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NAFLD Fibrosis Score

Test code: 91979(X)

Nonalcoholic fatty liver disease, or NAFLD, is a liver condition that is associated with obesity, diabetes, dyslipidemia, and hyperinsulinemia. NAFLD affects 38% of adults worldwide.1 The disease encompasses a broad range of functionally distinct liver disorders. In its most indolent form (simple steatosis), it is characterized by the histologic accumulation of fat within hepatocytes. In some patients, this fat accumulation is accompanied by varying degrees of inflammation and fibrosis (nonalcoholic steatohepatitis [NASH]). In patients with NAFLD, liver fibrosis is among the most important predictors of progression to end-stage liver disease and outcome.

The panel assesses selected laboratory values (serum glucose [test code: 483], platelet count [test code: 723], AST [test code: 822], ALT [test code: 823], and albumin [test code: 223]) and readily available patient characteristics (age, BMI, and diabetes status).

The NAFLD fibrosis score is a validated, noninvasive tool for identifying patients whose NAFLD has advanced to liver fibrosis.2-4 In patients with a high NAFLD fibrosis score, additional testing such as Enhanced Liver Fibrosis (ELF) score, elastography, or liver biopsy may be considered. NAFLD fibrosis score may overestimate risk in certain populations, such as those with obesity or type 2 diabetes mellitus, and thus may not be appropriate in the primary care setting.5 For initial NAFLD risk assessment, recent guidance recommends the use of the FIB-4 index.5,6

In patients with NAFLD fibrosis scores above 0.676, advanced liver fibrosis can be diagnosed with high accuracy. In patients with NAFLD fibrosis scores below -1.455, advanced liver fibrosis can be excluded with high accuracy. Scores between -1.455 and 0.676 are considered “indeterminate.”2

Yes. A calculator for NAFLD fibrosis score is available online. 

A NAFLD fibrosis score cannot be calculated if the required patient information is missing. The following information is required: age, height, weight, and diabetes status. 


  1. Riazi K, Azhari H, Charette JH, et al. The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis. The Lancet Gastroenterology & Hepatology. 2022;7(9):851-861. doi:10.1016/S2468-1253(22)00165-0
  2. Angulo P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: A noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45(4):846-854. doi:10.1002/hep.21496
  3. Angulo P, Bugianesi E, Bjornsson ES, et al. Simple noninvasive systems predict long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2013;145(4):782-789. doi:10.1053/j.gastro.2013.06.057
  4. Castera L, Vilgrain V, Angulo P. Noninvasive evaluation of NAFLD. Nat Rev Gastroenterol Hepatol. 2013;10(11):666-675. doi:10.1038/nrgastro.2013.175
  5. Cusi K, Isaacs S, Barb D, et al. American association of clinical endocrinology clinical practice guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings. Endocr Pract. 2022;28(5):528-562. doi:10.1016/j.eprac.2022.03.010
  6. Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-1835. doi:10.1097/HEP.0000000000000323


This FAQ is provided for informational purposes only and is not intended as medical advice. Test selection and interpretation, diagnosis, and patient management decisions should be based on the physician’s education, clinical expertise, and assessment of the patient.


Document FAQS.152 Version: 1

Version 1: Effective 08/23/2023 to present

Version 0: Effective 09/13/2014 to 08/23/2023