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Similarly, another in vitro study found that TMAO can also upregulate the NF-B signaling pathway to promote adipogenic differentiation and inhibit the osteogenic differentiation of bone marrow-derived mesenchymal stem cells (BMSCs) (59)

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In the liver, choline is converted into betaine, which provides methyl groups that help transform homocysteine into methionine.11 This matters because elevated homocysteine is a well-established risk factor for cardiovascular disease, linked to arterial plaque, blood clots, and stroke.38 While folate and vitamin B12 also contribute to this process, choline-derived betaine may provide as much as 60% of the methyl groups needed to keep homocysteine levels under control.11 By helping regulate homocysteine, adequate choline intake contributes to healthier blood vessels and reduced cardiovascular risk