Choline adequacy and health outcomes in vegetarian and vegan diets

Choline is an essential nutrient with roles in neurotransmitter synthesis, one-carbon metabolism, and lipid transport. Animal-derived foods such as eggs and red meat are the richest dietary sources, but increased consumption of these foods is associated with elevated risks of cardiovascular disease, cancer, and other chronic conditions, which raises concerns about their promotion for choline adequacy. This narrative review synthesizes evidence on choline intake, adequacy, and health outcomes across omnivorous, vegetarian, and vegan diets. The scientific literature published between 2000 and 2025 was reviewed to investigate choline requirements, nutrient interactions, and the potential role of supplementation. Implications for cardiovascular disease, cancer, non-alcoholic fatty liver disease, and pregnancy outcomes were considered. The findings indicated that vegetarian and vegan diets supply lower choline levels than omnivorous diets, but overt deficiency is rare, likely due to nutrient interactions and potential overestimation of requirements. Increasing intake of animal foods to meet choline requirements may be associated with increased chronic disease risk based on the broader dietary pattern evidence. In contrast, increasing intake of plant-based choline sources such as legumes and whole grains, along with supplementation when necessary during pregnancy, can promote nutrient adequacy and support more favorable health outcomes.