Food and Behaviour Research

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Choline - A Neglected Nutrient Vital for Healthy Brains - BOOK HERE

Prenatal choline supplementation improves child sustained attention: A 7-year follow-up of a randomized controlled feeding trial

Bahnfleth C, Strupp B, Caudill M, Canfield R (2022) FASEB Jan;36(1):e22054 doi: 10.1096/fj.202101217R 

Web URL: Read this and related articles on PubMed


Numerous rodent studies demonstrate developmental programming of offspring cognition by maternal choline intake, with prenatal choline deprivation causing lasting adverse effects and supplemental choline producing lasting benefits.

Few human studies have evaluated the effect of maternal choline supplementation on offspring cognition, with none following children to school age. Here, we report results from a controlled feeding study in which pregnant women were randomized to consume 480 mg choline/d (approximately the Adequate Intake [AI]) or 930 mg choline/d during the 3rd trimester.

Sustained attention was assessed in the offspring at age 7 years (n = 20) using a signal detection task that showed benefits of maternal choline supplementation in a murine model. Children in the 930 mg/d group showed superior performance (vs. 480 mg/d group) on the primary endpoint (SAT score, p = .02) and a superior ability to maintain correct signal detections (hits) across the 12-min session (p = .02), indicative of improved sustained attention.

This group difference in vigilance decrement varied by signal duration (p = .04). For the briefest (17 ms) signals, the 480 mg/d group showed a 22.9% decline in hits across the session compared to a 1.5% increase in hits for the 930 mg/d group (p = .04). The groups did not differ in vigilance decrement for 29 or 50 ms signals.

This pattern suggests an enhanced ability to sustain perceptual amplification of a brief low-contrast visual signal by children in the 930 mg/d group. This inference of improved sustained attention by the 930 mg/d group is strengthened by the absence of group differences for false alarms, omissions, and off-task behaviors.

This pattern of results indicates that maternal 3rd trimester consumption of the choline AI for pregnancy (vs. double the AI) produces offspring with a poorer ability to sustain attention - reinforcing concerns that, on average, choline consumption by pregnant women is approximately 70% of the AI.


Previously published results from this randomised controlled clinical trial have already shown benefits for the visual and cognitive development of infants during their first year of life if their mothers were suppemented with choline at twice the recommended daily intake (which the placebo group received). See:

This new study confirms that these advantages of early high-dose choline supplementation for children's brain development were still evident when the children reached 7 years of age.

These findings strongly indicate that the current dietary recommendations for 'adequate' choline intake are too low to support optimal brain development.  And yet choline intake for most of the general population - including 70-90% of pregnant women - falls below this level.

These are remarkable results, as clinical trials in humans are extremely difficult to achieve with such long-term follow up. 

They are also fully consistent with a huge body of existing evidence from animal studies, showing that choline deficiencies in early life permanently impair brain development and cognition.

For the related news article please see:

For further information on this topic please see:

These open-access reviews outline the functions of choline, its main dietary sources (primarily animal-derived foods), and the implications of deficiencies - particularly in early life, when these can permanently impair brain development and function according to an extensive body of pre-clinical and some human studies. 

Both explain why the ongoing failure of regulatory authorities to do more to recognise and raise awareness of the essentiality of choline - particularly in the face of low and declining intakes - is potentially a serious public health problem.
In this freely available online presentation, FAB's Dr Alex Richardson provides a summary overview of choline, with a particular focus on how DHA and choline work together for normal brain development. 

This talk also includes advance coverage of key findings from this newly published study (provided in advance by the authors), as well as its background and rationale.

See also: