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NAFLD activity score (NAS)

Histologic grading of non-alcoholic fatty liver disease activity.

NAFLD activity score (NAS)
Steatosis (% of hepatocytes)
Lobular inflammation (foci per 200x field)
Hepatocellular ballooning
Result0 points

Largely not diagnostic of NASH (>=5 correlates with NASH, <=2 usually not NASH).

Category
Largely not diagnostic of NASH

When to use

  • Standardised semiquantitative reporting of NAFLD disease activity on liver biopsy, chiefly for trials.

Formula

NAS = steatosis (0-3) + lobular inflammation (0-3) + ballooning (0-2). Range 0-8.

Pearls and pitfalls

  • NAS was designed for measuring change in trials, not as a stand-alone diagnosis of NASH.
  • Fibrosis is staged separately and is not part of the NAS.

References

  1. Kleiner DE, Brunt EM, Van Natta M, et al. Hepatology. 2005;41(6):1313-21.