Folic acid and choline among under consumed nutrients in report from Dietary Guidelines Advisory Committee

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On July 15, 2020, the United States Department of Agriculture (USDA) released the 2020 Dietary Guidelines Advisory Committee’s (DGAC) final scientific report. This is an objective review of the latest available science on specific nutrition topics that will inform the USDA and U.S. Department of Health and Human Services as they co-develop the 2020-2025 Dietary Guidelines for Americans. The guidelines are recommendations on what to eat and drink to promote health and prevent chronic diseases.

The scientific report includes recommendations for the supplementation of folic acid in pregnant women. It acknowledges that there are inadequate folate intakes in women who are pregnant or capable of becoming pregnant, which can increase the risk of neural tube defects in developing fetuses. This is particularly important during the first trimester of pregnancy, when the neural tube is formed and closed.

“This Committee’s findings on folic acid supplements are consistent with those of previous Committees, namely that folic acid supplementation is associated with better maternal folate status during pregnancy and reduced risk of congenital anomalies in the child,” states the report. “The current review also suggests that folic acid supplementation may reduce the risk of hypertensive disorders among women at high-risk or with a previous history of these disorders. Given that preeclampsia is among the leading causes of maternal mortality, and both pre-eclampsia and congenital anomalies are linked to increased risk for preterm birth and infant mortality, folic acid status during pregnancy has important public health ramifications.

“Supplementation with 400 μg/day of synthetic folic acid plus dietary intake of an additional 200 μg/day was recommended by previous Committees. The U.S. Preventive Services Task Force recommends that all women of reproductive age take a daily supplement containing 400 to 800 μg of folic acid, which is consistent with recommendations by the CDC and the IOM.”

This is in line with what the current dietary guidelines recommend. The report also states that the underconsumption of vitamin D, calcium, dietary fiber, and potassium may pose a public health concern. This is due to the overconsumption of total energy, saturated fats, sodium added sugars, and alcohol, while intakes of fruits, vegetables, and whole grains are below current recommendations.

One nutrient cited frequently in the report to pose special public health challenges at various life stages and specific populations is choline. The underconsumption of choline is of concern in infants, toddlers between 12 and 24 months, adolescents ages 9 to 14, and women who are pregnant or lactating. More research is required to determine whether underconsumption poses a public health concern.

“Choline’s increased recognition in the DGAC report is an important scientific milestone for the public health community,” says Jonathan Bortz, MD, senior director, Nutrition Science, Balchem, in a press release. “We are quickly approaching an inflection point in time for choline awareness. In addition to the findings released in this report, Balchem has, and will continue to support research needed to develop a blood biomarker for choline, which will provide a more accurate understanding of the level of deficiency among Americans and help to generate stronger guidance and messages.”

“As the body of research into choline continues to grow, particularly the critical role it plays in fetal brain development and cognitive function in infants and toddlers, having this comprehensive report identify choline as ‘under-consumed’ by this exact population constitutes a call to action,” said Tom Druke, marketing director, human nutrition and health, Balchem. This is particularly true when you consider that despite the 450 mg dietary reference intake (RDI) for pregnant women and 550 mg RDI for adults in general, a 2016 study found that only eight of the top 25 prenatal vitamins contained choline, and none of them provided more than 55 mg per daily dose. 

Balchem acknowledges that tradeoffs are made based on what amount will fill a tablet or capsule compared to those delivering full benefits, but states that if manufacturers included 110 mg in prenatal and other formulas, this would help close the gap and allow for an “excellent source” nutrient content claim.

Food insecurity is another major concern cited in the report. “Food insecurity and lack of access to affordable healthy food is a persistent problem. In 2018, more than 37 million people, including 6 million children, lived in households that were uncertain of having, or unable to acquire, enough food to meet their needs,” the report reads. “Certain populations are disproportionately affected, including low-income, Black non-Hispanic, and Hispanic households, households with young children, and households headed by a single woman or man.”

Dietary supplement industry trade organizations are encouraged by the report's acknowledgement that supplements may help consumers meet their nutrient requirements. “[The Council for Responsible Nutrition] is especially pleased to see the committee’s recognition of the appropriate use of dietary supplements during pregnancy and lactation life stages,” said Haiuyen Nguyen, senior director, scientific and regulatory affairs, The Council for Responsible Nutrition (CRN; Washington, D.C.), in a press release. “We appreciate the report’s acknowledgment that nutrient needs during these life stages are not expected to be met by food alone, especially for essential nutrients like iron, iodine, and folic acid. CRN also agrees with the committee’s suggestion that choline and magnesium should be further evaluated as levels of inadequacy of both nutrients are high in pregnant and lactating women.”

“For the first time, the Advisory Committee was asked to evaluate evidence on the relationships between dietary supplements of specific nutrients and health outcomes in pregnancy and lactation and birth to 24 months life stages,” adds Nguyen. “This shift demonstrates great progress and CRN hopes to see future Dietary Guidelines recognize supplements as part of a strategy to meet essential nutrient intake even beyond the nutrients included in the 2020 report.”

Against this backdrop, the recommendations are evidence that more must be done by Congress to ensure that Americans have access to proper nutrition. “Congress needs to do more to ensure Americans have access to products that support their health, and expanding health savings accounts and programs like WIC (Women, Infants, and Children) to include nutritional supplements is the best way to make that happen,” says Daniel Fabricant, PhD, president and CEO of the Natural Products Association (NPA; Washington, D.C.), in a press release. NPA also supports legislation that would expand the Supplemental Nutrition Assistance Program (SNAP).

USDA and HHS plan to publish the 2020-2025 Dietary Guidelines for Americans by the end of December 2020. USDA and HHS are accepting written public comment until August 13, 2020, and the public will also be able to provide oral comments on the scientific report at a public meeting on August 11, 2020.

Updated on July, 24, 2020 at 2:50PM