows of time when choline demand is particularly high, such as during pregnancy, and evidence supports that targeted supplementation during this period is both beneficial and safe.”
