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First-degree relatives of patients with NAFLD-cirrhosis at risk for advanced fibrosis

First-degree relatives of patients with nonalcoholic fatty liver disease and cirrhosis have a 12-times higher risk for developing advanced fibrosis compared with first-degree relatives without NAFLD, according to results of a well-phenotyped familial cohort study.

“This prospective study quantifies the risk of advanced fibrosis in first degree relatives of NAFLD related cirrhosis,” Rohit Loomba, MD, director of the NAFLD Research Center, UC San Diego Health, said to Healio.com/Hepatology.“These novel data suggest that we should screen first degree relatives of patients with NAFLD cirrhosis for the presence of advanced fibrosis."

Rohit Loomba

The researchers prospectively enrolled 26 patients with NAFLD-related cirrhosis and 39 of their first-degree relatives (sibling, child or parent) between February 2013 and March 2016. Additionally, the researchers recruited 69 pairs of twin, sibling and sibling, or parent–offspring controls with no evidence of NAFLD.

Compared with the first-degree relatives of controls, first-degree relatives of patients with NAFLD-related cirrhosis had a higher BMI (31 kg/m² vs. 25.5 kg/m²; P < .0001), were more likely to be diabetic (15.4% vs. 2.9%; P < .0249), had a higher liver fat content on magnetic resonance imaging of proton density fat fraction (10.7% vs. 2.8%; P < .001) and had a higher prevalence of NAFLD (74% vs. 8.7%; P < .001).

The prevalence of advanced fibrosis in the first-degree relatives was 1.4% for those related to study patients without NAFLD, 12% in those related to study patients with NAFLD without fibrosis, and 18% in those related to study patients with NAFLD with cirrhosis (P < .003).

First-degree relatives of patients with NAFLD-related cirrhosis had a higher risk for advanced fibrosis compared with the control population (OR = 14.9; 95% CI, 1.8-125). This risk remained significant after adjusting for age, sex, Hispanic ethnicity, BMI and diabetes status (OR = 12.5; 95% CI, 1.1-146.1)

First-degree relatives of patients with NAFLD-related cirrhosis also had a high risk for cirrhosis compared with controls (OR = 80.85; 95% CI, 32.85-198.99) using a prevalence of 0.27%, as reported previously. In using a prevalence of 0.15%, the odds ratio was 145.63 (95% CI, 55.65-381.06.

“These data may impact and potentially change clinical practice in increasing awareness of advanced fibrosis in NAFLD in high-risk populations such as those with a first-degree relative with NAFLD-cirrhosis,” the researchers concluded. “Further studies are needed to determine the interval for surveillance after initial screening. The clinical implications of this study are potentially significant, as earlier detection of cirrhosis would perhaps lead to earlier initiation of hepatocellular carcinoma screening and surveillance.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.