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Choline and choline-related nutrients in regular and preterm infant growth

European Journal of Nutrition volume 58, pages 931–945 (2019)Cite this article

Abstract

Background

Choline is an essential nutrient, with increased requirements during development. It forms the headgroup of phosphatidylcholine and sphingomyelin in all membranes and many secretions. Phosphatidylcholine is linked to cell signaling as a phosphocholine donor to synthesize sphingomyelin from ceramide, a trigger of apoptosis, and is the major carrier of arachidonic and docosahexaenoic acid in plasma. Acetylcholine is important for neurodevelopment and the placental storage form for fetal choline supply. Betaine, a choline metabolite, functions as osmolyte and methyl donor. Their concentrations are all tightly regulated in tissues.

Clincal impact

During the fetal growth spurt at 24–34-week postmenstrual age, plasma choline is higher than beyond 34 weeks, and threefold higher than in pregnant women [45 (36–60) µmol/L vs. 14 (10–17) µmol/L]. The rapid decrease in plasma choline after premature birth suggests an untimely reduction in choline supply, as cellular uptake is proportional to plasma concentration. Supply via breast milk, with phosphocholine and α-glycerophosphocholine as its major choline components, does not prevent such postnatal decrease. Moreover, high amounts of liver PC are secreted via bile, causing rapid hepatic choline turnover via the enterohepatic cycle, and deficiency in case of pancreatic phospholipase A2 deficiency or intestinal resection. Choline deficiency causes hepatic damage and choline accretion at the expense of the lungs and other tissues.

Conclusion

Choline deficiency may contribute to the impaired lean body mass growth and pulmonary and neurocognitive development of preterm infants despite adequate macronutrient supply and weight gain. In this context, a reconsideration of current recommendations for choline supply to preterm infants is required.

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Abbreviations

ABC-A1:

Adenosine-triphosphate binding cassette transporter A1

AF:

Amniotic fluid

αGPC:

α-Glycerophosphocholine

AI:

Adequate intake

ApoA1:

Apolipoprotein A1

ARA:

Arachidonic acid

a.s.p.e.n.:

American Society for Parenteral and Enteral Nutrition

ATP:

Adenosine triphosphate

BHMT:

Betaine:homocysteine-N-methyltransferase

CDP-choline:

Cytidylyldiphosphocholine

CTP:

Cytidinetriphosphate

DHA:

Docosahexaenoic acid

ESPGHAN:

European Society for Paediatric Gastroenterology Hepatology and Nutrition

HDL:

High density lipoproteins

LC-PUFA:

Long-chain poly-unsaturated fatty acid

PC:

Phosphatidylcholine

PE:

Phosphatidylethanolamine

PEMT:

PE-N-methyltransferase

PMA:

Postmenstrual age

RDA:

Recommended dietary allowance

SAM:

S-adenosyl-methionine

SNP:

Single nucleotide polymorphism

SPH:

Sphingomyelin

TPN:

Total parenteral nutrition

UL:

Upper tolerable limit

VLDL:

Very low density lipoproteins

wk:

Weeks

VLBW:

Very low birth weight

ELBW:

Extremely low birth weight

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Acknowledgements

Funding was provided by Zentrum Ernährungsmedizin of the Medical Faculty of the University of Tuebingen and University of Hohenheim (Project no. E.1100008).

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Affiliations

  1. Department of Neonatology, Children’s Hospital, Faculty of Medicine, Eberhard-Karls-University, Calwer Straße 7, 72076, Tübingen, Germany

    Wolfgang Bernhard, Christian F. Poets & Axel R. Franz

  2. Center for Pediatric Clinical Studies, Children’s Hospital, Faculty of Medicine, Eberhard-Karls-University, Tübingen, Germany

    Axel R. Franz

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  1. Wolfgang Bernhard
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  2. Christian F. Poets
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Correspondence to Wolfgang Bernhard.

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Bernhard, W., Poets, C.F. & Franz, A.R. Choline and choline-related nutrients in regular and preterm infant growth. Eur J Nutr 58, 931–945 (2019). https://doi.org/10.1007/s00394-018-1834-7

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Keywords

  • Arachidonic acid
  • Betaine
  • Choline
  • Docosahexaenoic acid
  • Enteral nutrition
  • Essential nutrients
  • Fetal development
  • Growth spurt
  • Lean body mass
  • Membrane
  • Methyl donor
  • Nutrition
  • Parenchyma
  • Parenteral nutrition
  • Phosphatidylcholine
  • Preterm infant
  • Sphingomyelin