Introduction: Metabolic associated fatty liver disease (MAFLD) is one of the most common liver diseases worldwide. NAFLD is associated with metabolic syndrome, which consists of obesity, hypertension, diabetes, and hyperlipidemia. This study aimed to identify the role of Genetic polymorphism in the development of metabolic-associated fatty liver disease among the family members of metabolic-associated steatohepatitis cirrhosis patients. Methods: This was a cross-sectional observational study conducted in the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from January 2015 to December 2016. In this study, 50 patients with NASH cirrhosis attended Hepatology OPD or were admitted to the inpatient department within the study period, and 81 first-degree family members were included after considering inclusion and exclusion criteria. Result: The mean age was 35.34 ± 10.29 years, and the mean BMI was 25.59 ± 4.28. Serum lipid profiles showed mean HDL at 36.91 ± 7.49 mg/dL and triglycerides at 161.23 ± 59.76 mg/dL. Male predominance (54.32%) was observed among family members. A total of 78% of families had 1st-degree relatives affected by fatty liver. Fatty liver was present in 47 family members (58%), with 36 (76.6%) showing PNPLA3 polymorphism (C/G), compared to 19 (55.9%) in the non-fatty liver group (P=0.033). Comparing metabolic syndrome components, fatty liver family members showed significantly higher serum triglycerides (>150 mg/dL, P=0.001), fasting glucose (>5.6 mmol/L, P=0.003), and HDL <40 mg/dL for males or <50 mg/dL for females. Conclusion: This study showed that family members of MASH cirrhosis patients show a high prevalence of fatty liver, metabolic abnormalities, and PNPLA3 polymorphism, especially in 1st-degree relatives.