The metabolic burden of methyl donor deficiency with focus on the betaine homocysteine methyltransferase pathway

Nutrients. 2013 Sep 9;5(9):3481-95. doi: 10.3390/nu5093481.


Methyl groups are important for numerous cellular functions such as DNA methylation, phosphatidylcholine synthesis, and protein synthesis. The methyl group can directly be delivered by dietary methyl donors, including methionine, folate, betaine, and choline. The liver and the muscles appear to be the major organs for methyl group metabolism. Choline can be synthesized from phosphatidylcholine via the cytidine-diphosphate (CDP) pathway. Low dietary choline loweres methionine formation and causes a marked increase in S-adenosylmethionine utilization in the liver. The link between choline, betaine, and energy metabolism in humans indicates novel functions for these nutrients. This function appears to goes beyond the role of the nutrients in gene methylation and epigenetic control. Studies that simulated methyl-deficient diets reported disturbances in energy metabolism and protein synthesis in the liver, fatty liver, or muscle disorders. Changes in plasma concentrations of total homocysteine (tHcy) reflect one aspect of the metabolic consequences of methyl group deficiency or nutrient supplementations. Folic acid supplementation spares betaine as a methyl donor. Betaine is a significant determinant of plasma tHcy, particularly in case of folate deficiency, methionine load, or alcohol consumption. Betaine supplementation has a lowering effect on post-methionine load tHcy. Hypomethylation and tHcy elevation can be attenuated when choline or betaine is available.

Publication types

  • Review

MeSH terms

  • Animals
  • Betaine / administration & dosage
  • Betaine / blood
  • Betaine-Homocysteine S-Methyltransferase / antagonists & inhibitors
  • Betaine-Homocysteine S-Methyltransferase / metabolism*
  • Choline / administration & dosage
  • Choline / blood
  • DNA Methylation
  • Dietary Supplements
  • Disease Models, Animal
  • Fasting
  • Fatty Liver / etiology
  • Fatty Liver / pathology
  • Folic Acid / administration & dosage
  • Folic Acid / blood
  • Homocysteine / blood
  • Humans
  • Liver / drug effects
  • Liver / metabolism
  • Metabolic Networks and Pathways*
  • Methionine / metabolism
  • Muscular Diseases / etiology
  • Muscular Diseases / pathology
  • S-Adenosylmethionine / deficiency*
  • S-Adenosylmethionine / metabolism


  • Homocysteine
  • Betaine
  • S-Adenosylmethionine
  • Folic Acid
  • Methionine
  • Betaine-Homocysteine S-Methyltransferase
  • Choline