title: Choline intake in a large cohort of patients with nonalcoholic fatty liver disease.
abstract: BACKGROUND
  There is significant histologic and biochemical overlap between nonalcoholic fatty liver disease (NAFLD) and steatohepatitis associated with choline deficiency.
  
  
  OBJECTIVE
  We sought to determine whether subjects with biopsy-proven NAFLD and evidence of an inadequate intake of choline had more severe histologic features.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Guerrerio
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Colvin
authors.forename: Amy K
authors.initials: AK
authors.lastname: Schwartz
authors.forename: Jean P
authors.initials: JP
authors.lastname: Molleston
authors.forename: Karen F
authors.initials: KF
authors.lastname: Murray
authors.forename: AnnaMae
authors.initials: A
authors.lastname: Diehl
authors.forename: Parvathi
authors.initials: P
authors.lastname: Mohan
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Schwimmer
authors.forename: Joel E
authors.initials: JE
authors.lastname: Lavine
authors.forename: Michael S
authors.initials: MS
authors.lastname: Torbenson
authors.forename: Ann O
authors.initials: AO
authors.lastname: Scheimann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000375:Aging; D001706:Biopsy; D002648:Child; D002794:Choline / Q000008:administration & dosage*; D002796:Choline Deficiency / Q000503:physiopathology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004032:Diet / Q000009:adverse effects*; D005234:Fatty Liver / Q000209:etiology* / Q000473:pathology; D005260:Female; D005355:Fibrosis; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D017698:Postmenopause; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D002794:Choline