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And in fact, liquid chromatography- tandem mass spectrometry analysis of blood samples found that eating one egg per day had a sizable e† ect on choline and biomarkers in choline-associated path- ways in brain development. In a separate analysis, which appeared in The American Journal of Clinical Nutrition, infants in the egg group had higher concentrations of choline than those in the control group, for a comparative e† ect size of 0.35. Chessa Lutter, PhD, Adjunct Research P rofessor of Fa m i ly Science at t he University of Maryland School of Public Hea lth, Senior Nutrition Researcher in the Food Security and Agriculture Division at nonprofi t RTI International, and a coauthor of the American Journal of Clinical Nutrition study, says choline is important during pregnancy and infancy for a host of reasons, including its contribu- tions to the structural integrity of cell membranes and its role in the production of the neurotransmitter acetylcholine. "Acetylcholine is necessary for memory, mood, muscle control, and other brain and nervous system functions," Lutter says. "Choline is also known to play a role in the modulation of gene expression, cell membrane signaling, lipid transport and metabolism, and early brain development. Choline is important, but [the observed growth e† ects] were [about] much more than choline. The growth e† ects, I think, were due to multiple aspects of what's in eggs." Infants in the intervention group not only had higher choline concentrations " Too often, we focus on nutrition just for ... growth parameters, but I think it's very important that we think about nutrition also for brain development." ¨ LORA IANNOTTI, PHD, ASSOCIATE DEAN FOR PUBLIC HEALTH AND ASSOCIATE PROFESSOR AT THE BROWN SCHOOL AT WASHINGTON UNIVERSITY IN ST. LOUIS Crucial Choline DURING PREGN A NCY, HIGHER estrogen levels can trigger a pathway in the liver to produce choline, but not all women's bodies can "turn on" that ability, accord- ing to Steven Zeisel, MD, PhD, Professor in the Department of Nutrition at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, Director of the UNC Nutrition Obesity Research Center and Director of the UNC Nutrition Research Institute. Unless genetic testing reveals that ability, Dr. Zeisel says, pediatricians should advise pregnant and breastfeed- ing women to include sources of choline in their diet so their infants receive an adequate amount. "Breast milk is a good source of choline for infants, but your milk's choline depends on your diet," Dr. Zeisel says. "The USDA Food Table is a [valuable resource] for fi guring out what sources of choline are good. If you choose not to feed in breast milk, then look at your infant formula. As long as it's one of the big-name commercial formulas, they've all been forced by the FDA to match human milk [in choline concentrations]." compared with the control, but they also had signifi cantly higher concentrations of betaine, a metabolite of choline that is important to liver function; methionine, an amino acid that aids metabolism; and DHA, an omega-3 fatty acid that con- tributes to brain development in infants. Iannotti calls the fi ndings about the DHA concentration "a wonderful surprise," noting that the way eggs package DHA a nd other nutrients a llows for effec- tive absorption. WIDE-RANGING IMPLICATIONS The Lulun ("egg" in Ecuador's Kichwa language) Project was groundbreaking, Lutter says, because it was the fi rst ran- domized, controlled longitudinal study to examine the e† ects of eggs on child growth and brain development biomarkers. Its results are a lready having an impact. The Ecuador Ministry of Hea lth now recommends the introduction of eggs at age 7 months based on the results. Iannotti says that as a relatively a† ordable animal- sourced food, eggs can play an important role in children's nutrition — and not just in the developing world. "I think it's OK to say that eggs can be promoted in most any context," she says. "[W]e have some work to do about information around allergies and choles- terol, which are ... two lingering concerns with physicians and mothers. What the literature tells us is, eggs aren't going to actually cause an allergy. The allergy is already there. In middle- and high-income countries, there has to be caution because there are more egg allergies present. The other kind of historic remnant of why people don't eat eggs is their connection to cholesterol. The literature has not shown that eggs are going to increase cholesterol, and that's true across all kinds of contexts. The bottom line is, I think [this study's fi ndings] are important for healthcare providers, mothers and fathers to appreci- ate and potentially adapt." ■ M D N E W S . C O M /// M D N E W S C L E V E L A N D /A K R O N / C A N T O N ■ M AY/J U N E 2 018 1 5