Health Hotline Magazine | August 2025

NUTRITION

By Geoff Brokx and Katherine MacNair

Inadequate Choline Intake Associated with NAFLD Risk

Non-alcoholic fatty liver disease (NAFLD) currently affects approximately 1 in 4 people, and the prevalence is rising. New research suggests that inadequate intake of choline, an essential nutrient, may increase the risk of developing this condition. NAFLD is one of the most common liver diseases and is characterized by excess fat accumulation in the liver among individuals who consume little to no alcohol. It is believed to be largely driven by the overconsumption of ultra-processed foods, particularly those high in refined carbohydrates and sugar, which promote fat buildup in the liver. Choline plays a crucial role in liver health, yet it is significantly under-consumed in the American diet. Only about 1 in 10 adults meet the recommended adequate intake levels. One of choline’s key functions is in the formation of very low-density lipoproteins (VLDL), which are necessary for transporting fat out of the liver. Without adequate choline, fat can accumulate in the liver, contributing to the development of NAFLD.

A 2023 study using data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES) investigated the relationship between choline intake and NAFLD in 1,458 U.S. adults. Participants were divided into three groups based on daily choline intake: inadequate (<214 mg/day), average (214–412 mg/day), and optimal (>412 mg/day). Liver fat levels were measured using ultrasound-based elastography. The researchers found that both average and optimal choline intake were associated with a significantly lower risk of NAFLD compared to inadequate intake. This study highlights the importance of sufficient choline intake for maintaining liver health. Given that 90 percent of U.S. adults do not meet the recommended dietary intake, choline supplements may offer a simple and effective strategy to support liver function and reduce the risk of fatty liver disease.

Fish Oil Supplementation is More Effective than Eating Fish to Lower Cardiovascu ar Risk A 2025 study published in the British Journal of Nutrition compared the effects of high-dose fish oil supplementation with consumption of oily fish and found that supplementation was more effective at reducing the number of circulating extracellular vesicles in the blood, as well as their ability to promote blood clotting. Extracellular vesicles (EVs) are small, membrane-bound sacs that transport proteins, fats, and genetic material between cells—like an internal delivery system that helps cells communicate and distribute resources. However, because EVs are released in greater numbers in response to inflammation or tissue injury, high levels of circulating EVs are considered a potential biomarker of cardiovascular stress and dysfunction. Some EVs also promote blood clot formation, an additional factor in the development of heart disease. Given these observations, there is growing interest in how diet and nutrients might impact EVs. One area of focus is omega-3 fatty acids, particularly EPA and DHA, which are well-known for their heart-protective effects. In this study, researchers randomly assigned healthy middle-aged adults to one of three groups: a daily fish oil supplement plus twice-weekly white fish meals, a placebo supplement plus oily fish meals (8-ounce servings of either salmon or mackerel twice a week), and a placebo supplement plus twice-weekly white fish meals. White fish was included in the study because it is a non-oily fish that is

low in omega-3s, so researchers used it to help isolate the effects of these essential nutrients on the results. While both the fish oil supplement and oily fish groups received the same total amount of omega-3s and similar amounts of DHA, the fish oil supplement group received a higher amount of EPA than the oily fish group (1.5g per day compared to an average of 0.4g per day). After 12 weeks, both experimental groups showed increases in EPA and DHA levels in EVs and red blood cells, but only the fish oil supplementation group showed a significant reduction in the number and clot-promoting activity of circulating EVs. The researchers attributed this difference to the higher EPA intake in the supplement group—approximately one gram per day more than the oily fish group. This level of EPA intake was only achievable through supplementation.

For references, please visit: naturalgrocers.com/issue-97

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