Total choline intake, liver fibrosis and the progression of metabolic dysfunction-associated steatotic liver disease: Results from 2017 to 2020 NHANES

Objectives: This study investigated the cross-sectional relationships of total choline intake with the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and its progression to liver fibrosis. Study design: The study used data on total choline intake, hepatic steatosis, and liver fibrosis from the cross-sectional 2017–2020 National Health and Nutrition Examination Survey, including 24-h dietary recalls and liver ultrasound elastography (FibroScan®). Main outcome measures: Steatosis was defined as a controlled attenuation parameter score ≥ 285 dB/m. Fibrosis was defined as median liver stiffness ≥8 kPa. Complex survey-adjusted regression models were used in all analyses. Effect modification by sex, race, and cardiometabolic risk factors was investigated. Result: Total choline intake was not associated with MASLD status (n = 5687; odds ratio per 100 mg/d [95 % confidence interval]: 0.96 [0.85,1.09]; P = 0.55). However, among people with MASLD, a higher total choline intake was associated with higher odds of fibrosis (n = 2019; 1.15 [1.01,1.30]; P = 0.03). This association was observed in men (P-interaction = 0.1; 1.23 [1.02,1.48]; P = 0.03), but not in women (1.05 [0.88,1.24]; P = 1.0). Choline intake also tended to be positively associated with fibrosis in people with MASLD who were overweight or had central obesity (P-interaction = 0.02; 1.15 [1.00,1.34]; P = 0.06). Conclusions: Overall, no significant association was observed between total choline intake and the prevalence of MASLD. However, in people with MASLD, a higher choline intake was associated with higher odds of developing liver fibrosis. This association appeared to differ by sex and cardiometabolic risk factors.