Eggs, Dietary Choline, and Nonalcoholic Fatty Liver Disease in the Framingham Heart Study.
Level 3 - non-randomized controlled study
Prospective cohort study with objective CT imaging follow-up over ~6 years
PubMed 39424072 · doi:10.1016/j.tjnut.2024.10.026
What was done
Researchers evaluated 1,414 participants from the Framingham Offspring and Third Generation cohorts across approximately 6 years of follow-up (2002–2005 to 2008–2011). Liver fat was measured by computed tomography using the liver phantom ratio (LPR). Incident nonalcoholic fatty liver disease (NAFLD) was defined as follow-up LPR ≤0.33 after excluding prevalent baseline cases and individuals with heavy alcohol consumption. Food frequency questionnaires assessed intakes of whole eggs (<1, 1, and ≥2 per week), weight-adjusted dietary choline, and combined lutein and zeaxanthin. Associations with incident NAFLD and annualized liver fat change were evaluated using multivariable modified Poisson regression and general linear models.
What was found
The cumulative incidence of NAFLD was 19% among 1,414 participants. Whole egg consumption and combined lutein and zeaxanthin intake showed no significant association with incident NAFLD risk or liver fat change. However, higher dietary choline intake was significantly associated with a lower risk of incident NAFLD (RR for tertile 3 vs. tertile 1: 0.69, 95% CI: 0.51, 0.94).
Why it matters
Choline is essential for hepatic lipid metabolism, and this study provides longitudinal evidence linking higher dietary choline intake to reduced NAFLD incidence in a community cohort, even though total egg intake itself was not directly protective.
Limits
Dietary intake was self-reported through food frequency questionnaires, introducing potential measurement error. The highest category of egg consumption was relatively low (≥2 eggs per week), precluding conclusions about high-intake patterns. Findings from the Framingham cohorts may not generalize to diverse populations, and residual confounding cannot be ruled out.
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.