MRS was performed on a 1.5 Tesla (T) whole body clinical scanner (General Electric Healthcare, Waukesha, WI) from December 2003 to February 2010 and on a 3T whole body scanner (General Electric Healthcare, Waukesha, WI) beginning in March 2010. Data collected from the 1.5T scanner were standardized to values collected from the 3T scanner. All VAHH participants were scanned using the same 3T scanner as used in WIHS participants. A time series of 128 (1.5T) or 64 (3T) acquisitions of spectra were obtained from an 8 cubic centimeter (cm3), single voxel region of tissue and were analyzed with motion correction and T2 relaxation time correction algorithms using a standardized MRS protocol[28 (link)]. The peak areas under the resonance frequencies of lipids and unsuppressed water were calculated for each participant and the liver fat fraction (LFF) derived as the ratio of the total lipids measure to the total lipids plus unsuppressed water measure. The LFF was then multiplied by 100 and expressed as a percent. A mean inter-examination coefficient of variation for MRS-measured LFF of 11.9% (range 2.8 – 20.3%) in a sample of 9 controls confirmed its reproducibility. Steatosis was defined as a LFF≥5%.