What is the evidence for choline supplementation in steatosis?

• A. No effect on steatosis
• B. Steatosis worsened with supplementation
• C. Investigations reported that steatosis resolved following choline supplementation; further studies to evaluate choline supplementation to prevent and treat PN associated liver disease are needed
• D. Choline supplementation has been proven to prevent PN-associated liver disease

Answer: (C)

Choline acts as a lipotropic nutrient, essential for the proper export of triglycerides from the liver as VLDL. In parenteral nutrition, choline deficiency can contribute to hepatic steatosis, so supplementation is studied as a way to counteract PN-associated liver changes. The best-supported statement is that investigations have reported steatosis resolving after choline supplementation, but there is a need for more research to evaluate whether choline can prevent and treat PN‑associated liver disease more broadly. While this points to a potential benefit, the evidence isn’t yet definitive or universal, so conclusive preventive claims aren’t made.