Journal Articles

Choline supplementation in children with fetal alcohol spectrum disorders: a randomized, double-blind, placebo-controlled trial

October 07, 2015

Choline supplementation in children with fetal alcohol spectrum disorders: a randomized, double-blind, placebo-controlled trialAm J Clin Nutr. 2015 Oct 7, Wozniak JR1, Fuglestad AJ2, Eckerle JK3, Fink BA2, Hoecker HL4, Boys CJ3, Radke JP5, Kroupina MG3, Miller NC3, Brearley AM6, Zeisel SH7, Georgieff MK3.

  • 1Department of Psychiatry, jwozniak@umn.edu.
  • 2Department of Psychiatry.
  • 3Department of Pediatrics, and.
  • 4School of Public Health, Emory University, Atlanta, GA;
  • 5Fagron Inc., St. Paul, MN; and.
  • 6Biostatistical Design and Analysis Center, University of Minnesota Twin Cities, Minneapolis, MN;
  • 7University of North Carolina at Chapel Hill Nutrition Research Institute, Kannapolis, NC.

Abstract

BACKGROUND:

Fetal alcohol spectrum disorders (FASDs) are conditions characterized by physical anomalies, neurodevelopmental abnormalities, and neurocognitive deficits, including intellectual, executive, and memory deficits. There are no specific biological treatments for FASDs, but rodent models have shown that prenatal or postnatal choline supplementation reduces cognitive and behavioral deficits. Potential mechanisms include phospholipid production for axonal growth and myelination, acetylcholine enhancement, and epigenetic effects.

OBJECTIVE:

Our primary goal was to determine whether postnatal choline supplementation has the potential to improve neurocognitive functioning, particularly hippocampal-dependent memory, in children with FASDs.

DESIGN:

The study was a double-blind, randomized, placebo-controlled pilot trial in children (aged 2.5-5 y at enrollment) with FASDs (n = 60) who received 500 mg choline or a placebo daily for 9 mo. Outcome measures were Mullen Scales of Early Learning (primary) and the elicited imitation (EI) memory paradigm (secondary).

RESULTS:

The administration proved feasible, and choline was well tolerated. Participants received a dose on 88% of enrolled days. The only adverse event linked to choline was a fishy body odor. Choline supplementation improved the secondary outcome (EI) only after immediate recall performance was controlled for, and the outcome was moderated by age. The treatment effect on EI items recalled was significant in the younger participants (2.5- to ≤4.0-y-olds); the young choline group showed an increase of 12-14 percentage points greater than that of the young placebo group on delayed recall measures during treatment. However, there was a marginal baseline difference in delayed item recall between the youngcholine and placebo groups as well as a potential ceiling effect for item recall, both of which likely contributed to the observed treatment effect. We also observed a trend toward a negative effect of choline supplementation on the immediate EI recall of ordered pairs; the young placebo group showed an increase of 8-17 percentage points greater than that of the choline group during treatment. There was an inverse relation between cholinedose (in mg/kg) and memory improvement (P = 0.041); the data suggest that weight-adjusted doses may be a better alternative to a fixed dose in future studies. Limitations included trend-level baseline differences in performance, the post-hoc determination of age moderation, and potential ceiling effects for the memory measure.

CONCLUSIONS:

This pilot study suggests that an additional evaluation of choline supplementation as an intervention for memory functioning inchildren with FASDs is warranted. The observed interaction between age and choline‘s effect on EI suggests that potential sensitive periods should be considered in future work. This trial was registered at clinicaltrials.gov as NCT01149538.

© 2015 American Society for Nutrition.

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