Evidence suggests that NAFLD might be a heritable disease, but the risk of advanced fibrosis in first-degree relatives of probands with NAFLD and cirrhosis was previously unknown. Caussy et al. performed a prospective analysis of 26 patients with NAFLD and cirrhosis plus their 39 first-degree relatives, along with a control population of individuals without evidence of NAFLD (n = 69) and their first-degree relatives (n = 69). Advanced fibrosis, diagnosed using magnetic resonance elastography, was significantly (P = 0.0032) more prevalent in first-degree relatives of probands than those in the control population. Additionally, the risk of advanced fibrosis was ∼12 times higher (95% CI 1.1–146.1, P = 0.0438) in proband first-degree relatives than relatives in the control group, even after multivariable adjustment. These findings suggest fibrosis screening could be considered in relatives of patients with NAFLD and cirrhosis.