Choline is an essential nutrient and people get some choline from internal production in the liver and get the rest from their diet. Most men and postmenopausal women, and about 45% of pre-menopausal women cannot internally produce enough choline to meet their needs and must eat some choline in foods daily. While the US Institute of Medicine (now National Academy of Medicine) established a recommended Adequate Intake (AI) in 1998 and the European Food Safety Authority established similar recommendations in 2016, dietary intake of choline for most people falls well below these recommendations.

Data from the US National Health and Nutrition Examination Survey (NHANES) indicates that over 90% of adult Americans eat less than the recommended intake of choline, with roughly a quarter of the US adult population consuming <50% of the recommended intake. In addition, we know that common genetic differences can increase dietary requirements for choline.

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