Higher dietary choline intake is associated with lower risk of nonalcoholic fatty liver in normal-weight Chinese women.
Level 4 - case-series / case-control
Cross-sectional observational analysis assessing dietary intake and fatty liver prevalence.
PubMed 25320186 · doi:10.3945/jn.114.197533
What was done
Researchers evaluated the association between dietary choline intake and nonalcoholic fatty liver disease (NAFLD) in 56,195 Chinese adults (aged 40–75 years) without substantial alcohol intake, hepatitis, cardiovascular disease, or cancer. All participants reported undergoing liver ultrasonography. Dietary choline was estimated using a validated food-frequency questionnaire, and fatty liver was determined via self-reported physician diagnosis.
What was found
Average choline intake was 289 ± 85 mg/day in women and 318 ± 92 mg/day in men. Initial adjustment for sociodemographic, lifestyle, and dietary factors showed an inverse association between the highest versus lowest quintile of choline intake and fatty liver (OR 0.68, 95% CI: 0.59–0.79 in women; OR 0.75, 95% CI: 0.60–0.93 in men). However, after further adjusting for metabolic disease history and BMI, the association was attenuated to non-significance overall (women: OR 0.88, 95% CI: 0.75–1.03, P-trend = 0.05; men: OR 0.85, 95% CI: 0.68–1.06, P-trend = 0.09). In stratified analyses by weight category in women, a significant inverse association remained only in normal-weight women (OR 0.72, 95% CI: 0.57–0.91, P-trend = 0.007), whereas no association was observed in overweight or obese women (OR 1.05, 95% CI: 0.84–1.31, P-trend = 0.99; P-interaction < 0.0001).
Why it matters
This study suggests that higher dietary choline intake may protect against nonalcoholic fatty liver disease primarily in individuals who are not overweight, where metabolic dysfunction driven by excess adiposity does not dominate the disease pathway.
Limits
The study is cross-sectional, precluding causal inference. Fatty liver status and ultrasonography confirmation were self-reported rather than clinically verified by liver biopsy or standardized imaging within the study protocol. Dietary intake relied on self-reported food-frequency questionnaires, which carry recall error. Findings in this middle-aged and older Chinese population may not generalize to other demographic or ethnic groups.
Cited by
- context Egg yolks and liver are the highest dietary sources of choline, and choline acts to remove fat from the liver to prevent or reverse fatty liver disease.