- •Almost 10% of children with NAFLD have extremely low LDL-C levels.
- •Patients with low LDL-C levels have more severe steatosis.
- •These patients are younger and less likely to have metabolic comorbidities.
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Conflict of interest: The authors have no conflicts of interest to disclose. Dr Mouzaki is acting as the submission's guarantor.
Lay summary: Approximately 1-in-10 patients with fatty liver disease have extremely low levels of LDL cholesterol (LDL-C), otherwise known as the bad cholesterol. This protects them from a heart disease standpoint, but it is not known if their liver disease is any different from that of patients with normal or high LDL-C levels. Here, we show that the liver disease of patients with extremely low LDL-C levels is as serious as that of patients with normal or high LDL-C levels, even though they tend to be younger and thinner.