The association between plasma choline, growth and neurodevelopment among Malawian children aged 6–15 months enroled in an egg intervention trial

Choline is an essential micronutrient that may influence growth and development; however, few studies have examined postnatal choline status and children's growth and development in low‐ and middle‐income countries. The aim of this observational analysis was to examine associations of plasma choline with growth and development among Malawian children aged 6–15 months enrolled in an egg intervention trial. Plasma choline and related metabolites (betaine, dimethylglycine and trimethylamine N‐oxide) were measured at baseline and 6‐month follow‐up, along with anthropometric (length, weight, head circumference) and developmental assessments (the Malawi Developmental Assessment Tool [MDAT], the Infant Orienting with Attention task [IOWA], a visual paired comparison [VPC] task and an elicited imitation [EI] task). In cross‐sectional covariate‐adjusted models, each 1 SD higher plasma choline was associated with lower length‐for‐age z‐score (−0.09 SD [95% confidence interval, CI −0.17 to −0.01]), slower IOWA response time (8.84 ms [1.66–16.03]) and faster processing speed on the VPC task (−203.5 ms [−366.2 to −40.7]). In predictive models, baseline plasma choline was negatively associated with MDAT fine motor z‐score at 6‐month follow‐up (−0.13 SD [−0.22 to −0.04]). There were no other significant associations of plasma choline with child measures. Similarly, associations of choline metabolites with growth and development were null except higher trimethylamine N‐oxide was associated with slower information processing on the VPC task and higher memory scores on the EI task. In this cohort of children with low dietary choline intake, we conclude that there were no strong or consistent associations between plasma choline and growth and development. Plasma choline was not associated with most measures of growth or neurodevelopment among this sample of Malawian children; three of the four significant associations were in the direction of poorer growth and development with higher plasma choline. Further research is needed to understand the link between postnatal choline status, growth and neurodevelopment in diverse settings. Improved biomarkers of choline status are required across all settings Key messages Few studies have examined the role of choline for child growth and neurodevelopment in low‐ and middle‐income countries, where intake of choline is likely low and suboptimal growth and development are common. Plasma choline was not associated with most measures of gr