Choline Intake in Malawian Children Aged 6–9 and 12–15 Months in an Egg Intervention Trial

Abstract

Objectives Choline is an essential nutrient which may be important for child growth and development; however, data on intake among children in low and middle income countries are scarce. We aimed to describe choline intake among Malawian children age 6–9 and 12–15 months enrolled in an egg intervention trial. Methods The Mazira Project was a randomized controlled trial of the effect of daily egg consumption on growth and development in Malawian children. Children 6–9 months old were randomized to the intervention group, which received one egg/day for 6 months, or to the control group, which did not receive eggs. Data on children's complementary food intake were collected by 24-hour recall interview with the primary caregiver at baseline (6–9 months of age; n = 659) and at endline (12–15 months of age; n = 595). Choline from complementary foods was calculated based on local recipe and food composition tables. Breastmilk intake was approximated as the child's estimated energy requirement minus energy from complementary foods, and then multiplied by an assumed choline concentration. Total choline intake was compared to the Adequate Intake (AI) level. Contribution to choline intake by food source was calculated at each time point. Since eggs are high in choline, analysis was stratified by group at endline. Results The median (IQR) total choline intake at 6–9 months was 98.2 (77.7–120.6) mg. Breastmilk was the top contributor (80% of total choline), followed by maize (10%). At 12–15 months, median (IQR) choline intake in the egg group was 126.2 (91.9–166.2) mg and the main contributors were breastmilk (40%), eggs (29%) and maize (10%). Choline intake in the control group was lower, at 94.3 (63.3–118.1) mg, and was mainly from breastmilk (53%) and maize (15%). Median intake was below the AI at both ages; however, at 12–15 months, median intake was 65% of the AI in the egg group and only 47% in the control group. Conclusions Choline intake is low among the Malawian children in this sample, potentially putting them at risk for poor development. The egg intervention increased choline intake, specifically from eggs, but the median intake in this group was still below the AI. Funding Sources The Bill and Melinda Gates Foundation, Egg Nutrition Center.

Effect of a Child-Owned Poultry Intervention Providing Eggs on Nutrition Status and Motor Skills of Young Children in Southern Ethiopia: A Cluster Randomized and Controlled Community Trial

“…Evidence is limited on the effects of egg intake on health, nutrition, growth and development of infants and young children in low-income countries. Improved nutrient intake including protein, choline, B vitamins, lutein, zeaxanthin as well as many important minerals and overall energy intake was reported as a result of egg consumption [ 9 , 10 , 11 , 12 , 13 ]. Egg interventions have reported increased linear growth, underweight and wasting, although effects were not consistent in different settings.…”

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

“…Fish consumption was more prevalent in our trial, with ∼25% of children consuming fish at baseline and ∼65% at 6-mo follow-up [compared with ∼17% and ∼20% in the Lulun Project ( 5 , 7 )]. Of note, fish was not a major source of choline intake in our trial due to the small portions consumed and the lower choline content compared with eggs and breast milk ( 24 ). Although infant portion sizes of fish were small (∼20 g) ( 11 ), breast milk of women near Lake Malawi is rich in DHA due to maternal fish consumption ( 25 ).…”