Choline and its metabolites are balanced by dietary intake and de novo synthesis of choline via either the cytidine-5-diphosphate-choline (CDP-choline) pathway or the phosphatidylethanolamine-N-methyltransferase (PEMT) pathway (1). Choline is classed as an essential nutrient as de novo synthesis is not sufficient to prevent liver damage when other interdependent nutrients (methionine, folate and vitamin B12) are available in sufficient amounts to sustain normal