Genome-wide association meta-analysis identifies 17 loci associated with nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is common and partially heritable and has no effective treatments. We carried out a genome-wide association study (GWAS) meta-analysis of imaging ( n = 66,814) and diagnostic code (3,584 cases versus 621,081 controls) measured NAFLD across diverse ancestries. We identified NAFLD-associated variants at torsin family 1 member B ( TOR1B ), fat mass and obesity associated ( FTO ), cordon-bleu WH2 repeat protein like 1 ( COBLL1 )/growth factor receptor-bound protein 14 ( GRB14 ), insulin receptor ( INSR ), sterol regulatory element-binding transcription factor 1 ( SREBF1 ) and patatin-like phospholipase domain-containing protein 2 ( PNPLA2 ), as well as validated NAFLD-associated variants at patatin-like phospholipase domain-containing protein 3 ( PNPLA3 ), transmembrane 6 superfamily 2 ( TM6SF2 ), apolipoprotein E ( APOE ), glucokinase regulator ( GCKR ), tribbles homolog 1 ( TRIB1 ), glycerol-3-phosphate acyltransferase ( GPAM ), mitochondrial amidoxime-reducing component 1 ( MARC1 ), microsomal triglyceride transfer protein large subunit ( MTTP ) , alcohol dehydrogenase 1B ( ADH1B ), transmembrane channel like 4 (TMC4)/membrane-bound O-acyltransferase domain containing 7 ( MBOAT7 ) and receptor-type tyrosine-protein phosphatase δ ( PTPRD ). Implicated genes highlight mitochondrial, cholesterol and de novo lipogenesis as causally contributing to NAFLD predisposition. Phenome-wide association study (PheWAS) analyses suggest at least seven subtypes of NAFLD. Individuals in the top 10% and 1% of genetic risk have a 2.5-fold to 6-fold increased risk of NAFLD, cirrhosis and hepatocellular carcinoma. These genetic variants identify subtypes of NAFLD, improve estimates of disease risk and can guide the development of targeted therapeutics.