Choline

Choline is an essential nutrient: in controlled feeding studies most adults deprived of dietary choline developed fatty liver or muscle damage that reversed when choline was restored. Surveys suggest most adults and most pregnant women eat less than the adequate intake, and vegetarian and vegan diets tend to supply less because choline is concentrated in animal foods. Evidence that extra choline in pregnancy improves child development is insufficient, cohort links between higher intake and better cognition are observational, and very high intakes have known side effects.

Mind
Vegan

Evidence retrieved up to 15 October 2026

What the research shows

In controlled feeding studies, most healthy adults who were fed a diet almost free of choline developed fatty liver or muscle damage, and normal organ function returned when choline was added back to the diet.

Moderate certainty

Further research may change the size of the effect.

No known concerns at usual amountsRisk

Who this is about

healthy adults in controlled feeding studies

Practical note

Graded moderate: controlled depletion-repletion feeding studies with direct, measured organ outcomes (liver fat by imaging, muscle damage), downgraded once for small samples (53 to 57 adults) from essentially one research group. Premenopausal women were less often affected (44 percent) than men (77 percent) and postmenopausal women (80 percent), and some men developed signs at the adequate intake of 550 mg per 70 kg a day.

Sources

Supports “When deprived of dietary choline, 77% of men and 80% of postmenopausal women developed fatty liver or muscle damage, whereas only 44% of premenopausal women developed such signs of organ dysfunction.” (Abstract, Results) Fischer LM, daCosta KA, Kwock L, Stewart PW, Lu TS, Stabler SP, Allen RH, Zeisel SH. 2007. American Journal of Clinical Nutrition. Sex and menopausal status influence human dietary requirements for the nutrient choline. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine
Supports “Choline is an essential nutrient, and deficiency causes liver and muscle dysfunction.” (Abstract) Sha W, da Costa KA, Fischer LM, Milburn MV, Lawton KA, Berger A, Jia W, Zeisel SH. 2010. FASEB Journal. Metabolomic profiling can predict which humans will develop liver dysfunction when deprived of dietary choline. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine
Context “Subjects who developed organ dysfunction during this diet had normal organ function restored after incremental amounts of choline were added back to the diet.” (Abstract, Design) Fischer LM, daCosta KA, Kwock L, Stewart PW, Lu TS, Stabler SP, Allen RH, Zeisel SH. 2007. American Journal of Clinical Nutrition. Sex and menopausal status influence human dietary requirements for the nutrient choline. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine

In observational cohort studies, adults with higher dietary choline intake had a lower risk of cognitive impairment or decline; as part of a healthy lifestyle, adequate dietary choline may help reduce the risk of cognitive decline, though randomised trials have not tested this.

Low certainty

Further research is likely to change this.

No known concerns at usual amountsBenefit

Who this is about

adults in observational cohort studies

Practical note

Graded low: a 2026 meta-analysis of nine cohorts (218378 participants) of observational associations, which can be confounded by overall diet; the association with dementia was not significant. The lowest risk was seen at dietary intakes of about 350 to 400 mg a day.

Sources

Supports “Higher dietary choline intake was significantly associated with a lower risk of adverse cognitive outcomes (pooled OR = 0.76, 95% CI: 0.63-0.92) and cognitive impairment/decline (pooled OR = 0.67, 95% CI: 0.47-0.95).” (Abstract) Feng S, An K, Wang Y, Cheng Z, Ma X, Zhao X, Chen X, Qiao J. 2026. Food and Function. Association of dietary choline intake with cognitive decline and related outcomes: a systematic review and dose-response meta-analysis of observational studies. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine

Because choline is concentrated in animal-derived foods, people following vegetarian or vegan diets tend to have lower choline intakes; a survey of pregnant women found lower median intakes in vegetarians and vegans than in omnivores.

Low certainty

Further research is likely to change this.

No known concerns at usual amountsRisk

Who this is about

people following vegetarian or vegan diets

Practical note

Graded low: one cross-sectional online survey (59 vegetarian or vegan pregnant women) plus narrative reviews; no study here measured choline status or health outcomes in vegans. In the survey, median intake was about 205 mg a day in vegetarians and vegans versus about 270 mg a day in omnivores.

Vegan note

A narrative review names cruciferous vegetables and certain beans as plant sources of choline, contributing about a tenth of the daily requirement.

Sources

Supports “Because choline is found predominantly in animal-derived foods, vegetarians and vegans may have a greater risk for inadequacy.” (Abstract) Wallace TC, Blusztajn JK, Caudill MA, Klatt KC, Natker E, Zeisel SH, Zelman KM. 2018. Nutrition Today. Choline: The Underconsumed and Underappreciated Essential Nutrient. CC BY-NC-ND 4.0; credit Wallace et al., Nutrition Today 2018
Supports “The median choline intake of omnivores was significantly higher than that of vegetarians/vegans (269.5 ± 141.5 mg/day vs. 205.2 ± 101.2 mg/day; p < 0.0001).” (Abstract) Roeren M, Kordowski A, Sina C, Smollich M. 2022. Nutrients. Inadequate Choline Intake in Pregnant Women in Germany. CC BY 4.0; credit Roeren et al., Nutrients 2022; Courtesy of the U.S. National Library of Medicine
Context “Certain plant foods like cruciferous vegetables and certain beans are good sources of choline and contribute approximately 10% of the daily requirement.” (Food sources) Wallace TC, Blusztajn JK, Caudill MA, Klatt KC, Natker E, Zeisel SH, Zelman KM. 2018. Nutrition Today. Choline: The Underconsumed and Underappreciated Essential Nutrient. CC BY-NC-ND 4.0; credit Wallace et al., Nutrition Today 2018
Context “This is now more important than ever given that accelerated food trends towards plant-based diets/veganism could have further ramifications on choline intake/status.” (Main text) Derbyshire E. 2019. BMJ Nutrition, Prevention and Health. Could we be overlooking a potential choline crisis in the United Kingdom? CC BY-NC 4.0; credit Derbyshire, BMJ Nutrition, Prevention and Health 2019

Dietary surveys indicate that most adults in the United States, and most pregnant women across studies, have choline intakes below the adequate intake.

Moderate certainty

Further research may change the size of the effect.

No known concerns at usual amountsRisk

Who this is about

adults in the United States and pregnant women

Practical note

Graded moderate for the descriptive finding: national dietary survey analyses and a 2025 meta-analysis of 12 prevalence studies in pregnancy (pooled 11 percent meeting recommendations) agree; downgraded because the adequate intake is not an average requirement, so falling below it does not by itself show deficiency. Reference values cited in the literature are an adequate intake of 550 mg a day for men and 425 mg a day for women in the US, and 400 mg a day for adults and 480 mg a day in pregnancy from EFSA.

Sources

Supports “However, 88.76% of pregnant women do not achieve the optimal choline intake.” (Abstract, Conclusion) Nguyen HT, Oktayani PPI, Lee SD, Huang LC. 2025. Nutrition Reviews. Choline in pregnant women: a systematic review and meta-analysis. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine
Supports “Recent analyses indicate that large portions of the population (ie, approximately 90% of Americans), including most pregnant and lactating women, are well below the AI for choline.” (Abstract) Wallace TC, Blusztajn JK, Caudill MA, Klatt KC, Natker E, Zeisel SH, Zelman KM. 2018. Nutrition Today. Choline: The Underconsumed and Underappreciated Essential Nutrient. CC BY-NC-ND 4.0; credit Wallace et al., Nutrition Today 2018

In randomised trials and observational studies, it remains unclear whether higher choline intake in pregnancy improves child neurodevelopment; most outcomes assessed showed no difference.

Low certainty

Further research is likely to change this.

No known concerns at usual amountsUnclear

Who this is about

pregnant women and their children

Practical note

Graded low: a 2025 systematic review found four randomised trials and five observational studies, most outcomes null, with critical limitations across studies; downgraded for risk of bias and imprecision.

Sources

Supports “Current evidence is insufficient to support or refute the hypothesis that increasing choline intake in pregnancy improves the neurodevelopmental outcomes of the child.” (Abstract, Conclusions) Gould JF, Hines S, Best KP, Grzeskowiak LE, Jansen O, Green TJ. 2025. Nutrients. Choline During Pregnancy and Child Neurodevelopment: A Systematic Review of Randomized Controlled Trials and Observational Studies. CC BY 4.0; credit Gould et al., Nutrients 2025; Courtesy of the U.S. National Library of Medicine

Very high choline intakes, at levels reached with supplements rather than food, are associated with fishy body odour, vomiting, excessive sweating and salivation, and low blood pressure.

Low certainty

Further research is likely to change this.

Take care: see the safety noteRisk

Who this is about

adults taking high-dose choline

Practical note

Graded low: the adverse effects come from small studies at doses of several grams a day (8 to 20 g a day in some studies), summarised in a narrative review.

Safety note

The US tolerable upper intake level for adults is 3.5 g a day, derived from a small study; EFSA did not set one. Choline intake raises production of TMAO, studied as a cardiovascular risk marker, and a 2024 meta-analysis of six cohorts associated higher dietary choline with higher all-cause and cardiovascular mortality, with high heterogeneity and possible confounding.

Sources

Supports “High intakes of choline are associated with a fishy body odor, vomiting, excessive sweating and salivation, hypotension, and liver toxicity.” (Toxicity) Wallace TC, Blusztajn JK, Caudill MA, Klatt KC, Natker E, Zeisel SH, Zelman KM. 2018. Nutrition Today. Choline: The Underconsumed and Underappreciated Essential Nutrient. CC BY-NC-ND 4.0; credit Wallace et al., Nutrition Today 2018
Context “This study showed that each 100 mg/day increment in choline consumption was significantly associated with a 6% and 11% higher risk of all-cause and cardiovascular disease mortality respectively.” (Abstract) Sharifi-Zahabi E, Soltani S, Asiaei S, Dehesh P, Mohsenpour MA, Shidfar F. 2024. Nutrition Research. Higher dietary choline intake is associated with increased risk of all-cause and cause-specific mortality: A systematic review and dose-response meta-analysis of cohort studies. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine