106 



CHOLINE 



or its precursors were added to the diet to compensate for the additional 

 calories supplied by this amount of sucrose. These experiments indicate 

 that the ratio of lipotropic factors to the total caloric intake must be above 

 a certain critical le\-el to protect the liver from harmful degrees of fat stor- 

 age and its almost inevitable successor, fibrosis. If the caloric intake be 

 raised by any means without a simultaneous increase in the lipotropes, the 

 resulting disturbance of liver function may eventually produce as grievous 



Fig. 6. Gross appearance of the liver of rat which had been maintained on a 

 choline-deficient diet for approximately one year. 



a result as the operation of an engine without adeciuate lubrication. Such 

 an imbalance has been produced in animals by choline-deficient caloric in- 

 crements supplied not only as carbohydrate and alcohol but also as fat or 

 methionine-poor protein. Persistent addiction to excessive amounts of 

 alcohol in man constitutes a fairly close clinical duplication of these experi- 

 mental conditions, and it is a reasonable working hypothesis that cirrhosis 

 of this type is due to choline deficiency .^'-^ It is possible also that the fatty 



^^^ It must be recognized, of course, that the alcoholic patient is probal>ly suffering 

 from multiple dietary deficiencies, involving not only the vitamins but also min- 

 erals and particularly proteins. 



