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Lysosomal acid lipase activity and liver fibrosis in the clinical continuum of non-alcoholic fatty liver disease.

  • Baratta, Francesco1, 2
  • Pastori, Daniele1
  • Tozzi, Giulia3
  • D'Erasmo, Laura1
  • Di Costanzo, Alessia1
  • Arca, Marcello1
  • Ettorre, Evaristo4
  • Ginanni Corradini, Stefano5
  • Violi, Francesco1, 6
  • Angelico, Francesco7
  • Del Ben, Maria1
  • 1 I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy. , (Italy)
  • 2 Department of Anatomical Sciences, Histological, Legal Medical and Locomotor, Sapienza University of Rome, Rome, Italy. , (Italy)
  • 3 Hepatology, Gastroenterology and Nutrition Unit, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy. , (Italy)
  • 4 Division of Gerontology, Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Sapienza University, Rome, Italy. , (Italy)
  • 5 Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy. , (Italy)
  • 6 Mediterranea Cardiocentro, Naples, Italy. , (Italy)
  • 7 Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy. , (Italy)
Published Article
Liver international : official journal of the International Association for the Study of the Liver
Publication Date
Dec 01, 2019
DOI: 10.1111/liv.14206
PMID: 31392821


Recent evidence showed a reduced activity of the lysosomal acid lipase (LAL) in patients with non-alcoholic fatty liver disease (NAFLD) and cryptogenic cirrhosis (CC). However, the relationship between LAL activity and liver fibrosis has never been investigated. Cross-sectional study including 575 outpatients referred for the management of cardio-metabolic and liver disease. The absence of liver fibrosis was defined by a FIB-4 < 1.30 and NAFLD fibrosis score (NFS) <-1.455. LAL activity was measured with dried blood spot technique. Overall, 515 patients had a diagnosis of NAFLD (454 NAFL and 61 biopsy-proven NASH) and 60 of CC. The value of LAL activity progressively decreased from healthy subjects to NAFL/NASH patients to CC (P < .001). LAL activity was reduced by 10% in patients with NAFL, by 20% in NASH and by 50% in CC. The prevalence of CC decreased across the tertiles of LAL activity: 22.2% in the lowest, 4.6% in the intermediate and 0.5% in the highest tertile. In NAFLD patients, 69.9% had a FIB4 < 1.30, and 43.1% a NFS <-1.455. Multivariate logistic regression analysis showed that Log (LAL activity) was associated with FIB-4 < 1.30 (Odds ratio [OR] 2.19 95% confidence interval [CI] 1.33-3.62, P = .002) and NFS < -1.455 (OR 2.43, 95% CI 1.51-3.91, P < .001) after adjustment for confounding factors. We found a progressive reduction of LAL activity according to liver disease severity. LAL activity was inversely associated with markers of liver fibrosis in patients with NAFLD. © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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