Another common group of fatty acid derivatives that did not appear to be elevated in plasma/serum of human MASLD were the cholesterol esters, with only one report citing elevated free cholesterol [160], suggesting an inactivity of the synthetic enzyme acyl-CoA: cholesterol acyltransferase (ACAT) or over activity of the hydrolytic enzyme lysosomal acid lipase (LAL). This evidence concerns the gene LIPA and metabolic dysfunction-associated steatotic liver disease.