Menopausal women with non-alcoholic fatty liver disease (NAFLD) who don’t consume enough of the essential nutrient choline appear to be at higher risk for liver scarring, according to research led by scientists at Johns Hopkins Children’s Center.
The findings of a multicenter study, which compared liver damage and choline consumption among 664 children and adults with NAFLD, were published online recently in The American Journal of Clinical Nutrition.
NAFLD affects one in three Americans, researchers estimate, and is marked by fatty build-up in the liver, with or without inflammation.
In its advanced form, known as non-alcoholic steatohepatitis, the disease causes cell death, irreversible scarring and liver failure.
Physicians do not know why some patients develop the more severe forms of the disease fairly quickly while others remain relatively healthy, but nutrition, body weight, genes and environment are all believed to play a role in disease progression. Recent research shows that more children and adults are developing fatty livers, likely due to growing obesity rates, the investigators say.
Choline-rich foods include dairy, eggs, cod, broccoli, peanut butter, lean beef, chicken breast, chicken liver, seed oils, leafy greens, cauliflower and legumes, such as peas, beans and lentils. Low choline intake was not linked to worse damage in children, women of childbearing age and men with NAFLD, a finding that underscores the existence of important age and gender differences in disease progression, the research team reports.
The scientists caution that the exact link behind low choline and liver damage remains unclear and emphasize that adding choline to one’s diet may not halt disease progression.
Researchers speculate that one possible explanation behind the worse scarring seen among post-menopausal women is that estrogen may affect a subset of genes that regulate choline synthesis, and that declining levels of estrogen after menopause may interfere with this process.
Complicating the picture, they note, is that NAFLD has many causes and develops differently from patient to patient. However, the researchers say, the new findings do point to choline as one possible catalyst that may hasten liver damage in certain patients.