Is there enough choline for children in food aid?

Authors: MAY, THADDAEUS - Baylor College Of Medicine; CAUDILL, MARIE - Cornell University; MANARY, MARK - Washington University

Submitted to: JAMA Pediatrics
Publication Type: Other
Publication Acceptance Date: 2/20/2023
Publication Date: 3/2/2023
Citation: May, T., Caudill, M., Manary, M.J. 2023. Is there enough choline for children in food aid?. JAMA Pediatrics. 177:223-224. https://doi.org/10.1001/jamapediatrics.2022.5543.
DOI: https://doi.org/10.1001/jamapediatrics.2022.5543

Interpretive Summary: Serious food insecurity affects over 200 million people, but needed food aid often lacks essential nutrients, such as choline – important for growth and brain development, especially in children and mothers. This article highlights the shortage of choline in current nutrient-fortified food aid products and calls for clinical trials to explore the possible benefits of adding choline to lessen the serious and long-lasting effects of malnutrition, particularly in vulnerable populations. Adding choline to food aid has the ability to improve energy uptake, growth, immune function, and brain development in malnourished children, reducing the risk of problems such as fatty liver disease, gut issues, and nutritional swelling.

Technical Abstract: The World Food Program has estimated that acute food insecurity threatens more than 200 million people today. Frequent natural disasters and conflicts ensure that food aid will remain necessary for the foreseeable future. Optimizing the quality of this food assistance is essential, especially for children and their mothers. Current formulations of nutrient-fortified food aid products are deficient in an essential nutrient that is critical for growth and brain development: choline. Previously, most food aid consisted of unfortified staples, mainly cereals. However, over the past 3 decades, there has been growing recognition that people facing food scarcity need higher-quality food, not just more food. Today, much food aid consists of specialized nutrient fortified foods. These manufactured products are enriched with vitamins and milk powder to meet the unique requirements of those who are nutritionally vulnerable,especially mothers who are pregnant or nursing and their children. The nutritional content of these nutrient-fortified products is set by United Nations agencies, particularly the Codex Alimentarius Commission, a collection of internationally recognized food standards that is published by the Food and Agricultural Organization of the World Health Organization. These international guidelines are meant to ensure that food aid is a reliable and adequate source of essential nutrients. Remarkably, the Codex Alimentarius Commission's nutritional bench marks for food aid content do not mention choline. This essential nutrient supports multiple organ systems, including early brain growth and development. The omission of choline from food aid guidelines is particularly relevant for the most vulnerable recipients of food aid.