Background : NAFLD is often clustered within families and the causes include both genetic and environmental factors. Family studies done thus far have been limited by small sample size. To examine the familial patterns , we performed a prospective study to see (a) Whether NAFLD is more common in first degree relatives (b) Genetically determined risk factors associated for clustering. Methods: First degree relatives of histologically confirmed NAFLD patients and spouses (controls) were included after excluding other causes of fatty liver. Those having raised transaminases >3 months or sonographic examination consistent with fatty liver, had undergone liver biopsy for histological confirmation. They were divided into three groups. Group I Patients Group II First degree relatives Group III Spouses Results: NAFLD was more prevalent among first degree relatives then spouses (37% and 17%, p<0.01). Anthropometric measurements, systolic and diastolic blood pressure, lipid profile and liver function tests were comparable in three groups. HOMA-R was similar in Group I and II (p=0.073), but was significantly different in Group I and III (p= 0.0001) and Group II and III (p=0.0001) respectively. Metabolic syndrome was present in >70% of patients and were comparable in three groups except for fasting glucose > 110, which was present in 76%, 77% and 57% of patients in group I, II and III respectively. Majority (>50%) of our patients among groups I, II and III were having only steatosis while NASH was present in 20%, 13% and 14% of patients.