ABSTRACT
Choline, an essential nutrient, is pivotal in supporting maternal and fetal health during pregnancy. In this comprehensive review, we explore the current evidence and the implications of choline supplementation in pregnancy. Choline is indispensable for neural tube formation, brain development, and the overall well-being of expectant mothers, rendering it a cornerstone of prenatal care. Inadequate choline intake is associated with neural tube defects, cognitive deficits in offspring, and maternal health complications. This review highlights the potential benefits of choline supplementation as demonstrated by clinical studies, including the reduction of congenital disabilities and improvements in cognitive outcomes. However, it is important to acknowledge the presence of methodological challenges, ethical considerations, and variations in study findings. To harness the full potential of choline in maternal nutrition, we advocate for increased awareness, continued research, and the development of ethical guidelines. In the broader context, policymakers must consider integrating choline recommendations into dietary guidelines. This step would ensure equitable access to this vital nutrient for all pregnant women, regardless of socioeconomic status. In conclusion, choline supplementation shows promise in enhancing both maternal and fetal health. However, its full benefits can only be realized through further research and concerted efforts in raising awareness.
ABSTRACT
OBJECTIVE: Apolipoprotein E4 may benefit children during early periods of life when the body is challenged by infection and nutritional decline. We examined whether apolipoprotein E4 affects intestinal barrier function, improving short-term growth and long-term cognitive outcomes in Brazilian shantytown children. METHODS: A total of 213 Brazilian shantytown children with below-median height-for-age z-scores (HAZ) received 200,000 IU of retinol (every four months), zinc (40 mg twice weekly), or both for one year, with half of each group receiving glutamine supplementation for 10 days. Height-for-age z-scores, weight-for-age z-scores, weight-forheight z-scores, and lactulose:mannitol ratios were assessed during the initial four months of treatment. An average of four years (range 1.4-6.6) later, the children underwent cognitive testing to evaluate non-verbal intelligence, coding, verbal fluency, verbal learning, and delayed verbal learning. Apolipoprotein E4 carriage was determined by PCR analysis for 144 children. RESULTS: Thirty-seven children were apolipoprotein E4(+), with an allele frequency of 13.9 percent. Significant associations were found for vitamin A and glutamine with intestinal barrier function. Apolipoprotein E4(+) children receiving glutamine presented significant positive Pearson correlations between the change in height-for-age z-scores over four months and delayed verbal learning, along with correlated changes over the same period in weight-for-age z-scores and weight-for-height z-scores associated with non-verbal intelligence quotients. There was a significant correlation between vitamin A supplementation of apolipoprotein E4(+) children and improved delta lactulose/mannitol. Apolipoprotein E4(-) children, regardless of intervention, exhibited negative Pearson correlations between the change in lactulose-to-mannitol ratio over four months and verbal learning and non-verbal intelligence. CONCLUSIONS: During development, apolipoprotein E4 may function concomitantly with gut-tropic nutrients to benefit immediate nutritional status, which can translate into better long-term cognitive outcomes.