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FIGURE 12-3 Serum alanine aminotransferase (ALT) activity in men ingesting a control or choline-deficient diet. Serum ALT was determined by using an automated spectrophotometric assay. Data are expressed as mean activity ± standard error of the mean. *Difference from day 7 value: p < 0.05. Reprinted with permission, from Zeisel et al. (1991). Copyright 1991 by the Federation of American Societies for Experimental Biology.

als, this is resolved when a source of dietary choline is provided (Buchman et al., 1992, 1993, 1995; Chawla et al., 1989; Shapira et al., 1986; Sheard et al., 1986). In a double-blind protocol, investigators administered lecithin (30 percent phosphatidylcholine) orally to patients receiving TPN twice daily for 6 weeks. At the end of this time, plasma choline had risen by more than 50 percent in the lecithin group whereas in the placebo group it had decreased by 25 percent. In the treated group, liver fat decreased by 30 percent (Buchman et al., 1992). In another small clinical study (Buchman et al., 1995), four patients who had low plasma concentrations of free choline after treatment with TPN (which contained no additional choline) were given 1 to 4 g/day of choline chloride for 6 weeks. During choline administration, plasma choline concentration

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