Plasma choline concentration was not increased after a 6-month egg intervention in 6–9-Month-old Malawian children: results from a randomized controlled trial

Authors: BRAGG, MEGAN - University Of California, Davis; PRADO, ELIZABETH - University Of California, Davis; ARNOLD, CHARLES - University Of California, Davis; ZYBA, SARAH - University Of California, Davis; MALETA, KENNETH - University Of Malawi; Caswell, Bess; Bennett, Brian; IANNOTTI, LORA - Washington University; LUTTER, CHESSA - University Of Maryland; STEWART, CHRISTINE - University Of California, Davis

Submitted to: Current Developments in Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/14/2021
Publication Date: 2/23/2022
Citation: Bragg, M.G., Prado, E.L., Arnold, C.D., Zyba, S.J., Maleta, K.M., Caswell, B.L., Bennett, B.J., Iannotti, L.L., Lutter, C.K., Stewart, C.P. 2022. Plasma choline concentration was not increased after a 6-month egg intervention among 6-9-month old Malawian children: Results from a randomized controlled trial. Current Developments in Nutrition. 6(2). Article nzab150. https://doi.org/10.1093/cdn/nzab150.
DOI: https://doi.org/10.1093/cdn/nzab150

Interpretive Summary: The primary objective for this analysis was to evaluate the effect of provision of one egg per day for six months on plasma choline concentration among Malawian children age 6-9 months at baseline. We hypothesized that children in the egg intervention group would have higher plasma choline compared to children in the control group. We also tested for group differences in several related metabolites: betaine (a methyl donor and the oxidized product of choline), dimethylglycine (DMG) (a metabolite of betaine), and trimethylamine N-oxide (TMAO). In secondary exploratory analyses, we tested several sociodemographic factors as moderators in the relationship between intervention group and plasma choline or its metabolites, as well as the role of plasma choline or its metabolites as mediators for the two primary outcomes that were significantly different by intervention group. Finally, in order to provide evidence of adherence to the egg intervention, preliminary metabolomics analyses of the intervention effect are presented.

Technical Abstract: Background: Eggs are a rich source of choline, an essential nutrient important for child growth and development. In a randomized trial of one egg/day among young children in Ecuador, the egg intervention led to significant improvements in growth, which were partially mediated by increased plasma choline concentration. A similar trial in Malawi (clinicaltrials.gov: NCT03385252) found little improvement in child growth or development. Objective: We aimed to evaluate the effect of one egg/day for 6 months on plasma choline concentrations among Malawian children enrolled in a randomized trial. Methods: Children age 6-9 months in rural Malawi were randomized to receive one egg/day (n=331) or nonintervention control (n=329) for 6 months. Anthropometric, developmental, and dietary data were collected at baseline and 6 month follow up, along with a blood draw. Plasma choline, betaine, dimethylglycine, trimethylamine N-oxide (TMAO), and docosahexaenoic acid were measured at both time points using mass spectrometry (n=200 per group). Linear regression analysis was used to determine the difference in plasma choline and related metabolites between groups after 6 months of intervention. Results: Plasma choline, betaine, dimethylglycine, and docosahexaenoic acid concentrations did not differ between groups at 6 month follow up. Plasma TMAO was significantly (26% [95% CI 7%, 48%]) higher in the egg intervention group in fully adjusted models. Conclusions: Provision of one egg/day for 6 months did not result in increases in plasma choline or related metabolites, except TMAO. This may partially explain the lack of effect on growth and development. Additional interventions are needed to improve choline status, growth, and development in this population.