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adequate choline intake has been shown to lower alanine aminotransferase levels and improve hepatic insulin sensitivity in clinical studies

First, MNA is not stable in in vivo

The mammalian sirtuins (Sirt1--Sirt7) participate in a number of cellular and physiological functions such as gene silencing, apoptosis, mitochondrial function, energy homeostasis, and longevity [237].Transgenic mice with overexpression of the sirt1 gene demonstrate decreased lipid-induced inflammation, improved glucose tolerance, and protection from hepatic steatosis when fed a high-fat diet [238]

This leads to poor B12 absorption, even in those who consume sufficient dietary sources[11]