Abstract
Growing evidence confirms choline as a critical perinatal nutrient. However, intake levels of choline and betaine among the Spanish fertile population remain unknown. Given their role in one-carbon metabolism with potential epigenetic effects, the aim of the present study was to evaluate the dietary intakes, their adequacy to existing guidelines and the main food sources together with other micronutrients involved in the methylation-methionine cycle (vitamin B6, folates and vitamin B12) in women of childbearing age. The ANIBES study, a cross-sectional study of a representative sample of women of childbearing age (18–45 years, n = 641) resident in Spain, was used. The sample was divided into younger women (18–30 years, n = 251) and older women (31–45 years, n = 390). Dietary intake was assessed by a three-day dietary record by using a tablet device. Total median intakes for the total sample were 303.9 mg/d for choline; 122.6 mg/d for betaine; 1.3 mg/d for vitamin B6; 140.8 μg/d for folates, and 3.8 μg/d for vitamin B12. The older subgroup showed significantly higher choline (p < 0.05), betaine (p < 0.001) and folates (p < 0.05) intakes than younger women. Main food sources for the whole sample were meat and meat products for choline (28.3%), vitamin B6 (25.7%) and vitamin B12 (22.8%); cereals and derivatives (79.9%) for betaine; vegetables (20.0%) for folates. Overall intake adequacy was only observed for vitamin B12, with a very limited number of participants showing adequate intakes for all the other micronutrients. These results illustrate there is a relevant need to raise awareness about optimizing the status of the methionine cycle-related vitamins and cofactors in this potentially vulnerable population.
Highlights
Recent intervention trials showed that about 70% of common and severe NTDs are preventable by periconceptional supplementation with FA, a percentage that rose to 90% when additional supplementation with the vitamins riboflavin, pyridoxine and cobalamin
The prevalence of adequacy for choline in the total study population was 39.5%, and 35.1% according to the European Food Safety Authority (EFSA), and IOM recommended dietary intakes (RDI) criteria, respectively (Table 3)
The proportion of adequacy for total choline intakes in younger women was 35.1% and 31.1%, and for older women it was 42.3% and 37.7% according to the EFSA and IOM references, respectively (Table 3)
Summary
The importance of ensuring an adequate status during pregnancy from the nutrients (choline, betaine, vitamin B6 , folates and vitamin B12 ) involved in one-carbon metabolism via the methionine-methylation cycle is well established. While dietary intake recommendations, and even supplementation protocols, are well defined for B vitamins [1,2,3], this is not the case for choline and betaine. Previous results have shown that prevalence rates of infants born with neural tube defects (NTDs) have successfully decreased since the implementation of supplementation and fortification protocols with synthetic folic acid (FA) [4]. NTDs continue to occur and available data suggests that 5–6 cases per 10,000 pregnancies represent the lowest prevalence that is achievable through these current protocols, indicating that a percentage of the remaining NTDs are not sensitive to FA [4,5]. Recent intervention trials showed that about 70% of common and severe NTDs are preventable by periconceptional (at least one month before conception and at least two months after conception) supplementation with FA, a percentage that rose to 90% when additional supplementation with the vitamins riboflavin (vitamin B2 ), pyridoxine (vitamin B6 ) and cobalamin
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