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Nutrition and Health (including climate and ecological aspects)

Dietary choline intake and non-alcoholic fatty liver disease (NAFLD) in U.S. adults: National Health and Nutrition Examination Survey (NHANES) 2017–2018



Whether there is an association between dietary choline intake and non-alcoholic fatty liver disease (NAFLD) in American adults remains unclear.


Data came from the National Health and Nutrition Examination Survey 2017–2018. Choline intake was defined by the mean amounts of two 24 h dietary recalls, and choline intake was categorized into three groups according to the quartiles: inadequate (<P25), average (P25–P75), and optimal (>P75). Hepatic steatosis was assessed with FibroScan®, in which VCTE was employed with controlled attenuation to derive the controlled attenuation parameter (CAP), and NAFLD was defined as a CAP score ≥285 dB/m. Multivariable linear regression was performed to assess the linear relationship between choline intake and CAP. Multivariable logistics regression models were conducted to assess the association between choline intake status and NAFLD in the final sample and subgroup analysis was then performed in men and women.


The amount of dietary choline was inversely associated with CAP score (β = −0.262, 95% CI: −0.280, −0.245). Compared to inadequate choline intake, optimal choline intake was related to a lower risk of NAFLD (OR: 0.705, 95% CI: 0.704–0.706) in the final sample. Subgroup analysis by gender revealed that the highest choline intake status was associated with a lower risk of NAFLD both in females (OR: 0.764, 95% CI: 0.762–0.766), and males (OR: 0.955, 95% CI: 0.953–0.958) when compared to the lowest choline intake.


With the latest NHANES data, we found that higher dietary choline was associated with a lower risk of NAFLD in American adults, and such a relationship exists in both females and males.

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Data availability

The NHANES dataset is publicly available online, accessible at (accessed on 8 March 2022).


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Authors and Affiliations



CC: conceptualization, methodology, and writing - original draft; LC: data curation, formal analysis, and writing - review & editing; M-GD, YL, FL, and J-QN: writing - review & editing.

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Correspondence to Chen Chai.

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Chai, C., Chen, L., Deng, MG. et al. Dietary choline intake and non-alcoholic fatty liver disease (NAFLD) in U.S. adults: National Health and Nutrition Examination Survey (NHANES) 2017–2018. Eur J Clin Nutr 77, 1160–1166 (2023).

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