Your liver can accumulate too much fat, which is becoming a common health problem. Scientists think this happens partly because many people don’t get enough choline, a nutrient found in foods like eggs and fish. This review looks at how choline might help protect your liver’s energy-producing parts (called mitochondria) from damage caused by alcohol and certain oils in food. Early studies suggest that getting more choline, especially in special forms that your body absorbs better, combined with drinking less alcohol and eating less of certain oils, could help reduce liver fat and improve how your body handles sugar. However, bigger studies are still needed to prove this works.

The Quick Take

  • What they studied: Whether getting enough choline in your diet, especially in advanced forms, could help reverse fatty liver disease by protecting the energy factories inside your liver cells.
  • Who participated: This is a review article that examined existing research on choline and fatty liver disease. It looked at studies in animals and small human studies, but did not conduct a new study with participants.
  • Key finding: People who don’t get enough choline tend to have more fat in their livers and higher liver damage markers. When animals were given more choline while reducing alcohol and certain oils, their liver fat decreased and their liver’s energy production improved.
  • What it means for you: If you have fatty liver disease, getting enough choline through diet or supplements (especially better-absorbed forms like citicoline) combined with reducing alcohol and certain vegetable oils may help. However, you should talk to your doctor before making changes, as larger human studies are still needed to confirm these benefits.

The Research Details

This is a narrative review, which means experts read through existing scientific research on choline and fatty liver disease and summarized what they found. Rather than conducting a new experiment, the authors looked at studies done in laboratory animals and small groups of people to understand how choline works in the body and how it might help with liver problems.

The review focused on understanding how choline supports important functions in your cells, especially in the liver. Choline helps build the protective membranes around your cells and helps your liver package and ship out fats. The authors examined research showing what happens when people don’t get enough choline, and what happens when they get more of it, particularly when combined with reducing alcohol and certain types of dietary fats.

The researchers also looked at different forms of choline supplements, comparing regular choline to more advanced versions like citicoline, which your body may absorb and use more effectively.

Understanding how choline works helps explain why some people develop fatty liver disease and suggests practical ways to prevent or treat it. By framing fatty liver as a problem with your liver’s energy production (rather than just too much fat), scientists can target the root cause instead of just treating symptoms. This approach is important because it suggests that nutrition changes might actually reverse early-stage fatty liver disease.

This is a review article, which means it summarizes existing research rather than presenting new experimental data. The strength of the conclusions depends on the quality of the studies reviewed. The authors acknowledge that while animal studies show promising results, large human studies are still lacking. The research comes from a peer-reviewed scientific journal, which means other experts have checked the work. However, because this is a narrative review (not a systematic review with strict criteria), there may be some bias in which studies were selected.

What the Results Show

Research shows that people who don’t get enough choline in their diet tend to have higher amounts of fat in their livers and higher levels of liver damage markers in their blood. This connection appears in multiple studies looking at American adults, many of whom fall short of recommended choline intake.

In animal studies, when researchers gave animals choline deficiency combined with alcohol or excess linoleic acid (a type of oil found in many vegetable oils), the animals developed worse fatty liver disease. Their liver cells’ energy factories (mitochondria) didn’t work as well, they couldn’t burn fat properly, and they developed more inflammation.

When choline was added back, or when animals were given advanced forms of choline like citicoline, these problems improved. The liver cells’ energy production got better, and the amount of fat stored in the liver decreased. These improvements were especially noticeable when choline was combined with reducing alcohol and excess linoleic acid intake.

Small human studies suggest similar benefits: people who increased their choline intake showed reductions in liver fat and improvements in how their bodies handle blood sugar (insulin sensitivity). However, these studies were small and more research is needed.

The review also found that different forms of choline may work differently in your body. Advanced formulations like citicoline appear to be absorbed better and may reduce the formation of a compound called trimethylamine-N-oxide, which has been linked to health problems. This suggests that not all choline supplements are equally effective.

The research highlights that fatty liver disease is fundamentally a problem with how your liver’s energy-producing structures work, not just a simple case of too much fat. This reframing is important because it suggests that targeting the energy problem (through choline and reducing toxins) might actually reverse the disease in early stages.

This review builds on previous understanding that choline is important for liver health, but adds new perspective by focusing on the energy-production aspect of the problem. Earlier research established that choline deficiency is common and linked to liver problems. This review goes further by explaining the mechanism—how choline protects the mitochondria (energy factories) in liver cells and how alcohol and certain oils damage these structures when choline is low. The dual-strategy approach (more choline plus fewer toxins) is a more comprehensive way of thinking about fatty liver treatment than previous single-factor approaches.

This is a narrative review, not a systematic review, so the selection of studies may reflect the authors’ perspective. The human studies reviewed were small and early-stage, so their results may not apply to larger populations. Most of the strongest evidence comes from animal studies, which don’t always translate directly to humans. The review doesn’t provide specific dosing recommendations because the research on optimal choline amounts for fatty liver disease is still developing. Additionally, the review focuses on choline but doesn’t deeply examine other important factors in fatty liver disease like overall calorie intake, exercise, and other nutrients.

The Bottom Line

If you have fatty liver disease or are at risk: (1) Ensure adequate choline intake through diet (eggs, fish, chicken, broccoli, Brussels sprouts) or consider supplements, particularly citicoline forms which may be better absorbed—moderate confidence based on animal and small human studies. (2) Reduce or eliminate alcohol consumption—high confidence based on extensive research. (3) Reduce intake of linoleic acid-rich vegetable oils (soybean, corn, sunflower oils) and replace with other fat sources—moderate confidence based on emerging research. (4) Discuss these changes with your doctor before starting supplements, especially if you take medications.

People with diagnosed fatty liver disease, those with risk factors (obesity, diabetes, metabolic syndrome), and adults who drink alcohol regularly should pay attention to choline intake. People with genetic conditions affecting choline metabolism should definitely discuss this with their doctor. However, if you have normal liver function and no risk factors, simply eating a balanced diet with adequate choline-rich foods is likely sufficient. Pregnant women and nursing mothers should be especially aware of choline needs, as it’s critical for fetal brain development.

Based on animal studies, improvements in liver fat and energy production can begin within weeks to a few months of choline repletion combined with reduced alcohol and excess oils. However, human studies are limited, so individual results will vary. Early-stage fatty liver disease may be more reversible than advanced disease. You should expect to work with your doctor over several months to assess improvements through blood tests and imaging.

Want to Apply This Research?

  • Track daily choline intake (target: 425-550 mg depending on age/sex) by logging foods like eggs, fish, poultry, and cruciferous vegetables. Also track weekly alcohol consumption and servings of high-linoleic acid oils used in cooking.
  • Set a daily reminder to include one choline-rich food at each meal (example: eggs at breakfast, fish at lunch, chicken at dinner). Replace cooking oils with alternatives lower in linoleic acid. If using supplements, set a daily reminder for consistent citicoline supplementation at the same time each day.
  • Monthly check-ins to review choline intake patterns and identify gaps. Quarterly tracking of how you feel (energy levels, digestion). Work with your doctor to monitor liver function tests (ALT, AST) and liver fat content (via ultrasound or imaging) every 3-6 months to measure progress.

This review summarizes scientific research but is not medical advice. Fatty liver disease is a serious condition that requires professional medical evaluation and monitoring. Do not start choline supplements or make significant dietary changes without consulting your doctor, especially if you have liver disease, take medications, are pregnant, or have other health conditions. The human studies reviewed are small and preliminary; larger clinical trials are still needed. This information is for educational purposes and should not replace professional medical diagnosis or treatment.