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

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, an egg intervention led to significant improvements in growth, which was 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 Infants age 6-9 months in rural Malawi were randomized to receive one egg/day (n = 331) or serve as a 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 UPLC-MS/MS (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 a fully adjusted model. 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.

The Effects of 1 Egg per Day on Iron and Anemia Status among Young Malawian Children: A Secondary Analysis of a Randomized Controlled Trial

“…The usual energy intake from eggs at 3-mo and 6-mo follow-up was approximately 30 kcal/d in the egg group and 1 kcal/d in the control group ( 40 ). We also compared plasma metabolites between groups and noted several markers related to egg consumption differed between the egg intervention and control group ( 43 ). These biomarkers are less susceptible to reporting bias and suggest that the eggs were indeed consumed by the index child, but they cannot provide information on dose or frequency of egg consumption.…”

Prevalence of diarrheagenicEscherichia coliand impact on child health in Cap-Haitien, Haiti

“…DHA levels appeared higher with increased diarrheal disease, which may reflect anti-inflammatory properties of DHA. Also, a recent trial in Malawi did not show associations between DHA, choline, and growth (45), but the Malawian population differed in dietary intake, likely attenuating effects on DHA and choline. The limited sample size precludes any conclusions, but DHA and choline levels do not appear to significantly fluctuate during acute diarrheal illness.…”

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

“…Details of plasma choline measurement for this study have been described (Bragg et al, 2022). Briefly, plasma choline was measured at baseline and 6‐month follow‐up using two analysis methods.…”

“…Eggs are a rich source of choline, and improvements in choline status were expected to mediate improvements in growth and development, similarly to an egg intervention trial in Ecuador (Iannotti, Lutter, Stewart, et al, 2017; Iannotti, Lutter, Waters, et al, 2017). However, there was no effect of eggs on most growth or developmental outcomes (Prado et al, 2020; Stewart et al, 2019), and no improvement in plasma choline concentration (Bragg et al, 2022) in Malawi. This analysis therefore serves a second purpose: by investigating the association between choline status and growth and development in this context, we may also gain a deeper understanding of the null results of the Mazira Project randomised trial.…”