of foods (mg/100 g) meats vegetables bacon, cooked 124.89 bean, snap 13.46 beef, trim-cut, cooked 78.15 beetroot 6.01 beef liver, pan fried 418.22 broccoli 40.06 chicken, roasted, with skin 65.83 brussels sprout 40.61 chicken, roasted, no skin 78.74 cabbage 15.45 chicken liver 290.03 carrot 8.79 cod, atlantic 83.63 cauliflower 39.10 ground beef, 75–85% lean, broiled 79.32–82.35 sweetcorn, yellow 21.95 pork loin cooked 102.76 cucumber 5.95 shrimp, canned 70.60 lettuce, iceberg 6.70 dairy products (cow) lettuce, romaine 9.92 butter, salted 18.77 pea 27.51 cheese 16.50–27.21 sauerkraut 10.39 cottage cheese 18.42 spinach 22.08 milk, whole/skimmed 14.29–16.40 sweet potato 13.11 sour cream 20.33 tomato 6.74 yogurt, plain 15.20 zucchini 9.36 grains fruits oat bran, raw 58.57 apple 3.44 oats, plain 7.42 avocado 14.18 rice, white 2.08 banana 9.76 rice, brown 9.22 blueberry 6.04 wheat bran 74.39 cantaloupe 7.58 wheat germ, toasted 152.08 grape 7.53 others grapefruit 5.63 bean, navy 26.93 orange 8.38 egg, hen 251.00 peach 6.10 olive oil 0.29 pear 5.11 peanut 52.47 prune 9.66 soybean, raw 115.87 strawberry 5.65 tofu, soft 27.37 watermelon 4.07 foods are raw unless noted otherwise. contents are "total choline" as defined above. daily values the following table contains updated sources of choline to reflect the new daily value and the new nutrition facts and supplement facts labels. it reflects data from the u.s. department of agriculture, agricultural research service. fooddata central, 2019. selected food sources of choline food milligrams (mg) per serving percent dv* beef liver, pan fried, 3 oz (85 g) 356 65 egg, hard boiled, 1 large egg 147 27 beef top round, separable lean only, braised, 3 oz (85 g) 117 21 soybeans, roasted, 1⁄2 cup 107 19 chicken breast, roasted, 3 oz (85 g) 72 13 beef, ground, 93% lean meat, broiled, 3 oz (85 g) 72 13 cod, atlantic, cooked, dry heat, 3 oz (85 g) 71 13 mushrooms, shiitake, cooked, 1⁄2 cup pieces 58 11 potatoes, red, baked, flesh and skin, 1 large potato 57 10 wheat germ, toasted, 1 oz (28 g) 51 9 beans, kidney, canned, 1⁄2 cup 45 8 quinoa, cooked, 1 cup 43 8 milk, 1% fat, 1 cup 43 8 yogurt, vanilla, nonfat, 1 cup 38 7 brussels sprouts, boiled, 1⁄2 cup 32 6 broccoli, chopped, boiled, drained, 1⁄2 cup 31 6 cottage cheese, nonfat, 1 cup 26 5 tuna, white, canned in water, drained in solids, 3 oz (85 g) 25 5 peanuts, dry roasted, 1⁄4 cup 24 4 cauliflower, 1 in (2.5 cm) pieces, boiled, drained, 1⁄2 cup 24 4 peas, green, boiled, 1⁄2 cup 24 4 sunflower seeds, oil roasted, 1⁄4 cup 19 3 rice, brown, long-grain, cooked, 1 cup 19 3 bread, pita, whole wheat, 1 large (6+1⁄2 in or 17 cm diameter) 17 3 cabbage, boiled, 1⁄2 cup 15 3 tangerine (mandarin orange), sections, 1⁄2 cup 10 2 beans, snap, raw, 1⁄2 cup 8 1 kiwifruit, raw, 1⁄2 cup sliced 7 1 carrots, raw, chopped, 1⁄2 cup 6 1 apples, raw, with skin, quartered or chopped, 1⁄2 cup 2 0 dv = daily value. the u.s. food and drug administration (fda) developed dvs to help consumers compare the nutrient contents of foods and dietary supplements within the context of a total diet. the dv for choline is 550 mg for adults and children age 4 years and older. the fda does not require food labels to list choline content unless choline has been added to the food. foods providing 20% or more of the dv are considered to be high sources of a nutrient, but foods providing lower percentages of the dv also contribute to a healthful diet. the u.s. department of agriculture's (usda's) fooddata central lists the nutrient content of many foods and provides a comprehensive list of foods containing choline arranged by nutrient content. dietary recommendations insufficient data is available to establish an estimated average requirement (ear) for choline, so the food and nutrition board (fnb) established adequate intakes (ais). for adults, the ai for choline was set at 550 mg/day for men and 425 mg/day for women. these values have been shown to prevent hepatic alteration in men. however, the study used to derive these values did not evaluate whether less choline would be effective, as researchers only compared a choline-free diet to a diet containing 550 mg of choline per day. from this, the ais for children and adolescents were extrapolated. recommendations are in milligrams per day (mg/day). the european food safety authority (efsa) recommendations are general recommendations for the eu countries. the efsa has not set any upper limits for intake. individual eu countries may have more specific recommendations. the national academy of medicine (nam) recommendations apply in the united states, australia and new zealand. choline recommendations (mg/day) age efsa adequate intake us nam adequate intake us nam tolerable upper intake levels infants and children 0–6 months not established 125 not established 7–12 months 160 150 not established 1–3 years 140 200 1,000 4–6 years 170 250 1,000 7–8 years 250 250 1,000 9–10 years 250 375 1,000 11–13 years 340 375 2,000 males 14 years 340 550 3,000 15–18 years 400 550 3,000 19+ years 400 550 3,500 females 14 years 340 400 3,000 15–18 years 400 400 3,000 19+ y 400 425 3,500 if pregnant 480 450 3,500 (3,000 if ≤18 y) if breastfeeding 520 550 3,500 (3,000 if ≤18 y) intake in populations twelve surveys undertaken in 9 eu countries between 2000 and 2011 estimated choline intake of adults in these countries to be 269–468 milligrams per day. intake was 269–444 mg/day in adult women and 332–468 mg/day in adult men. intake was 75–127 mg/day in infants, 151–210 mg/day in 1- to 3-year-olds, 177–304 mg/day in 3- to 10-year-olds and 244–373 mg/day in 10- to 18-year-olds. the total choline intake mean estimate was 336 mg/day in pregnant adolescents and 356 mg/day in pregnant women. a study based on the nhanes 2009–2012 survey estimated the choline intake to be too low in some us subpopulations. intake was 315.2–318.8 mg/d in 2+ year olds between this time period. out of 2+ year olds, only 15.6±0.8% of males and 6.1±0.6% of females exceeded the adequate intake (ai). ai was exceeded by 62.9±3.1% of 2- to 3-year-olds, 45.4±1.6% of 4- to 8-year-olds, 9.0±1.0% of 9- to 13-year-olds, 1.8±0.4% of 14–18 and 6.6±0.5% of 19+ year olds. upper intake level was not exceeded in any subpopulations. a 2013–2014 nhanes study of the us population found the choline intake of 2- to 19-year-olds to be 256±3.8 mg/day and 339±3.9 mg/day in adults 20 and over. intake was 402±6.1 mg/d in men 20 and over and 278 mg/d in women 20 and over. deficiency signs and symptoms symptomatic choline deficiency is rare in humans. most obtain sufficient amounts of it from the diet and are able to biosynthesize limited amounts of it. symptomatic deficiency is often caused by certain diseases or by other indirect causes. severe deficiency causes muscle damage and non-alcoholic fatty liver disease, which may develop into cirrhosis. besides humans, fatty liver is also a typical sign of choline deficiency in other animals. bleeding in the kidneys can also occur in some species. this is suspected to be due to deficiency of choline derived trimethylglycine, which functions as an osmoregulator. causes and mechanisms estrogen production is a relevant factor which predisposes individuals to deficiency along with low dietary choline intake. estrogens activate phosphatidylcholine producing pemt enzymes. women before menopause have lower dietary need for choline than men due to women's higher estrogen production. without estrogen therapy, the choline needs of post-menopausal women are similar to men's. some single-nucleotide polymorphisms (genetic factors) affecting choline and folate metabolism are also relevant. certain gut microbes also degrade choline more efficiently than others, so they are also relevant. in deficiency, availability of phosphatidylcholines in the liver are decreased – these are needed for formation of vldls. thus vldl-mediated fatty acid transport out of the liver decreases leading to fat accumulation in the liver. other simultaneously occurring mechanisms explaining the observed liver damage have also been suggested. for example, choline phospholipids are also needed in mitochondrial membranes. their inavailability leads to the inability of mitochondrial membranes to maintain proper electrochemical gradient, which, among other things, is needed for degrading fatty acids via β-oxidation. fat metabolism within liver therefore decreases. excess intake excessive doses of choline can have adverse effects. daily 8–20 g doses of choline, for example, have been found to cause low blood pressure, nausea, diarrhea and fish-like body odor. the odor is due to trimethylamine (tma) formed by the gut microbes from the unabsorbed choline (see trimethylaminuria). the liver oxidizes tma to trimethylamine n-oxide (tmao). elevated levels of tma and tmao in the body have been linked to increased risk of atherosclerosis and mortality. thus, excessive choline intake has been hypothetized to increase these risks in addition to carnitine, which also is formed into tma and tmao by gut bacteria. however, choline intake has not been shown to increase the risk of dying from cardiovascular diseases. it is plausible that elevated tma and tmao levels are just a symptom of other underlying illnesses or genetic factors that predispose individuals for increased mortality. such factors may have not been properly accounted for in certain studies observing tma and tmao level related mortality. causality may be reverse or confounding and large choline intake might not increase mortality in humans. for example, kidney dysfunction predisposes for cardiovascular diseases, but can also decrease tma and tmao excretion. health effects neural tube closure low maternal intake of choline is associated with an increased risk of neural tube defects. higher maternal intake of choline is likely associated with better neurocognition/neurodevelopment in children. choline and folate, interacting with vitamin b12, act as methyl donors to homocysteine to form methionine, which can then go on to form sam (s-adenosylmethionine). sam is the substrate for almost all methylation reactions in mammals. it has been suggested that disturbed methylation via sam could be responsible for the relation between folate and ntds. this may also apply to choline. certain mutations that disturb choline metabolism increase the prevalence of ntds in newborns, but the role of dietary choline deficiency remains unclear, as of 2015. cardiovascular diseases and cancer choline deficiency can cause fatty liver, which increases cancer and cardiovascular disease risk. choline deficiency also decreases sam production, which partakes in dna methylation – this decrease may also contribute to carcinogenesis. thus, deficiency and its association with such diseases has been studied. however, observational studies of free populations have not convincingly shown an association between low choline intake and cardiovascular diseases or most cancers. studies on prostate cancer have been contradictory. cognition studies observing the effect between higher choline intake and cognition have been conducted in human adults, with contradictory results. similar studies on human infants and children have been contradictory and also limited. perinatal development both pregnancy and lactation increase demand for choline dramatically. this demand may be met by upregulation of pemt via increasing estrogen levels to produce more choline de novo, but even with increased pemt activity, the demand for choline is still so high that bodily stores are generally depleted. this is exemplified by the observation that pemt −/− mice (mice lacking functional pemt) will abort at 9–10 days unless fed supplemental choline. while maternal stores of choline are depleted during pregnancy and lactation, the placenta accumulates choline by pumping choline against the concentration gradient into the tissue, where it is then stored in various forms, mostly as acetylcholine. choline concentrations in amniotic fluid can be ten times higher than in maternal blood. functions in the fetus choline is in high demand during pregnancy as a substrate for building cellular membranes (rapid fetal and mother tissue expansion), increased need for one-carbon moieties (a substrate for methylation of dna and other functions), raising choline stores in fetal and placental tissues, and for increased production of lipoproteins (proteins containing "fat" portions). in particular, there is interest in the impact of choline consumption on the brain. this stems from choline's use as a material for making cellular membranes (particularly in making phosphatidylcholine). human brain growth is most rapid during the third trimester of pregnancy and continues to be rapid to approximately five years of age. during this time, the demand is high for sphingomyelin, which is made from phosphatidylcholine (and