Low Choline Linked to Liver DiseaseLow Choline Linked to Liver Disease

BALTIMOREPostmenopausal women  with nonalcoholic fatty liver disease (NAFLD) who don't consume enough choline are significantly more likely to suffer from fibrosis, a disease that causes liver scarring, according to recent study from Johns Hopkins Children's Center (Am J Clin Nutr March 2012. DOI: 10.3945/ajcn.111.020156).

Researchers performed a cross-sectional analysis of 664 subjects enrolled in the multicenter, prospective Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) with baseline data on diet composition (from a recall-based food-frequency questionnaire) within six month of a liver biopsy.

Because choline needs vary by age, sex and menopausal status, participants were segregated into corresponding categories (children 9 to 13 y old, males younger than 14 years, premenopausal women older than 19 years, and postmenopausal women) on the basis of the Institute of Medicine's (IOM) definition of adequate intake (AI) for choline. Deficient intake was defined as less than 50 percent AI.  IOM recommends 425 mg daily choline consumption for non-pregnant, non-breastfeeding women and 550 mg daily for men. Teens should consume 400 mg daily and pre-teens 375 mg daily. Children between ages 4 and 8 should get 250 mg per day, and children between ages 1 and 3 should consume 200 mg daily. Infants less than 1 year of age should receive between 125 and 150 mg daily via formula or breast milk.

The found postmenopausal women with deficient choline intake had worse fibrosis (P = 0.002) once factors associated with NAFLD (age, race-ethnicity, obesity, elevated triglycerides, diabetes, alcohol use and steroid use) were considered in multiple ordinal logistic regression models. Advanced liver scarring was found in nearly half of the 63 postmenopausal women in the group with choline-deficient diets, compared with 30 percent of the 131 post-menopausal women with non-deficient diets. Differences were far less pronounced among men, children and women of child-bearing age. Advanced liver scarring was found in 18 percent of choline-deficient women of childbearing age and in 10 percent of those with non-deficient diets. Eighteen percent of choline-deficient males 14 years of age and older had advanced liver scarring compared with 16 percent among their non-deficient counterparts. Advanced liver fibrosis was seen in 10 percent of choline deficient children ages 9 through 13, while 17 percent of non-deficient ones had the same degree of liver scarring.

Researchers said one possible explanation behind the worse scarring seen among post-menopausal women is that estrogen may affect a subset of genes that regulate choline synthesis, and that declining levels of estrogen after menopause may interfere with this process.

It's still important for other age groups to make sure they are not deficient in choline, as it offers other benefits. For instance, a 2004 study found women who take dietary choline supplements while pregnant may benefit their infants brains.

Choline is an essential mineral found in dairy, eggs, cod, broccoli, peanut butter, lean beef, chicken breast, chicken liver, seed oils, leafy greens, cauliflower and legumes, such as peas, beans and lentils.

NAFLD affects one in three Americans, researchers estimate, and is marked by fatty build-up in the liver, with or without inflammation. In its advanced form, known as non-alcoholic steatohepatitis, the disease causes cell death, irreversible scarring and liver failure.