Epidemiology
Systematic review of 40,045 patients finds the Lp(a)-fatty liver relationship remains genuinely contradictory across studies (Indian J Gastroenterol 2024)
Original title: Association between hepatic steatosis and lipoprotein(a) levels in non-alcoholic patients: A systematic review
This PRISMA-guided, PROSPERO-registered systematic review searched for studies evaluating the association between Lp(a) and non-alcoholic fatty liver disease (NAFLD) or steatohepatitis (NASH), identifying ten eligible observational studies covering 40,045 patients (9,266 in NAFLD groups, 30,779 in controls). Of five studies evaluating NAFLD directly, four found hepatic steatosis associated with lower Lp(a), while one found the opposite. Two NASH-specific studies found no significant Lp(a) difference from controls, though rising Lp(a) correlated with liver fibrosis in one of them. A study analysing both NAFLD and NASH together found a neutral result in NAFLD but a positive relationship in NASH, and two studies using the newer metabolic-associated fatty liver disease (MAFLD) definition also showed neutral results. The authors conclude that while an association between Lp(a) and hepatic steatosis is plausible, the published evidence to date remains contradictory and inconclusive.
Original abstract
Background And Objectives: It is well known that lipid abnormalities exist in the context of non-alcoholic fatty liver disease (NAFLD). The association between lipoprotein(a) [Lp(a)] levels and NAFLD is poorly understood. The main objective of the present study was to assess the association between Lp(a) levels and NAFLD.
Methods: This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO CRD42023392526). A literature search was performed to detect studies that evaluated the association between Lp(a) levels, NAFLD and steatohepatitis (NASH).
Results: Ten observational studies, including 40,045 patients, were identified and considered eligible for this systematic review. There were 9266 subjects in the NAFLD groups and 30,779 individuals in the respective control groups. Five studies evaluated patients with NAFLD (hepatic steatosis was associated with lower Lp(a) levels in four studies, while the remaining showed opposite results). Two studies evaluating NASH patients showed that Lp(a) levels were not different compared to controls. However, the increment of Lp(a) levels was correlated with liver fibrosis in one of them. In addition, one study analyzed simultaneously patients with NAFLD and NASH, showing a neutral result in NAFLD patients and a positive relationship in NASH patients. Two studies that included patients with the new definition of metabolic-associated fatty liver disease (MAFLD) also showed neutral results.
Conclusion: Although there could be an association between Lp(a) levels and hepatic steatosis, the results of the studies published to date are contradictory and not definitive.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.