Few studies on humans have comprehensively evaluated the intake composition of methyl-donor nutrients (MDNs: choline, betaine, and folate) in relation to visceral obesity (VOB)-related hepatic steatosis (HS), the hallmark of non-alcoholic fatty liver diseases. In this case–control study, we recruited 105 patients with HS and 104 without HS (controls). HS was diagnosed through ultrasound examination. VOB was measured using a whole-body analyzer. MDN intake was assessed using a validated quantitative food frequency questionnaire. After adjustment for multiple HS risk factors, total choline intake was the most significant dietary determinant of HS in patients with VOB (Beta: −0.41, p = 0.01). Low intake of choline (<6.9 mg/kg body weight), betaine (<3.1 mg/kg body weight), and folate (<8.8 μg/kg body weight) predicted increased odds ratios (ORs) of VOB-related HS (choline: OR: 22, 95% confidence interval [CI]: 6.5–80; betaine: OR: 14, 95% CI: 4.4–50; and folate: OR: 19, 95% CI: 5.2–74). Combined high intake of choline and betaine, but not folate, was associated with an 81% reduction in VOB-related HS (OR: 0.19, 95% CI: 0.05–0.69). Our data suggest that the optimal intake of choline and betaine can minimize the risk of VOB-related HS in a threshold-dependent manner.

In humans, PEMT rs7946 polymorphism exerts sex-specific effects on choline requirement and hepatic steatosis (HS) risk. Few studies have explored the interaction effect of the PEMT rs7946 polymorphism and sex on the effect of adequate choline intake on HS risk. In this cross-sectional study, we investigated the association between PEMT polymorphism and adequate choline intake on HS risk. We enrolled 250 older patients with metabolic disorders with (n = 152) or without (n = 98; control) ultrasonically diagnosed HS. An elevated PEMT rs7946 A allele level was associated with a lower HS risk and body mass index in both men and women. Dietary choline intake—assessed using a semiquantitative food frequency questionnaire—was associated with reduced obesity in men only (p for trend < 0.05). ROC curve analysis revealed that the cutoff value of energy-adjusted choline intake for HS diagnosis was 448 mg/day in women (AUC: 0.62; 95% CI: 0.57–0.77) and 424 mg/day in men (AUC: 0.63, 95% CI: 0.57–0.76). In women, GG genotype and high choline intake (>448 mg/day) were associated with a 79% reduction in HS risk (adjusted OR: 0.21; 95% CI: 0.05–0.82); notably, GA or AA genotype was associated with a reduced HS risk regardless of choline intake (p < 0.05). In men, GG genotype and high choline intake (>424 mg/day) were associated with a 3.7-fold increase in HS risk (OR: 3.7; 95% CI: 1.19–11.9). Further adjustments for a high-density lipoprotein level and body mass index mitigated the effect of choline intake on HS risk. Current dietary choline intake may be inadequate for minimizing HS risk in postmenopausal Taiwanese women carrying the PEMT rs7946 GG genotype. Older men consuming more than the recommended amount of choline may have an increased risk of nonalcoholic fatty liver disease; this risk is mediated by a high-density lipoprotein level and obesity.

Purpose: Chronic viral hepatitis is a major global public health problem. The guidelines suggest the long-term performance of regular ongoing liver examinations to monitor liver inflammation and screen for hepatocellular carcinoma. However, the effects of regular liver examinations on health-related quality of life (HRQoL) have not been adequately evaluated. Therefore, this study evaluated the effects of regular ongoing examinations on the quality of life of patients with hepatitis. Methods: A cross-sectional study was conducted from October to December 2016 in four hospitals in northern Taiwan. A hepatitis pay-for-performance (P4P) program was launched in 2010 to ensure that hepatitis patients have regular ongoing liver examinations. The study group consisted of patients who joined and stayed in the program for more than one year. The study assessed HRQoL utilizing the five-level version of the EuroQol-5 Dimension (EQ-5D-5L) and the EuroQoL visual analog scale (EQ-VAS). The responses for the EQ-5D-5L in hepatitis patients were transformed into the EQ-5D index according to the Taiwanese population’s value set. Sociodemographic and clinical characteristics were collected by questionnaire, and descriptive statistics were presented. A two-part model and generalized linear model with a Poisson distribution and a log link function, respectively, were used to examine the associations of the EQ-5D index and EQ-VAS score with participation in the hepatitis P4P program. We applied propensity score weighting with inverse probability weighting to control for selection bias. Results: In all, 508 patients (aged 57.6 ± 11.6 years; 60.8% male) were enrolled in this study. The mean (standard deviation, SD) reported EQ-5D index and EQ-VAS scores were 0.93 (0.12) and 75.1 (13.8), and the median (interquartile range, IQR) values were 1 (0.108) and 80 (15), respectively. The study group had a moderately significantly higher EQ-VAS score (mean ratio = 1.029, P < 0.001). However, the differences in the EQ-5D index scores between the study and control groups were not significant. Conclusion: Patients with hepatitis partially benefited from receiving hepatitis P4P in Taiwan, which featured regular ongoing liver examinations, in that their EQ-VAS scores were enhanced but not their EQ-5D index scores.

Objective: Patient-centered care (PCC) and continuity of care (COC) are both promoted as quality indicators, yet it remains unclear whether these experiential and structural dimensions of care show different pathway patterns for patient-reported outcomes in diabetes. This study examined their associations with health-related quality of life (HRQoL) and satisfaction among patients with type 2 diabetes, and whether these associations involved patient activation and adherence pathways. Methods: We conducted a cross-sectional survey of 1,394 patients with type 2 diabetes across six hospitals in northern Taiwan in 2016. PCC and COC (patient-reported Bice-Boxerman index) were modeled as care-related predictors; patient activation, assessed using the Patient Activation Measure, and adherence, assessed using a 7-item composite of medication-taking and completion of recommended diabetes examinations, were modeled as intermediate variables; HRQoL (EQ-5D-5L) and satisfaction were the outcome. Path analysis was performed in Stata with maximum likelihood estimation, adjusting for sociodemographic and clinical covariates; hospital-clustered robust standard errors were used to account for patients nested within hospitals. Unstandardized direct, indirect, and total effects with 95% confidence intervals were derived from the hospital-clustered model. Results: With PCC and COC as care-related predictors, patient activation and adherence as intermediate variables, and HRQoL and satisfaction as outcomes, autonomy support and information/education/communication were positively associated with patient activation and patient satisfaction. Both domains showed significant direct and indirect associations through patient activation with satisfaction, with total effects of 0.1805 and 0.3607, respectively (both P < 0.001). Continuity of care was positively associated with patient activation (b = 0.1384, P < 0.001), adherence (b = 0.4367, P = 0.044), and satisfaction (total effect b = 0.1708, P = 0.004). Patient activation was positively associated with satisfaction and HRQoL, whereas adherence was positively associated with HRQoL. Continuity of care was indirectly associated with HRQoL primarily through adherence (combined indirect effect b = 0.0121, P < 0.001). Information/education/communication showed a negative direct association but a positive indirect association with HRQoL, resulting in a nonsignificant total effect. Conclusions: PCC and continuity of care showed complementary, outcome-specific pathway patterns. PCC-related indirect associations with HRQoL were activation-related, whereas continuity of care was associated with HRQoL primarily through adherence; both were associated with satisfaction through direct and activation-related pathways.

Inadequate choline intake-induced choline metabolic stress (CMS) has been divergently linked to metabolic dysfunction-associated steatotic liver disease (MASLD), yet underlying mechanisms remain unclear. We hypothesized that CMS modifies plasma-free amino acid (PFAA) signatures to influence MASLD risk. In a nested case–control study of 125 participants, dietary choline intake and blood choline metabolites were assessed together with targeted metabolomics and transcriptomic profiling. MASLD was characterized by low choline intake, reduced plasma betaine/choline ratio (Pbcr), elevated homocysteine, increased branched-chain amino acids (BCAAs), and depleted serine/glycine, achieving strong predictive accuracy (AUC = 0.90). CMS was associated with reduced lymphocytic transcripts involved in BCAA catabolism and altered mTORC1/Akt/IRS1 signaling. Nonlinear Pbcr- and intake-dependent MASLD risk patterns were attenuated after adjustment for genetic–metabolite networks. These findings identify CMS-responsive metabolic mediators supporting precision choline interventions.