The Association of Plasma Choline With Growth and Development Among Young Malawian Children Enrolled in an Egg Intervention Trial

Abstract

Objectives Choline has been positively associated with child growth and development, but few studies have been in areas of high stunting and low choline intake. This secondary analysis examines the association of plasma choline with growth/development in Malawian children enrolled in a randomized trial of 1 egg/day versus nonintervention control. Methods Venous blood, anthropometric, and developmental measures were collected at enrollment (at age 6–9 mos) and at endline 6 mos later. Plasma choline, betaine, dimethylglycine, and trimethylamine N-oxide were measured using untargeted metabolomics among 400 children. Length, weight, and head circumference were converted to z-scores using WHO Growth Standards. Developmental measures included fine and gross motor, personal social, and language skills (measured and normed using the Malawi Developmental Assessment Tool), memory (elicited imitation [endline only] and visual paired comparison tasks), and attention (Infant Orienting with Attention [IOWA] task). Generalized linear models, adjusted for covariates including group assignment, were used to examine the association of plasma choline with growth/developmental outcomes. Results In cross-sectional models including both time points (baseline, endline) and adjusting for repeated measures, a 1 SD-unit increase in plasma choline was negatively associated with length-for-age z-score (–0.11 SD [95% CI: –0.20, –0.02]) and positively associated with IOWA reaction time (8.8 ms [1.7, 16.0]), meaning slower shifts in attention with higher plasma choline. In predictive models, higher baseline plasma choline predicted lower endline fine motor z-scores (–0.13 SD [–0.22, –0.04]). There were no associations of plasma choline with weight-for-age, head-circumference-for-age, weight-for-length, or the other developmental outcomes. Analysis of other biomarkers revealed few significant associations with growth/development. Conclusions Plasma choline was not strongly associated with growth or development in this sample of Malawian children. The few significant associations suggested poorer growth/development with higher plasma choline. Further research in various contexts is needed. Funding Sources Bill and Melinda Gates Foundation; Egg Nutrition Center.