Calculators & Tools

NAFLD Activity Score (NAS)

Histological activity in non-alcoholic fatty liver disease (NASH CRN system).

1 What is the NAFLD Activity Score (NAS)?

The NAFLD Activity Score (NAS) is a GI & Liver scoring tool used in paediatric practice. Histological activity in non-alcoholic fatty liver disease (NASH CRN system). It scores 3 criteria and interprets the total across 3 bands, so the number always arrives with the severity it implies rather than on its own. In PediAid each criterion is shown as a labelled option with the weight it carries, so the total can be checked rather than taken on trust.

2 When to use it

  • Grading severity at the bedside in GI & Liver
  • Recording an objective severity band in the case notes
  • Deciding when a total crosses the threshold for escalation
  • Re-scoring to track whether a child is improving or deteriorating
  • Checking the exact criteria of a score used infrequently

3 Formula & method

The score sums 3 criteria: Steatosis (% of hepatocytes involved); Lobular inflammation (foci per 200× field); Hepatocyte ballooning. Totals are then banded: any score - Not diagnostic of NASH: nAS 0-2 - largely not diagnostic of steatohepatitis; 3 points or more - Borderline: nAS 3-4 - borderline; correlate with the overall histological pattern rather than the score alone; 5 points or more - Consistent with NASH: nAS ≥5 - mostly diagnosed as steatohepatitis. Fibrosis is staged SEPARATELY (F0-F4) and is the strongest predictor of long-term outcome.
  • Total range 0-8. NAS was designed to measure disease ACTIVITY for trials, not to replace a diagnostic pathology assessment. Paediatric NAFLD often shows a portal (type 2) pattern.
  • Source: Kleiner DE et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005;41:1313-21.

4 Frequently asked questions

How many criteria does the NAFLD Activity Score (NAS) use?

3. They are Steatosis (% of hepatocytes involved); Lobular inflammation (foci per 200× field); Hepatocyte ballooning.

What do the bands of the NAFLD Activity Score (NAS) mean?

The total is interpreted as: any score - Not diagnostic of NASH: nAS 0-2 - largely not diagnostic of steatohepatitis; 3 points or more - Borderline: nAS 3-4 - borderline; correlate with the overall histological pattern rather than the score alone; 5 points or more - Consistent with NASH: nAS ≥5 - mostly diagnosed as steatohepatitis. Fibrosis is staged SEPARATELY (F0-F4) and is the strongest predictor of long-term outcome.

Does the score replace clinical judgement?

No. It is a structured way to record and communicate severity. A clinician concerned about a child should act on that concern regardless of the total.

Where does this score come from?

Total range 0-8. NAS was designed to measure disease ACTIVITY for trials, not to replace a diagnostic pathology assessment. Paediatric NAFLD often shows a portal (type 2) pattern.

Does it work offline?

Yes. Score definitions are bundled with the PediAid app, so the score computes without a connection.

For qualified clinicians. This page and the PediAid app are a clinical aid only. Calculations and reference data must be verified against the patient's clinical context, the source guideline and your local protocols before any treatment decision is made.