Magnetic resonance spectroscopy to unravel metabolic alterations in hepatic steatosis in humans

The prevalence of non-alcoholic fatty liver (NAFL) / hepatic steatosis has become a major threat to metabolic health as it is a common risk factor for developing diabetes and cardiovascular disease. Despite the known adverse health effects of NAFL, primary metabolic abnormalities leading to NAFL are poorly understood in humans due to the lack of non-invasive techniques. Magnetic resonance spectroscopy (MRS) is a powerful tool to safely study metabolism non-invasively in a dynamic manner. However, the potential of in vivo MRS is not yet fully utilized. In this dissertation, new MR protocols were developed to detect metabolic pathways that contribute to hepatic fat accumulation as well as to characterize metabolic abnormalities associated with NAFL. Next to the abnormal liver fat, other characteristic features were identified in NAFL, such as altered T2 relaxation times, a more saturated fatty acid profile and low choline concentrations in volunteers with steatosis.