LPL and fatty liver disease: It is tempting to speculate that TRL clearance is impaired in TD, possibly due to reduced lipoprotein lipase (LPL) activity [previously reported in TD (28)], impaired storage capacity (eg, due to accumulation of foam cells in the adipose tissue), an increased secretion of VLDL by the liver as a compensatory mechanism in the presence of hepatic steatosis, or both.