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Phosphatidylethanolamine N-methyltransferase (PEMT) is a hepatic methylation enzyme that is essential for the utilization of choline. Because estrogen activates this gene, premenopausal women fulfill part of their choline requirement through endogenous synthesis. However, a common genetic polymorphism reverses this capability, increasing dietary requirements. Genetic testing is prudent in women who exhibit symptoms of choline deficiency, such as elevated liver enzymes, signs of hepatic steatosis and/or cognitive impairment. Risk is amplified by postmenopausal status and vegetarian diets.
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