Choline and metabolic health, a missing link in a critical chain.

PURPOSE OF REVIEW: Emerging evidence suggests that choline plays a significant role in mediating metabolic disease beyond the regulation of hepatic triglycerides. The aim of this article is to present a current, brief synthesis focused on the impact of choline intake on metabolic health and to identify future directions in this research space. RECENT FINDINGS: Recent work has linked low choline intake to obesity, metabolic dysfunction-associated steatotic liver disease (MASLD), type 2 diabetes, and obesity-associated cognitive decline. A new methodology now enables more precise discrimination of choline intake in clinical populations. Emerging evidence reframes circulating trimethylamine N-oxide (TMAO) as a marker of metabolic dysfunction driven by obesity and a high-fat diet, rather than a direct consequence of dietary choline intake. Preclinical and clinical studies further suggest that adequate choline intake may be protective against obesity-related disease progression, particularly when established early in life. SUMMARY: Choline is emerging as an important mediator of metabolic health and disease progression. A deeper understanding of the mechanisms regulating choline metabolism is critical to tailor nutritional therapies and mitigate metabolic disease progression. The impact of new antiobesity medications, including GLP-1 receptor agonists, on choline requirements also warrants investigation.