Fatty liver and
splenomegaly are typical features of genetic
lysosomal acid lipase (
LAL) deficiency. No data in adult patients with non-genetic reduction of LAL activity are available. We investigate the association between spleen dimensions and LAL activity in
non-alcoholic fatty liver disease (
NAFLD) patients, in whom a reduced LAL activity has been reported. We include 425 consecutive patients who underwent abdominal ultrasound to evaluate hepatic steatosis and spleen dimensions. LAL activity was measured with dried blood spot method (Lalistat2).
NAFLD was present in 74.1% of screened patients. Higher median spleen longitudinal diameter (10.6 vs. 9.9 cm; p < 0.001) and spleen area (SA) (32.7 vs. 27.7 cm2; p < 0.001), together with a higher and proportion of
splenomegaly (17.8 vs. 5.5%, p = 0.001), are present in patients with
NAFLD compared to those without. In
NAFLD patients, median LAL activity is 0.9 nmol/spot/h. LAL activity is lower in 56 patients with
splenomegaly, as compared to those without (p = 0.009). At multivariable logistic regression analysis, age (above median, OR 0.344; p = 0.003), LAL activity (below median, OR 2.206, p = 0.028), and platelets (OR 0.101, p = 0.002) are significantly associated with
splenomegaly.
NAFLD patients disclose a relatively high prevalence of spleen enlargement and
splenomegaly, which are significantly associated with a reduced LAL activity, suggesting that LAL may contribute to spleen enlargement in this setting.