title: Higher dietary choline intake is associated with lower risk of nonalcoholic fatty liver in normal-weight Chinese women.
abstract: BACKGROUND
  Choline deficiency has been shown to induce liver fat accumulation in both rodent and human studies. However, it is unclear whether dietary choline intake is related to fatty liver in the general population.
  
  
  OBJECTIVE
  We examined the association between choline intake and nonalcoholic fatty liver.
  
  
  METHODS
  Participants included 56,195 Chinese women and men, 40-75 y of age, with no or negligible alcohol consumption and with no history of hepatitis, cardiovascular disease, or cancer. All participants reported undergoing liver ultrasonography. Fatty liver was defined by self-report of a physician diagnosis. Habitual dietary intakes were assessed via validated food-frequency questionnaires.
  
  
  RESULTS
  The average total choline intakes were 289 ± 85 mg/d in women and 318 ± 92 mg/d in men. Major food sources were eggs, soy foods, red meat, fish, and vegetables. A higher choline intake was associated with lower risk of fatty liver; after adjustment for sociodemographic characteristics, lifestyle factors, and other dietary intakes, the ORs (95% CIs) for the highest vs. the lowest quintiles of choline intake were 0.68 (0.59, 0.79) in women and 0.75 (0.60, 0.93) in men (both P-trend < 0.01). The inverse association was attenuated after further adjustment for history of metabolic disease and, in particular, BMI. The corresponding ORs (95% CIs) were 0.88 (0.75, 1.03) in women (P-trend = 0.05) and 0.85 (0.68, 1.06) in men (P-trend = 0.09). Stratified analyses suggested a potential effect modification by obesity status in women; the OR (95% CI) across extreme quintiles was 0.72 (0.57, 0.91) in normal-weight women vs. 1.05 (0.84, 1.31) in overweight or obese women (P-trend = 0.007 vs. 0.99, P-interaction < 0.0001).
  
  
  CONCLUSIONS
  Higher dietary choline intake may be associated with lower risk of nonalcoholic fatty liver only in normal-weight Chinese women.
authors.affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN; and.
authors.forename: Danxia
authors.initials: D
authors.lastname: Yu
authors.affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN; and.
authors.forename: Xiao-Ou
authors.initials: XO
authors.lastname: Shu
authors.affiliation: Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China.
authors.forename: Yong-Bing
authors.initials: YB
authors.lastname: Xiang
authors.affiliation: Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China.
authors.forename: Honglan
authors.initials: H
authors.lastname: Li
authors.affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN; and.
authors.forename: Gong
authors.initials: G
authors.lastname: Yang
authors.affiliation: Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China.
authors.forename: Yu-Tang
authors.initials: YT
authors.lastname: Gao
authors.affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN; and.
authors.forename: Wei
authors.initials: W
authors.lastname: Zheng
authors.affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN; and xianglan.zhang@vanderbilt.edu.
authors.forename: Xianglan
authors.initials: X
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D044466:Asian People; D015992:Body Mass Index; D001835:Body Weight; D002794:Choline / Q000008:administration & dosage*; D002796:Choline Deficiency / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D005399:Fishes; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008460:Meat; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology*; D015596:Nutrition Assessment; D009765:Obesity / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D045730:Soy Foods; D011795:Surveys and Questionnaires; D014675:Vegetables
chemical_list: D002794:Choline
keywords: choline; diet; nonalcoholic fatty liver; obesity; population-based study