NAFLD fibrosis score (NFS)
Advanced fibrosis in fatty liver disease (MASLD/NAFLD)
Sources last checked: 2026-10-13
NAFLD fibrosis score (NFS)
Advanced fibrosis in fatty liver disease (MASLD/NAFLD)
Albumin in g/dL as in the source. Less specific in people over 65 and in diabetes; EASL prefers FIB-4 as the first step.
Interpretation
| < −1.455 — advanced fibrosis unlikely | Low cut-off (NPV 88–93 % in the derivation/validation cohorts). |
|---|---|
| −1.455 to 0.676 — indeterminate | Indeterminate; EASL–EASD–EASO 2024 foresees a second-line test (elastography) for this range. |
| > 0.676 — advanced fibrosis likely | High cut-off (PPV 82–90 % in the derivation/validation cohorts). |
What is the NAFLD fibrosis score (NFS)?
The NAFLD fibrosis score (NFS) estimates advanced fibrosis in fatty liver disease from age, BMI, hyperglycaemia, AST/ALT ratio, platelets and albumin. Angulo and colleagues derived and validated it in 2007 in 733 patients with biopsy-proven NAFLD from several countries.
When to use it
- Adults with MASLD/NAFLD as an alternative or complement to FIB-4
- Selecting who needs elastography or hepatology referral
- Research comparisons of non-invasive fibrosis tests
When not to use it
- Other liver diseases (viral, alcohol-related) — not validated there
- People over 65 years, where specificity falls
How it is calculated
NFS = −1.675 + 0.037 × age + 0.094 × BMI + 1.13 × (IFG/diabetes) + 0.99 × AST/ALT − 0.013 × platelets − 0.66 × albumin (g/dL).
Clinical pearls and limitations
- Albumin in g/dL as in the source. Less specific in people over 65 and in diabetes; EASL prefers FIB-4 as the first step.
- Low cut-off −1.455 rules out, high cut-off 0.676 rules in advanced fibrosis.
- Albumin is entered in g/dL (g/L ÷ 10), as in the original equation.
- Between the two cut-offs the result is indeterminate; EASL–EASD–EASO 2024 foresees a second-line test such as elastography.
Frequently asked questions
What NAFLD fibrosis score excludes advanced fibrosis?
A score below −1.455; above 0.676 advanced fibrosis is likely.
NFS or FIB-4?
Both have moderate accuracy; EASL–EASD–EASO 2024 uses FIB-4 as the first step because it is simpler and widely available.
Is the NAFLD fibrosis score still valid with the new MASLD terminology?
Yes — the populations largely overlap, and the 2024 EASL–EASD–EASO guideline still lists NFS with its original cut-offs.
Evidence and guidelines
- Primary source: Angulo P et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology 2007;45(4):846-854.
- EASL–EASD–EASO Clinical Practice Guidelines on the management of MASLD (2024), table of non-invasive tests: NFS F3 cut-offs −1.455 / 0.676.
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