Dietary Choline Intake by Children with Autism Is below the Recommended Dietary Reference Intake (DRI) Established by the IOM

Background:   Choline is an essential dietary nutrient that is required for normal neurodevelopment and is a precursor for membrane phosphatidlycholine, neurotransmitter acetylcholine, and the methyl donor betaine. Choline is important for normal membrane signaling and integrity, synaptic plasticity, and is an important precursor for maintenance of DNA methylation and epigenetic regulation of gene expression.  Inadequate intake of choline has been associated with abnormal neurodevelopment, increased anxiety, and inflammation in humans. 

Objectives:  To examine the dietary intake of nutrients required for normal methylation and phosphatidylcholine metabolism to determine whether nutritional deficits may be related to low methylation capacity previously observed in children with autism.

Methods:   Five national sites (AR, NY, CO, OH and PA) participated in data collection as part of the Autism Intervention Research Network for Physical Health (AIR-P) study on Diet and Nutrition in children with Autism.  The cohort consisted of 127 children with autism between ages 2 to 11 who had participated in the Autism Treatment Network (ATN) registry.  At each site, a three-day food record was completed by the participant’s caregiver in order to obtain a snapshot of the participant’s normal diet. The Nutrition Data System for Research© (NDSR) software was used to analyze nutrient content of foods.  Macro and micronutrients from the diet record, with and without supplements, were calculated from the three-day record. The Dietary Reference Intakes (DRI) determined by the Food and Nutrition Board of the IOM were used for the age-specific recommended dietary nutrient intake for healthy children.  For this study, the mean intakes of choline, betaine, methionine, folate and B12 were calculated based on each child’s food and supplement ingestion as analyzed with the NDSR software.

Results:  Using the age-adjusted DRI for choline recommended by the IOM, 80% of the autistic children were below recommended intake for choline and 40% consumed less than 2/3 of the DRI.  The age-specific choline intakes are presented in the table below. 

Age Group	Dietary Reference Intake	Mean Intake of Children with ASD ( ± SE)	% < DRI
1-3 y	200 mg/day	179 ± 8 mg/day	69.9
4-8 y	250 mg/day	196 ± 9 mg/day	79.8
9-11y	375 mg/day	244 ± 28 mg/day	86.7

The mean betaine intake among the children with autism was 114 mg/day.  Although the DRI for betaine for children has not been established, average intake in healthy adults is ~300 mg/day.  Further, 38% of the autistic children had both choline intake less than the DRI and betaine intake less than 100 mg/day.  The mean dietary intake of folate, B12 and methionine was above the DRI for these nutrients independent of supplement use.  Plasma levels of choline and betaine on a subset of participants will be presented.

Conclusions:  The low dietary intake of choline and betaine in children with autism may contribute to reduced methylation capacity in some children with autism.

Acknowledgements:  This study was conducted at five sites participating in the ATN and was funded by a cooperative agreement from HRSA to Massachusetts General Hospital.