# Choline supplementation in preterm infants: effects of four different supplements on choline plasma concentrations

## TL;DR

This study compares four choline supplements in preterm infants and finds they similarly increase choline levels, which are important for development.

## Contribution

The study evaluates the effectiveness of four choline supplements in preterm infants, showing they similarly boost plasma choline concentrations.

## Key findings

- All four choline supplements increased plasma choline concentrations similarly after 48 hours.
- GPC increased choline levels most rapidly within 6 hours of supplementation.
- No significant differences were observed in betaine or PC plasma concentrations among the supplements.

## Abstract

Current nutritional practices for preterm infants result in lower choline plasma concentrations than in a fetus matched for postmenstrual age. Choline is needed for growth and metabolism by membrane formation and plasma transport of polyunsaturated fatty acids (PUFA) via phosphatidylcholine (PC), and for methylation processes via betaine. Especially high concentrations of PUFA-PC are present in brain, eye, liver and lung; therefore, choline deficiency may contribute to developmental disorders of these organs. We studied short-term effects of four enterally administered choline compounds on plasma concentrations of choline-related parameters in preterm infants.

Prospective study (June 2022–February 2024) in 32 enterally fed preterm infants (28.0–32.0 weeks gestation). Participants were randomized to receive an additional 30 mg/kg/d choline-equivalent in 6–8 doses with their meals for 48 h. Supplements: choline chloride, choline bitartrate, alpha-glycerophosphorylcholine (GPC) or egg-PC (of which GPC and PC are natural components of human milk). Blood was taken before meals < 72 h before start, 3 h or 6 h after start, and 3 h or 6 h after end of supplementation. Plasma concentrations of choline, betaine and PC were quantified by tandem mass-spectrometry.

Choline plasma concentrations and areas-under-the-curve (0–54 h) were similar between supplements. GPC increased choline concentration most rapidly (6 h, p = 0.01), and all supplements increased choline plasma concentrations at 51–54 h after start of supplementation, compared to baseline. There were no differential effects on betaine or PC plasma concentrations.

Choline chloride, choline bitartrate, GPC and egg-PC increase choline plasma concentrations after 48 h of supplementation to a similar extent and are similarly suited for long-term choline supplementation.

This study was registered at the Deutsches Register Klinischer Studien (DRKS) (German Register for Clinical Studies), DRKS00020502.

The online version contains supplementary material available at 10.1007/s00394-025-03865-w.