Nonalcoholic fatty liver disease (NAFLD) is a term for health conditions caused by an accumulation of fat in the liver. It’s often found in people who are overweight or have obesity.

NAFLD is the most common liver disease worldwide, affecting 25% of the global population. The number of people with NAFLD is expected to increase because rates of overweight and obesity are increasing, including in children.

The condition can lead to liver scarring, also called liver fibrosis. If the fibrosis advances further, it can lead to liver cancer, cirrhosis, or liver failure.

If your doctor suspects you have NAFLD, they may use diagnostic tests to determine how much liver scarring you have, if any. These may include a panel of blood tests used to calculate your NAFLD fibrosis score.

Keep reading to learn more about the NAFLD fibrosis score, including when it’s used, how it’s calculated, and how to interpret the results.

Doctors use the NAFLD fibrosis score to predict the risk and degree of fibrosis.

The score is based on a panel of tests that look for markers in your blood. Some of the factors calculated in your score include:

  • your serum glucose
  • albumin
  • platelet count
  • age
  • height-to-weight ratio (body mass index, or BMI)
  • diabetes status

The test also measures the ratios of two liver enzymes, aspartate aminotransferase (AST) and alanine aminotransferase (ALT).

Your doctor may recommend getting a fibrosis score as a way to rule out advanced liver fibrosis, without having to undergo a more invasive procedure like a liver biopsy.

If the score does not definitively rule out fibrosis, your doctor may recommend additional tests.

People who have a NAFLD fibrosis score above 0.676 are the most likely to have advanced liver fibrosis.

If you have a score below -1.455, you’re unlikely to have advanced liver fibrosis.

The scores in between are considered indeterminate, according to Quest Diagnostics, a clinical laboratory that conducts the tests. If you have an indeterminate fibrosis score, you may need additional tests.

NAFLD Fibrosis ScoreLikelihood of liver scarring
above 0.676Most likely
between -1.455 and 0.676Undetermined
below -1.455Unlikely

An NAFLD fibrosis score is based on a panel of blood tests, while a FibroScan uses ultrasound technology to measure hardness and fatty changes in your liver.

Doctors typically use a FibroScan to learn more about the severity and progression of your liver condition and determine treatment.

During a FibroScan test, you lay on your back while a technician places an ultrasound probe on the skin over the area of your liver. It usually takes about 10 minutes.

After the test, you will get a report with a liver stiffness score, which measures your liver’s hardness, as well as scores indicating how much fat has built up in the cells of your liver.

Your liver stiffness results determine whether your liver is normal or if you have mild, moderate, severe, or advanced liver scarring.

Other diagnostic tests your doctor may use if you have been diagnosed with, or are suspected to have, NAFLD, include the following.

Physical exam

Your doctor may examine you by touch for signs of cirrhosis such as an enlarged spleen or a buildup of fluid in the abdomen (ascites). They may also look for signs of insulin resistance.

Other tests

Your doctor may also order:

  • additional blood tests
  • imaging tests such as a CT (computed tomography) scan, MRI (magnetic resonance imaging), or special types of ultrasound to look for lumps or bumps on your liver.
  • a liver biopsy, in which small pieces of tissue are removed from your liver and examined under a microscope to determine the amount of liver damage

Why do doctors use the NAFLD fibrosis scoring and FibroScan tests?

Many doctors prefer NAFLD scoring and FibroScan tests because they are fairly quick, noninvasive, and provide a good idea of whether you have liver scarring or how far it has advanced.

Doctors can use the results of these tests to determine if more invasive testing, such as a liver biopsy, is needed.

How is the NAFLD fibrosis score calculated?

Some of the factors that determine your score include your serum glucose, albumin, platelet count, age, BMI, and diabetes status.

The score also measures the ratios of two liver enzymes: aspartate aminotransferase (AST) and alanine aminotransferase (ALT).

Can NAFLD fibrosis scores improve?

Depending on the stage of your condition, you can repair or reverse scarring related to NAFLD with various interventions like diet changes, lifestyle modification, and weight loss (if needed).

One small 2018 study showed improvement in 39 patients after 6 months of lifestyle modification.

Another study showed recovery in patients with obesity who underwent gastric bypass surgery.

Healing your liver involves removing what caused the condition. As your liver condition improves, your scores will improve.

Can the liver heal from fibrosis?

A 2019 study found that a 10% to 45% regression of fibrosis is possible with lifestyle modifications.

Your test results should indicate the amount of scarring in your liver. If you have normal levels, that means there’s no scarring. If you have moderate or severe scarring, you can reverse or undo the damage through lifestyle changes and other interventions.

Cirrhosis can generally not be reversed, but you can slow down the progression if you catch it soon enough. A 2017 review of studies indicates that advances are being made in this area.

NAFLD is a common disease that is on the rise globally. It refers to an excess of fat buildup in your liver. It can lead to liver scarring and serious liver damage such as cirrhosis.

If your doctor suspects you have NAFLD, you might be asked to take a panel of blood tests to determine your NAFLD fibrosis score. These tests will suggest whether there’s liver scarring.

Your doctor may also order an ultrasound test called a FibroScan. This test can help determine the amount of fatty buildup in your liver as well as its stiffness.

Both tests are noninvasive and will give you a good idea of where you stand. If you catch NAFLD early enough, the liver scarring can be reversed. If you already have severe damage or liver cirrhosis, you may be able to slow the progression of your condition.