Risk Factors of Liver Fibrosis Among First Degree Relatives of Patients With NASH Related Cirrhosis (NRC)

Study Overview
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Brief Summary
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The study aim to identify the risk factors of liver fibrosis among first degree relatives. This study consists of 2 parts (Cross Sectional and Case Control Study). Part 1: The first primary objective will be achieved by following study design. Study population: First degree relatives of NRC. Study design: A Cross Sectional Study Part 2 The second Primary objective will be achieved by following study design. Study design: A Case Control Study Study population: Case: NASH related Cirrhosis patients Control-1: Healthy Control. Control-2: HBV Disease Control Study period: 3 Years All the patients diagnosed with NASH cirrhosis attending Institute of Liver and Biliary Sciences OPD/IPD will be enrolled. An informed consent will be taken. Complete details of the subject will be taken. The data will be collected on socio-demographic by (socio-demographic questionnaire), alcohol by AUDIT-C (Alcohol Use Disorders Identification Test), Tobacco by FTND (Fagerstrom Test Nicotine Dependence), physical activity by IPAQ (International Physical Activity Questionnaire), Diet by FFQ (Food Frequency Questionnaire), physical measurement & all the comorbidities. Blood will be collected and analyzed for Platelets, PT/INR, Serum Creatinine, LFT, FBS, HOMA-IR, Lipid Profile, HBsAg, AntiHBs, Anti HBc, Anti HCV, Anti HAV, IgM anti HAV, IgM anti HEV, auto-Immune markers, Ceruloplasmin, Transferrin, S.Ferritin, Alpha1antitrpsin and genetic markers. The stool will be collected and analyzed for gut microbiota profiling.

Detailed Description
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The data will be collected on socio-demographic by (socio-demographic questionnaire), alcohol by AUDIT-C (Alcohol Use Disorders Identification Test), Tobacco by FTND (Fagerstrom Test Nicotine Dependence), physical activity by IPAQ (International Physical Activity Questionnaire), Diet by FFQ (Food Frequency Questionnaire), 24-hour dietary recall method, physical measurement & all the comorbidities. Blood will be collected and analyzed for CBC, LFT, KFT, PT/INR, FBS, HOMA-IR, Lipid Profile, HBsAg, AntiHBs, Anti HBc, Anti HCV, Anti HAV, IgM anti HAV, IgM anti HEV, auto-Immune markers, Ceruloplasmin, Transferrin, S.Ferritin, Alpha1antitrpsin and genetic markers. The stool will be collected and analyzed for gut microbiota profiling. Controlled Attenuation Parameter and liver stiffness will be measured by using transient elastography. Ultrasound abdomen will be done First degree relatives of indexed patients will be enrolled. First degree relatives who will not accompanying the indexed subject will be contacted telephonically and will be requested to participate in the study. The data on first degree relative will be collected on similar parameter as of the indexed patient. This will be a cross sectional study. For each case, 1 healthy controls will be taken. Healthy Control will be identified from the OPD/IPD of ILBS. Liver transplant donors, hospital volunteers, Blood Donors, healthy attendants who are accompanying other patients of different specialties will be enrolled. An informed consent will be taken. The data will be collected on similar parameter as of the indexed patient. This will be case control study. We will also have disease control (HBV control) for each case enrolled. Subject suffering from Hepatitis B virus related liver cirrhosis will be included as disease control. For each case, 1 disease control will be included. Disease Control will be identified from the OPD/IPD of ILBS. An informed consent will be taken. The data will be collected on similar parameter as of the indexed patient. Genetic markers and stool microbiota profiling will be done in 30% of the subsets of sample i.e NASH related Cirrhosis, First Degree Relatives, Healthy Control and HBV Disease control.

Official Title
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Risk Factors of Liver Fibrosis Among First Degree Relatives of Patients With NASH Related Cirrhosis (NRC).

Conditions
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Liver Cirrhoses

Intervention / Treatment
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* Other: No intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria for NASH related Cirrhosis (Group 1-Index Case) Age ≥18 yrs Diagnosed cases of NASH with Cirrhosis. Exclusion Criteria for NASH related Cirrhosis (Group 1) Acute on Chronic Liver Failure Patients with HBV, HCV, Wilson's, Hemochromatosis, alpha 1 antitrypsin deficiency, primary biliary cirrhosis). Patient on treatment with amiodarone or methotrexate. Patient with any malignancies Patient on chemotherapy Inclusion Criteria for First Degree Relatives (Group 2) Age ≥8 yrs All the first degree relatives of index case. Exclusion Criteria for First Degree Relatives (Group 2) 1. Alcohol intake Inclusion Criteria for Healthy Control (Group 3) Age ≥18 yrs Subjects with no history of any known liver disease Non-Alcoholic Matched with Age (+/- 5 yrs.) and Gender Exclusion Criteria for Healthy Control (Group 3) 1. None Inclusion Criteria for HBV Disease Control (Group 4) Age ≥18 yrs HBV Cirrhosis Matched with Age (+/- 5 yrs.) and Gender Exclusion Criteria for HBV Disease Control (Group 4) Patient with any malignancies HBV related Liver Fibrosis (≤ F3).

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| NASH related Cirrhosis<br> | Other: No intervention<br>* No intervention<br>|
| Healthy Controls<br> | Other: No intervention<br>* No intervention<br>|
| First Degree Relatives of NASH related Cirrhosis<br> | Other: No intervention<br>* No intervention<br>|
| HBV Disease Control<br> | Other: No intervention<br>* No intervention<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Physical activity-related risk factors as assessed using the International Physical Activity Questionnaire (IPAQ) between NASH related cirrhosis and their First Degree Relatives. |  | Day 0 | 
| Physical activity-related risk factors as assessed using the International Physical Activity Questionnaire (IPAQ) between NASH related cirrhosis and Healthy Control group. |  | Day 0 | 
| Dietary risk factors as captured by Food Frequency Questionnaire (FFQ) & 24 hour dietary recall method between NASH related cirrhosis and their First Degree Relatives. |  | Day 0 | 
| Dietary risk factors as captured by Food Frequency Questionnaire (FFQ) & 24 hour dietary recall method between NASH related cirrhosis and Healthy Control group |  | Day 0 | 
| Difference in microbiota profiling as done by 16s RNA sequencing technique between NASH related cirrhosis and their First Degree Relatives. |  | Day 0 | 
| Difference in microbiota profiling as done by 16s RNA sequencing technique between NASH related cirrhosis and Healthy Control group |  | Day 0 | 
| Genetic Single Nucleotide Polymorphism (SNP's) and Metabolic parameters in NASH related Cirrhosis patients and their 1st degree relatives. |  | Day 0 | 
| Genetic Single Nucleotide Polymorphism (SNP's) and Metabolic parameters in NASH related Cirrhosis patients and Healthy Control group. |  | Day 0 | 
| Metabolic syndrome as risk factors between NASH cirrhosis and their First Degree Relatives. |  | Day 0 | 
| Metabolic syndrome as risk factors between NASH cirrhosis and healthy Control |  | Day 0 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of Liver fibrosis among first degree relatives of patients with NASH related Cirrhosis. |  | Day 0 | 
| Physical activity-related risk factors as assessed using the International Physical Activity Questionnaire (IPAQ) between NASH related cirrhosis and HBV disease control. |  | Day 0 | 
| Dietary risk factors as captured by Food Frequency Questionnaire (FFQ) and 24 hours dietary recall method between NASH related cirrhosis and HBV disease control. |  | Day 0 | 
| Difference in microbiota profiling as done by 16s RNA sequencing technique between NASH related cirrhosis and HBV disease control. |  | Day 0 | 
| Genetic Single Nucleotide Polymorphism (SNP's) and Metabolic parameters in NASH related Cirrhosis patients and HBV disease control. |  | Day 0 | 
| Metabolic syndrome as risk factors between NASH cirrhosis and HBV Cirrhosis |  | Day 0 |