Choline, a nexus for neurocognitive nutrients: A narrative review

Choline is a critical but often overlooked essential nutrient with a well-characterized biological role in early neurodevelopment and a plausible, though not yet fully established in humans, role in lifelong cognitive function. This narrative review examines the importance of choline, particularly during fetal and neonatal development, and considers biological mechanisms, including epigenetic programming through DNA and histone methylation, that may contribute to its long-term beneficial effects. A structured literature search was conducted using PubMed and Google Scholar, supplemented by reference list review. By synthesizing evidence from animal models and the more limited body of human studies, this review evaluates choline's plausible role in fetal brain development, cognitive function, neuroprotection across the lifespan, and its potential to attenuate neurocognitive impairments associated with various neurological disorders and environmental insults. Although preclinical data are extensive and mechanistically compelling, human trial evidence remains limited in scale and duration, and causal conclusions for most outcomes cannot yet be drawn. Despite these limitations, current intake in the United States and abroad falls consistently short of recommendations, particularly among pregnant women. The findings of this review highlight the need for increased clinical awareness of choline's significance, evaluation of prenatal supplementation protocols, and continued research to inform dietary guidelines, especially during critical periods of development. Future research directions should include large-scale human trials to establish optimal intake across different life stages and to clarify the molecular mechanisms mediating choline's effects. Prioritizing choline in public health and research efforts during pregnancy and early development may offer meaningful opportunities to support neurocognitive outcomes at the population level.