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1 Department of Internal Medicine, Donald W. Reynolds Cardiovascular Clinical Research Center at University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA; Department of Radiology, Donald W. Reynolds Cardiovascular Clinical Research Center at University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
2 Department of Radiology, Donald W. Reynolds Cardiovascular Clinical Research Center at University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
3 Department of Internal Medicine, Donald W. Reynolds Cardiovascular Clinical Research Center at University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
4 Department of Internal Medicine, Donald W. Reynolds Cardiovascular Clinical Research Center at University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA; Howard Hughes Medical Institute at University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
* To whom correspondence should be addressed. E-mail: lidia.szczepaniak{at}utsouthwestern.edu.
Despite the increasing prevalence of nonalcoholic fatty liver disease (NAFLD), the criteria used to diagnose the disorder remain poorly defined. Localized proton magnetic resonance spectroscopy (MRS) accurately measures hepatic triglyceride content (HTGC), but has only been used in small research studies. Here MRS was used to analyze the distribution of HTGC in the in 2,349 participants from the Dallas Heart Study (DHS). The reproducibility of the procedure was validated by showing that duplicate HTGC measurements were high correlated (R=0.99, p<0.001) and the coefficient of variation between measurements was low (8.5%). Intake of a high-fat meal did not significantly affect the measurements and values were similar when measurements were made from the right and left hepatic lobes. To determine the upper-limit-of-normal for HTGC, the distribution of HTGC was examined in the 345 subjects from the DHS who had no identifiable risk factors for hepatic steatosis (nonobese, nondiabetics subjects with minimal alcohol consumption, normal liver function tests and no known liver disease). The 95th percentile of HTGC in these subjects was 5.56%, which corresponds to a hepatic triglyceride level of 55.6 mg.per gram. Using this value as a cutoff, the prevalence of hepatic steatosis in Dallas County was estimated to be 33.6%. Thus, MRS provides a sensitive, quantitative noninvasive method to measure HTGC and when applied to a large urban U.S. population revealed a strikingly high prevalence of hepatic steatosis.
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