Choline intake in a large cohort of patients with nonalcoholic fatty liver disease

• Published in: The American journal of clinical nutrition Vol. 95; no. 4; pp. 892 - 900
• Main Authors: Guerrerio, Anthony L, Colvin, Ryan M, Schwartz, Amy K, Molleston, Jean P, Murray, Karen F, Diehl, AnnaMae, Mohan, Parvathi, Schwimmer, Jeffrey B, Lavine, Joel E, Torbenson, Michael S, Scheimann, Ann O
• Format: Journal Article
• Language: English
• Published: Bethesda, MD American Society for Nutrition 01.04.2012; American Society for Clinical Nutrition, Inc
• Subjects: Adequate Intakes; administration & dosage; Adolescent; Adult; adverse effects; Aged; Aging; alcohols; Biological and medical sciences; Biopsy; Child; children; choline; Choline - administration & dosage; Choline Deficiency; Choline Deficiency - physiopathology; Cohort Studies; computer software; Cross-Sectional Studies; diabetes; Diet; Diet - adverse effects; Dietary minerals; Digestive and Liver Diseases; disease severity; etiology; fatty liver; Fatty Liver - etiology; Fatty Liver - pathology; Feeding. Feeding behavior; Female; Fibrosis; Food; food frequency questionnaires; foods; Fundamental and applied biological sciences. Psychology; Humans; liver; Liver - pathology; Liver diseases; logit analysis; Male; males; medicine; men; Middle Aged; Non-alcoholic Fatty Liver Disease; Nutrition; obesity; pathology; patients; physiopathology; placebos; Postmenopause; Severity of Illness Index; steroids; Surveys and Questionnaires; triacylglycerols; Vertebrates: anatomy and physiology, studies on body, several organs or systems; vitamin E; women; Young Adult; Human; Digestive diseases; Hepatic disease; Choline; Non alcoholic steatohepatitis
• ISSN: 0002-9165; 1938-3207; 1938-3207
• DOI: 10.3945/ajcn.111.020156

There is significant histologic and biochemical overlap between nonalcoholic fatty liver disease (NAFLD) and steatohepatitis associated with choline deficiency. We sought to determine whether subjects with biopsy-proven NAFLD and evidence of an inadequate intake of choline had more severe histologic features. We 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 6 mo of a liver biopsy. Food questionnaires were analyzed with proprietary software to estimate daily intakes of choline. Liver biopsies were centrally read, and consensus was scored with the NASH CRN-developed scoring system. Because choline needs vary by age, sex, and menopausal status, participants were segregated into corresponding categories (children 9-13 y old, males ≥14 y old, premenopausal women ≥19 y old, and postmenopausal women) on the basis of the Institute of Medicine's definition of adequate intake (AI) for choline. Deficient intake was defined as <50% AI. 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. Choline intake was not identified as a contributor to disease severity in children, men, or premenopausal women. Decreased choline intake is significantly associated with increased fibrosis in postmenopausal women with NAFLD. The Pioglitazone vs Vitamin E vs Placebo for Treatment of Non-Diabetic Patients With Nonalcoholic Steatohepatitis trial was registered at clinicaltrials.gov as NCT00063622, and the Treatment of Nonalcoholic Fatty Liver Disease in Children trial was registered at clinicaltrials.gov as NCT00063635.