Eggs early in complementary feeding increase choline pathway biomarkers and DHA: a randomized controlled trial in Ecuador

Abstract

Background: Choline status has been associated with stunting among young children. Findings from this study showed that an egg intervention improved linear growth by a length-for-age z score of 0.63.Objective: We aimed to test the efficacy of eggs introduced early in complementary feeding on plasma concentrations of biomarkers in choline pathways, vitamins B-12 and A, and essential fatty acids.Design: A randomized controlled trial, the Lulun (“egg” in Kichwa) Project, was conducted in a rural indigenous population of Ecuador. Infants aged 6–9 mo were randomly assigned to treatment (1 egg/d for 6 mo; n = 80) and control (no intervention; n = 83) groups. Socioeconomic data, anthropometric measures, and blood samples were collected at baseline and endline. Household visits were made weekly for morbidity surveillance. We tested vitamin B-12 plasma concentrations by using chemiluminescent competitive immunoassay and plasma concentrations of choline, betaine, dimethylglycine, retinol, essential fatty acids, methionine, dimethylamine (DMA), trimethylamine, and trimethylamine-N-oxide (TMAO) with the use of liquid chromatography–tandem mass spectrometry.Results: Socioeconomic factors and biomarker concentrations were comparable at baseline. Of infants, 11.4% were vitamin B-12 deficient and 31.7% marginally deficient at baseline. In adjusted generalized linear regression modeling, the egg intervention increased plasma concentrations compared with control by the following effect sizes: choline, 0.35 (95% CI: 0.12, 0.57); betaine, 0.29 (95% CI: 0.01, 0.58); methionine, 0.31 (95% CI: 0.03, 0.60); docosahexaenoic acid, 0.43 (95% CI: 0.13, 0.73); DMA, 0.37 (95% CI: 0.37, 0.69); and TMAO, 0.33 (95% CI: 0.08, 0.58). No significant group differences were found for vitamin B-12, retinol, linoleic acid (LA), α-linolenic acid (ALA), or ratios of betaine to choline and LA to ALA.Conclusion: The findings supported our hypothesis that early introduction of eggs significantly improved choline and other markers in its methyl group metabolism pathway. This trial was registered at clinicaltrials.gov as NCT02446873.

Egg intervention effect on linear growth no longer present after two years

“…Stunting prevalence was reduced by 47% (prevalence ratio, 0.53; 95% CI [0.37, 0.77]), and length‐for‐age z score (LAZ) increased by 0.63 (95% CI [0.38, 0.88]; Iannotti et al, ). Reinforcing the growth findings was the significant increases in biomarker concentrations of choline and docosahexaenoic acid among others, with similarly large effect sizes (Iannotti et al, ). Other nutrients and metabolites, such as Vitamin B12 and retinol, were not significantly increased, however (Iannotti, Lutter, Waters, et al, ).…”

“…Reinforcing the growth findings was the significant increases in biomarker concentrations of choline and docosahexaenoic acid among others, with similarly large effect sizes (Iannotti et al, ). Other nutrients and metabolites, such as Vitamin B12 and retinol, were not significantly increased, however (Iannotti, Lutter, Waters, et al, ).…”

“…In the Lulun Project, choline, betaine, and methionine were significantly increased in the egg compared with control, suggesting effects on the one‐carbon pathway and in part mediated the linear growth effect (Iannotti, Lutter, Waters, et al, ). Depending on storage pools, these nutrients may be required more consistently in the diet compared with others.…”

Small‐scale egg production centres increase children's egg consumption in rural Zambia

“…Animal source foods (ASF) are an efficient mechanism for meeting children's dietary requirements, because relatively small amounts can make large contributions to their nutrient intake (Allen, , ; Dror & Allen, ; Murphy & Allen, ; Neumann, Harris, & Rogers, ). There is strong evidence that the incorporation of ASF into the diets of young children can improve dietary quality, micronutrient intake, and nutrition outcomes (Allen, ; Allen, Backstrand, & Stanek, ; Darapheak, Takano, Kizuki, Nakamura, & Seino, ; Grillenberger et al, ; Herrador et al, ; Iannotti, Lutter, Stewart, et al, ; Iannotti, Lutter, Waters, et al, ; Krasevec, An, Kumapley, Bégin, & Frongillo, ; Krebs et al, ; Lien et al, ; Long et al, ; Neumann et al, ). However, the poorest families in low and lower middle income countries often rely on low‐quality, plant‐based diets consisting primarily of starchy staples (Allen, , ; Arimond & Ruel, ; Black et al, ), and novel approaches are needed to improve ASF availability and consumption in these settings.…”

“…Third, backyard poultry production has a low cost of entry and maintenance (Alders & Pym, ; Gueye, ). Finally, eggs are an appropriate first complementary food (Iannotti, Lutter, Bunn, & Stewart, ), and feeding young children just one egg per day can have dramatic effects on their growth (Iannotti, Lutter, Stewart, et al, ) and micronutrient status (Iannotti, Lutter, Waters, et al, ).…”