The impact of choline supplementation on oxidative stress and clinical outcomes among patients with non-alcoholic fatty liver disease: a randomized controlled study

Background: Non-alcoholic fatty liver disease (NAFLD) is a prevalent condition characterized by the accumulation of fat in the liver. Nutrition, particularly micronutrients, plays a crucial role in the development and progression of NAFLD. Objectives: This study aimed to assess the impact of choline supplementation on oxidative stress, inflammation, and clinical outcomes in patients with NAFLD. Design: A randomized, controlled, single-blinded study. Methods: Eligible NAFLD patients were randomized to; choline group ( n = 39), received conventional management plus phosphatidylcholine (PC) 2400 mg/day for 12 weeks, or c ontrol group ( n = 40), received conventional management for 12 weeks, and 10 healthy volunteers were included. Anthropometric, clinical, and laboratory evaluations were performed at baseline and after treatment. Results: After 12 weeks, choline group showed significant differences versus controls by improvement in controlled attenuation parameter (304 vs 332 dB/m, p < 0.001) and fibrosis score (5.3 vs 6.8 kPa, p < 0.001), reduction in thiobarbituric acid reactive substances levels (1.9 vs 3.8 nmol/mL, p < 0.001), a decline in leptin levels (1.3 vs 2.1 ng/mL, p < 0.001) and liver enzyme (alanine aminotransferase and aspartate aminotransferase), p < 0.001 and 0.004 respectively). Also, the lipid profile improved by a significant decline in triglyceride levels in choline versus controls 133 versus 158, p = 0.048. Conclusion: Choline supplementation in NAFLD patients demonstrated a favorable impact on hepatic steatosis, oxidative stress, inflammatory markers, liver enzyme levels, and lipid profile. These findings suggest that choline may be a promising therapeutic option for NAFLD management. Further large-scale, long-term studies are warranted to investigate the clinical benefits of choline supplementation in NAFLD patients. Trial registration: The study was registered at clinicaltrials.gov and given the ID number: NCT05200156.