Recent research clarifies the relationship between choline deficiency and nonalcoholic fatty liver disease (NAFLD), and provides details about how choline affects liver health. Those with diets low in choline are at greater risk for developing fatty liver and liver damage. Choline is an essential nutrient that supports normal liver function and helps prevent NAFLD and fatty liver. According to the American Liver Foundation, NAFLD affects up to 25 percent of people in the U.S.

More than 90 percent of the U.S. population does not meet the Adequate Intake recommendation for choline —550 mg/day for men and 425 for women. Choline influences the metabolism of fats in the body and helps manage the circulating level of cholesterol and bile. Liver disease incidence has more than doubled in the past 20 years. In 2012, it was one of the top 10 causes of deaths for U.S. Hispanics, and the number 12 cause for the total population. To learn more, visit the American Liver Foundation website at

Dietary requirements for choline are affected by estrogen status, genetics, and the protective role choline can play in supporting liver health by working with gut bacteria (microbiome). Estrogen helps support the body’s synthesis of choline. Premenopausal women and postmenopausal women taking estrogen may have a lower dietary requirement. However, 40 percent of women have a genetic defect that raises their dietary requirement for choline to 550 mg/day. Choline requirements are also significantly affected by an individual’s type of gut bacteria (microbiome).

Our consumption of choline-rich foods has decreased in recent years, so it is almost always necessary to supplement the diet with choline. The U.S. Food and Drug Administration recently added choline as a permitted nutrient to be listed voluntarily on the Nutrition Facts panel on food labels. In addition to consuming adequate amounts of choline, other important steps to help prevent NAFLD are maintaining a healthy weight, eating a balanced diet, exercising regularly, limiting alcohol intake, and only taking medicines that you need and following dosing recommendations.