Introduction NAFLD is the most evolving global morbidity progresses to cirrhosis, liver cancer and Transplantation. Clinical Spectrum is heterogeneous with biochemical and histological diversity. CESD is a part of metabolic storage disease with an intrinsic Lysosomal Acid Lipase deficiency (LAL) mimicking clinical overlap with NAFLD. This clinical pilot study evaluates the clinical overlap of similar metabolic syndromes with diverse aetiology And outcome.

Methods Three hundred (n=300) patients with fatty liver disease with Hepatomegaly, splenomegaly or Both with Mean BMI 27%, Mean (Anthropometric assay W/H ratio mean 0.9, HDL 28, LDL 148, Triglyceride 187, HbA1c 5.9, HOMA Score 2.2, CRP 2.3, ALT 67, RBP 2.3, Homocystein 11, Leptin 3.6, Adiponectin 1.1 TNF-α 1,2, IL10 1.2, IL12 0.8. MELD 4). All under went Abdominal Sonogram and carotid artery Doppler. Serum Fibro sure, NASH score was measured and liver biopsy was performed in NASH group. Patients were divided into Group A (n=100) control with mean BMI 27.8% and no hepato-splenomegaly, Group B (n=100) NAFLD with low BMI <26%, and Group C, NASH (n=100) with NAFLD with BMI >30%.

Conclusion Estimated prevalence of LAL 8.3% compared to the historical data (25 in 1 million) LAL has heterogeneity with an overlap WITH NAFLD and NASH. LAL deficiency has peripheral atherogenic potential with significant clinical morbidities with high Steatotic, Fibrogenic, and inflammatory scores than NAFLA or NASH. CESD is an integral part of Fatty liver disease.

Competing interests None declared.