Choline for NAFLD / MASLD
Choline reliably reverses fatty liver only when it is caused by choline deficiency (as in long-term IV nutrition); for ordinary NAFLD/MASLD the evidence that supplementing choline helps is weak and rests on a single small, open-label trial, so it should not be relied on as a treatment.
Why this grade7-layer evidence engine
The grade is held to Weak (C) because of a critical scope split the data force. Choline deficiency clearly drives reversible liver steatosis: a small double-blind RCT in patients on total parenteral nutrition (PMID 11531217, n=15) showed 2 g/day choline chloride raised liver CT density and lowered ALT versus placebo. That proves a human choline requirement, not that choline treats NAFLD in general.
Direct NAFLD evidence is thin and low-certainty. The only trial in a general NAFLD population (PMID 40838115, n=79, 2025) gave 2,400 mg/day phosphatidylcholine for 12 weeks and reported lower liver-fat (CAP) scores, ALT, AST and oxidative stress, with most patients improving a fibrosis stage. But it was open-label, short, and small, so bias cannot be excluded. A 200-patient cohort (PMID 38222945) was uncontrolled and combined choline with Prunus mume, so it cannot isolate choline's effect.
Regulators treat choline only as an essential nutrient, not a liver therapy: the US FDA classifies it as a NUTRIENT SUPPLEMENT and WHO/Codex lists it as a required infant-formula component. No major clinical body (NIH ODS, Mayo, Cleveland Clinic, Harvard) endorses choline supplements to treat NAFLD, and no double-blind RCT or meta-analysis supports that use. Weight loss and a Mediterranean diet remain the guideline first-line approach.
Scoring transparency
All scores computed by a 7-layer evidence engine — fully auditable▸View the full decision path (audit trail)
- compute_raw_score — 加權公式: L2×0.30 + L3×0.25 + L5×0.25 + L11×0.10 + L1×0.10 = 0.542
- tier_from_score — 依分數區間映射至 tier letter
- apply_hec_rules — 無高階證據可裁決
- tier_strict_requirement_check — Tier 條件達標，未降階
- detect_disputes — 偵測到 0 個 hard + 0 個 soft dispute
- decide_status — 依 tier + dispute 結果決定 status