Vitamins & Nutrition
Choline and fatty liver in the UK: the nutrient most diets miss, and the blood test that shows it
Reviewed by a qualified clinician · analysed at UKAS-accredited UK labs (ISO 15189)
Last reviewed September 20266 min read
Every Helvy guide is written by our health editors, then checked by a qualified clinician before it goes live and re-checked as the science moves. We name clinical roles, not individuals, until each reviewer has agreed to be credited publicly. This is wellness guidance to help you understand your own data, not a diagnosis.
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Choline is a nutrient your liver needs to package fat and send it out. In a feeding study, 77% of men deprived of it developed fatty liver or muscle damage, which reversed once choline went back in. The UK sets no intake target. ALT, the liver enzyme, is the routine blood marker to read first.
Find the panel that reads your liver →As of September 2026. Choline is having a moment. A May 2026 study in the International Journal of Molecular Sciences found that people with fatty liver ate less choline and carried a distinct blood signature, and the “missing nutrient” angle has spread through the supplement press since.
Perhaps a scan showed your liver is “a bit fatty”. Perhaps you feel heavy and tired after meals and a search led you here. Choline is the nutrient the headlines say most UK diets miss. This is what the evidence shows, and the blood test that tells you where your liver stands.
1. What does choline have to do with fatty liver?
Your liver cannot export fat without it.
Choline is a nutrient in the B-vitamin family. Eggs, meat, fish, milk and soya carry most of it. Your liver makes some choline itself, but not enough. A 2019 paper in BMJ Nutrition, Prevention & Health calls it an essential nutrient that “cannot be produced by the body in amounts needed for human requirements”.
The liver uses choline to make phosphatidylcholine, the coating on the particles that carry fat out into the blood. Run short and the coating runs out, so the fat stays in the liver cells. That is what a fatty liver is: fat building up where it should not.
The clearest evidence is a feeding study from the University of North Carolina, published in the American Journal of Clinical Nutrition in 2007. Fifty-seven healthy adults ate a diet with almost no choline for up to six weeks. 77% of the men and 80% of the post-menopausal women developed fatty liver or muscle damage. Only 44% of pre-menopausal women did. Once choline went back into the diet, organ function returned to normal.
That is deficiency, produced on purpose in a laboratory. It is not proof that the fat on your scan came from a choline gap. Most fatty liver in the UK travels with weight, insulin resistance and alcohol, and the NHS says plainly that “healthy lifestyle changes can reduce the build-up of fat in your liver”. Our fatty liver blood test guide covers those bigger causes.
2. Which blood test shows a fatty liver?
ALT, read alongside ALP and your blood fats. And it often reads normal.
“Non-alcoholic fatty liver disease is usually diagnosed after blood tests or scans are done for another reason.”
NHS, non-alcoholic fatty liver disease
- ALT, the first marker. ALT is alanine aminotransferase, an enzyme that lives inside liver cells. When those cells are stressed or swollen with fat it leaks into the blood, so a raised ALT is the routine early sign. Our ALT guide explains the range.
- ALP, alongside it. Alkaline phosphatase is a second liver enzyme, tied to the bile ducts. Reading the two together tells a clinician which part of the liver is complaining.
- Triglycerides and the cholesterol:HDL ratio. Triglycerides are the blood fat a struggling liver handles worst. The ratio divides your total cholesterol by the protective HDL part. Both give the wider picture a fatty liver usually sits in.
One catch. ALT can sit inside the normal range with fat already present, which is why the NHS line above matters. Our guide to fatty liver blood test normal ranges explains how often that happens.
Helvy's Thyroid & Vital Organs panel (£159) carries ALT, ALP, triglycerides and the cholesterol:HDL ratio, with albumin and total protein, from a home finger-prick sample. The liver function test guide walks through each marker. Helvy does not sell choline. A blood choline level is a research measurement, not a routine one, and it is not on any Helvy panel.
A blood test measures biomarkers and offers wellness insight. It does not diagnose fatty liver. A scan does that, and a qualified clinician reads the result in context.
3. How much choline do you need, and are UK diets short?
About 400 mg a day. The UK does not count it.
The European Food Safety Authority set an adequate intake of 400 mg a day for all adults in 2016, with more in pregnancy and breastfeeding. The UK has no figure of its own. Choline is not in the McCance and Widdowson food tables, and the National Diet and Nutrition Survey does not report it. The BMJ paper asked, in its title, whether the UK was overlooking a “choline crisis”, and concluded that the nutrient must not “continue to be overlooked in the UK”.
Where intake has been measured, Europe runs low. A British Journal of Nutrition analysis of national food surveys, the UK's among them, put average adult intakes at 291 to 468 mg a day. Women averaged 291 to 374 mg. Most groups sat under the 400 mg mark.
The food arithmetic is simple, using the Linus Pauling Institute's table of common foods:
- One large egg: 151 mg, over a third of the day.
- Beef liver, 85 g: 355 mg, close to the whole target.
- Salmon or cod, 85 g: about 71 to 75 mg.
- Chicken breast, 85 g, or a cup of cooked broccoli: 62 mg each.
- A cup of milk: 43 mg.
Two eggs get you most of the way. That is why the BMJ paper worried about the shift to plant-based eating: it cites US survey data in which pregnant women eating at least one egg a day were eight times more likely to meet the target. Eggs and liver are the two richest sources, and both are the first things a plant-based diet drops.
4. Does taking choline help a fatty liver?
The trials are small and they disagree. Measure it, do not assume it.
One randomised trial, published in Therapeutic Advances in Chronic Disease in 2025, gave 39 people with fatty liver 2,400 mg of phosphatidylcholine a day for 12 weeks alongside usual care. Forty others had usual care alone. The choline group finished with less liver fat on scan (304 against 332 dB/m), lower liver enzymes and lower triglycerides. It was single-blinded, ran in one centre in Egypt, and the authors call for larger, longer trials.
Pulling the other way, a 2025 analysis of 5,687 US adults in Maturitas found no link between choline intake and having a fatty liver at all. Among the 2,019 who already had one, a higher intake went with higher odds of scarring, mostly in men. More is not obviously better.
Choline is allowed to say one thing about the liver in Great Britain. The authorised health claim is that choline “contributes to the maintenance of normal liver function”. That is a maintenance claim for the nutrient. No supplement may claim to treat fatty liver, and the EFSA upper limit for adults is 3.5 g a day.
So if you add eggs, or start a supplement, put a number on it. An ALT and a triglyceride reading before, and the same two about 12 weeks later, is the length of the trial above and the simplest honest test of whether anything moved. Our guide to lowering ALT explains what a meaningful shift looks like, and the energy and fatigue hub covers the tiredness that often sits alongside.
READY TO TEST?
Start with a baseline, not a supplement
ALT, ALP, triglycerides and the cholesterol:HDL ratio sit on one home finger-prick panel. The quiz will confirm it fits your question. Results in around 5 working days from UKAS-accredited UK laboratories.
Frequently asked questions
Does choline deficiency cause fatty liver?
In a controlled feeding study, yes. 77% of men and 80% of post-menopausal women deprived of choline developed fatty liver or muscle damage within six weeks, and it reversed when choline went back in. Whether ordinary UK intakes are low enough to matter is not established, because the UK does not measure choline intake.
Can choline supplements clear a fatty liver?
No supplement may claim that in Great Britain. One small 12-week trial found less liver fat and lower liver enzymes with phosphatidylcholine. A large US survey found no link between intake and fatty liver, and higher intake went with more scarring in people who already had it. Measure rather than assume.
How much choline is in an egg?
About 151 mg in one large egg, over a third of the 400 mg a day adequate intake the European Food Safety Authority sets for adults. Beef liver carries 355 mg per 85 g serving.
Does the UK have a recommended choline intake?
No. The European Food Safety Authority sets 400 mg a day for adults, but the UK has no figure of its own. Choline is not in the UK food composition tables and the National Diet and Nutrition Survey does not report it.
Which blood test shows fatty liver?
ALT is the routine first marker, read with ALP, triglycerides and the cholesterol:HDL ratio. All four sit on Helvy's Thyroid & Vital Organs panel. A blood test measures these markers; it does not diagnose fatty liver, and ALT can read normal with fat present. A qualified clinician should read the result.
Related guides
Fatty Liver Blood Test UK
ALT, AST, GGT and the AST:ALT ratio, and why a normal ALT can still hide it.
How to Lower ALT Levels
What actually moves the number, and how long it takes.
Triglycerides Blood Test UK
The blood fat a struggling liver handles worst.
Turmeric and Your Liver
Another capsule sold for the liver, and the warning behind it.