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    NAFLD (Non-Alcoholic Fatty Liver Disease) Activity Score

    Diagnoses steatohepatitis, based on histology, in NAFLD patients.
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    INSTRUCTIONS

    Use in patients who have had liver biopsy for NAFLD. The score should not be used as a surrogate for NASH diagnosis (see Brunt and Kleiner 2011 for details).

    When to Use

    Do you use the NAFLD Activity Score and want to contribute your expertise? Join our contributor team!

    <5%
    0
    5-33%
    +1
    34-66%
    +2
    >66%
    +3
    No foci
    0
    1 focus per 200× field
    +1
    2‐4 foci per 200× field
    +2
    >4 foci per 200× field
    +3
    None
    0
    Few balloon cells
    +1
    Many cells/prominent ballooning
    +2

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    Do you use the NAFLD Activity Score and want to contribute your expertise? Join our contributor team!

    Formula

    Addition of the selected points:

    Variable

    Points

    Steatosis (grade): low- to medium-power evaluation of parenchymal involvement by steatosis

    <5%

    0

    5-33%

    1

    34-66%

    2

    >66%

    3

    Inflammation (lobular): overall assessment of all inflammatory foci

    No foci

    0

    1 focus per 200× field

    1

    2‐4 foci per 200× field

    2

    >4 foci per 200× field

    3

    Liver cell injury (ballooning)

    None

    0

    Few balloon cells

    1

    Many cells/prominent ballooning

    2

    Facts & Figures

    Interpretation:

    NAFLD Activity Score

    Activity*

    0

    No activity

    1–2

    Mild activity

    3–5

    Moderate activity

    6–8

    Marked activity

    *Note: the score correlates with steatohepatitis diagnosis, but should not be used to definitively diagnose NASH.

    Dr. David E. Kleiner

    About the Creator

    David E. Kleiner, MD, PhD, is an anatomical pathologist at the National Cancer Institute. He is also director of clinical operations and chief of the postmortem pathology section at the NIH. Dr. Kleiner’s research focuses primarily on chronic liver disease and transplantation pathology.

    To view Dr. David E. Kleiner's publications, visit PubMed