This little-known nutrient deficiency can lead to fatty liver

Choline deficiency can cause the liver to store excess fat and raise fatty liver risk. Experts flagged its wider importance for brain function, pregnancy and infant development.

In Short

• A recent Lancet study estimated MASLD affects 38.9 percent of Indian adults
• Choline helps produce acetylcholine, supporting memory, attention, heart rate and muscles
• Experts said the body makes little choline, so diet remains essential

Most people may not have heard of choline – a crucial nutrient whose deficiency can cause the liver to store too much fat that may lead to non-alcoholic fatty liver disease (NAFLD), among the most rapidly rising public health challenges in India.

The condition, now rechristened as metabolic dysfunction-associated steatotic liver disease (MASLD), affects nearly a whopping 38.9 percent of Indian adults, according to an important study published in The Lancet Regional Health Southeast Asia.

Choline is an essential water-soluble dietary amine – natural organic compounds found in food. It is not strictly categorised as a vitamin or mineral, it is sometimes grouped with the B-vitamin complex due to similarities in metabolism and function.

A 2018 research paper called choline “the underconsumed and underappreciated essential nutrient." Experts say that choline is good for the brain, heart, and liver, but it has been hugely overlooked. Also, it’s immensely beneficial for pregnant and lactating women.

Choline is classified as an essential nutrient because the liver can make only a small amount, but the body cannot produce enough to meet daily needs and must be obtained from the diet.

In an era where taking supplements is increasingly popular, a balanced diet full of whole foods is still the most practical way to get an adequate amount of choline.

So, where does choline come from, and are we getting enough of it? Let’s unpack what exactly it is.

WHY DO WE NEED CHOLINE?

Well, every cell in our body contains choline. The body uses choline to create acetylcholine, explained Dr. Anshuman Kaushik, bariatric surgeon at CK Birla Hospital, Gurugram. Acetylcholine acts as a chemical messenger that carries signals between nerve cells and plays a key role in regulating muscle contractions, heart rate, memory formation, and attention.

It’s a crucial nutrient. But there is not enough data to establish a Recommended Dietary Allowance for choline. Also, it cannot be measured, there is no single, widely used testing method, according to Dr. Kaushal.

“But its deficiency is one of the contributing factors for fatty liver disease,” said Dr. Kaushal. How? A choline deficiency can cause the liver to store too much fat. This increases the risk for non-alcoholic fatty liver disease. But there is no established link that dietary choline or choline supplementation can treat NAFLD.

"Human studies have consistently shown that choline deficiency directly triggers liver dysfunction" said Dr. Kaushal.

There is some evidence that it improves cognitive performance. “The current body of research supports that adequate choline levels support cognitive development and function in the brain through pregnancy and early childhood," said Dr. Aditya Gupta, Director—Neurosurgery & Cyberknife, Artemis Hospital Gurugram.

Studies have established that choline is an important nutrient for a baby’s development in the womb.

Dr. Mannan Gupta, Chairman & HOD - Obstetrics & Gynaecology, Elantis HealthCare, New Delhi explained that “choline is needed to support the growth and development of the brain and nervous system in the developing fetus.”

He added that “adequate choline can also help to lower the risk of certain congenital abnormalities in the brain or spinal cord." As demand for choline is greater in the fetus during pregnancy, this necessitates an increase in the amount of choline a woman requires during pregnancy to maintain maternal health and support fetal growth.”

Similarly, lactating mothers also need choline, as breast milk provides choline to the infant, he noted.

HOW TO GET CHOLINE FROM YOUR DIET?

According to Dr. Kaushal, it’s best to get choline from one's diet. Choline is found in both plant-based diets and animal foods. Eggs and meat are rich sources of choline. But vegetarian sources are aplenty. Soybeans, cauliflower, and mushrooms are excellent sources too.

Half a cup of roasted soybeans has 107 mg of choline, an egg has around 147 mg, while a chicken breast has around 72 mg, and a cup of cooked quinoa has 43 mg of choline.

Adding peanuts, almonds, broccoli, and whole grains, as well as soy chunks, to one’s diet can immensely boost your choline intake, according to Dr. Gupta.

- Ends