The association between plasma choline, growth and neurodevelopment among Malawian children aged 6-15 months enrolled in an egg intervention trial

Authors: BRAGG, MEGAN - University Of California, Davis; PRADO, ELIZABETH - University Of California, Davis; Caswell, Bess; ARNOLD, CHARLES - University Of California, Davis; GEORGE, MATTHEWS - University Of Malawi; OAKES, LISA - University Of California, Davis; BECKNER, AARON - University Of California, Davis; DEBOLT, MICHAELA - University Of California, Davis; Bennett, Brian; MALETA, KENNETH - University Of Malawi; STEWART, CHRISTINE - University Of California, Davis

Submitted to: Maternal and Child Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/1/2022
Publication Date: 12/25/2022
Citation: Bragg, M., Prado, E., Caswell, B.L., Arnold, C., George, M., Oakes, L., Beckner, A., DeBolt, M., Bennett, B.J., Maleta, K., Stewart, C. 2022. The association between plasma choline, growth and neurodevelopment among Malawian children aged 6-15 months enrolled in an egg intervention trial. Maternal and Child Nutrition. 19(2). Article e13471. https://doi.org/10.1111/mcn.13471.
DOI: https://doi.org/10.1111/mcn.13471

Interpretive Summary: Choline is an essential micronutrient that may influence growth and development in young children. However, few studies have examined choline status and children’s growth and development in low and middle income countries, where intake of choline is likely low and suboptimal growth and development are common. We examined the associations between plasma choline and measures of physical growth and cognitive development among rural Malawian children age 6 to 15 months. Plasma choline was not associated with most measures of growth or development; the few significant associations were in the direction of poorer growth and development with higher plasma choline. Further research is needed to understand the link between postnatal choline status, growth, and neurodevelopment in diverse settings. Improved biomarkers of choline status are required across all settings.

Technical Abstract: Choline is an essential micronutrient that may influence growth and development; however, few studies have examined early postnatal choline status and children’s growth and development in low and middle income countries. The aim of this observational analysis was to examine the association between plasma choline and growth and development among young Malawian children age 6-15 months using data from an egg intervention trial. Plasma choline and related metabolites (betaine, dimethylglycine, and trimethylamine N-oxide) were measured at baseline and 6 month follow up, along with anthropometric and developmental assessments. Anthropometric measures (length, weight, head circumference) were converted to z-scores using World Health Organization Growth Standards. Developmental assessments included the Malawi Developmental Assessment Tool (MDAT), the Infant Orienting with Attention task (IOWA), a visual paired comparison task, and an elicited imitation task. Plasma choline was negatively associated with length-for-age z-score (-0.09 SD [95% CI -0.17, -0.01]) and positively associated with IOWA response time (8.84 ms [1.66, 16.03]) in fully adjusted cross-sectional models. Plasma choline at baseline was also negatively associated with MDAT fine motor normed z-score at 6 month follow up (-0.13 SD [95% CI: -0.22, -0.04]) in predictive models. There were no other significant associations between plasma choline, growth, and development. Associations between choline metabolites, growth, and development were similarly null. In this cohort of children with low dietary choline intake, we conclude that there were not strong associations between biomarkers of choline status with indicators of child growth and development.