MRI Study Shows Higher Fibrosis Risk Among First-Degree Relatives of People with NAFLD and Advanced Fibrosis

Screening for advanced fibrosis in first-degree relatives of people with cirrhosis or advanced fibrosis is not currently recommended by the American Gastroenterological Association nor the American Association for the Study of Liver Diseases. Emerging research suggests reevaluating that guidance.

In a recent prospective study published in the Journal of Clinical Investigation, researchers performed screening (primarily with magnetic resonance elastography) to assess the prevalence of advanced fibrosis in first-degree relatives of people with non-alcoholic fatty liver disease (NAFLD) and advanced fibrosis. The study of 220 participants in a University of California, San Diego (UCSD)-based derivation cohort and 176 people in a subsequent validation cohort from the University of Helsinki included first-degree relatives of probands with NAFLD and advanced fibrosis, those with NAFLD and no advanced fibrosis, and people with non-NAFLD, according to the study.

The researchers found that first-degree relatives of probands with NAFLD and advanced fibrosis were 15.6 percent more likely to develop advanced fibrosis, according to the derivation study cohort. The validation cohort showed a 14 percent higher likelihood of advanced fibrosis in this population. The combined cohort analysis also revealed a 13.6 percent prevalence of NAFLD in the first-degree relatives of those with NAFLD and advanced fibrosis.

The study authors said the findings clearly demonstrate the need for liver fibrosis screening for those with a family history of advanced fibrosis.

“When patients with NAFLD-related advanced fibrosis are seen in liver clinics, their first-degree relatives should be counseled for risk of advanced fibrosis among family members, and they should be offered screening for advanced fibrosis with either MRE or (vibration-controlled transient elastography (VCTE)) or other modalities,” wrote Rohit Loomba, M.D., a professor in the Division of Gastroenterology and director of the NAFLD Research Center at the UCSD School of Medicine, and colleagues.

First-degree relatives of probands with NAFLD and no advanced fibrosis demonstrated a 5.9 percent higher risk of advanced fibrosis in the derivation cohort while the validation cohort showed a 2.6 percent risk in the validation cohort, according to the study. The combined cohort analysis showed a 40.4 percent prevalence of NAFLD in this population.

Loomba and colleagues noted that other significant risk factors for advanced fibrosis in first-degree relatives included obesity, diabetes mellitus, dyslipidemia, hypertension, and age > 50.

In regard to study limitations, the study authors noted that they did not evaluate genetic and environmental factors associated with the progression of NAFLD. With the study population being primarily comprised of White and Hispanic participants, Loomba and colleagues suggested that future research assess NAFLD and fibrosis in other populations to help validate the current study findings. Noting a higher incidence of NAFLD in postmenopausal women, the researchers maintained that subsequent studies should examine the impact of menopausal status on fibrosis prevalence in relatives.