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Adv Nutr. 2016 Jan 15;7(1):5-13. doi: 10.3945/an.114.007955. Print 2016 Jan.

Choline, Its Potential Role in Nonalcoholic Fatty Liver Disease, and the Case for Human and Bacterial Genes.

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School of Public Health, Curtin Health Innovation Research Institute-Metabolic Health, Curtin University, Bentley, Australia;
School of Exercise and Health Science, Edith Cowan University, Joondalup, Australia;
School of Medicine and Pharmacology, The University of Western Australia, Nedlands, Australia; and Liver Transplant Unit, Sir Charles Gairdner Hospital, Nedlands, Australia.


Our understanding of the impact of poor hepatic choline/phosphatidylcholine availability in promoting the steatosis characteristic of human nonalcoholic fatty liver disease (NAFLD) has recently advanced and possibly relates to phosphatidylcholine/phosphatidylethanolamine concentrations in various, membranes as well as cholesterol dysregulation. A role for choline/phosphatidylcholine availability in the progression of NAFLD to liver injury and serious hepatic consequences in some individuals requires further elucidation. There are many reasons for poor choline/phosphatidylcholine availability in the liver, including low intake, estrogen status, and genetic polymorphisms affecting, in particular, the pathway for hepatic de novo phosphatidylcholine synthesis. In addition to free choline, phosphatidylcholine has been identified as a substrate for trimethylamine production by certain intestinal bacteria, thereby reducing host choline bioavailability and providing an additional link to the increased risk of cardiovascular disease faced by those with NAFLD. Thus human choline requirements are highly individualized and biomarkers of choline status derived from metabolomics studies are required to predict those at risk of NAFLD induced by choline deficiency and to provide a basis for human intervention trials.


NAFLD; choline; liver diseases; microbiome; nonalcoholic steatosis; phosphatidylcholine

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