{"id":2567,"date":"2009-02-28T20:12:10","date_gmt":"2009-02-28T20:12:10","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/gasnafld\/"},"modified":"2025-05-14T19:11:53","modified_gmt":"2025-05-14T19:11:53","slug":"gasnafld","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/gasnafld\/","title":{"rendered":"Histological Scoring System for Nonalcoholic Fatty Liver Disease (NAFLD)"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p><\/p>\n<div class=\"Section1\">\n<p class=\"MsoNormal\">Components of NAFLD Activity Score (NAS) and Fibrosis Staging<\/p>\n<p><!--more--><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td style=\"border: 1pt solid windowtext; padding: 0cm 5.4pt; width: 99.7577%;\" colspan=\"4\" valign=\"top\">\n<p class=\"MsoNormal\"><strong> NAS Components (see scoring interpretation)<\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 14.6667%;\" valign=\"top\">\n<p class=\"MsoNormal\"><strong> Item<\/strong><\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\"><strong> Score<\/strong><\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\"><strong> Extent<\/strong><\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\"><strong> Definition and Comment<\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 14.6667%;\" rowspan=\"4\" valign=\"top\">\n<p class=\"MsoNormal\">Steatosis<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\">0<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\">&lt;5%<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\">Refers to amount of surface area involved by steatosis as evaluated on low to medium power examination; minimal steatosis (&lt;5%) receives a score of 0 to avoid giving excess weight to biopsies with very little fatty change<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\">1<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\">5-33%<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\">\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\">2<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\">&gt;33-66%<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\">\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\">3<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\">&gt;66%<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\">\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 14.6667%;\" rowspan=\"4\" valign=\"top\">\n<p class=\"MsoNormal\">Lobular Inflammation<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\">0<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\">No foci<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\">Acidophil bodies are not included in this assessment, nor is portal inflammation<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\">1<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\">&lt;2 foci\/200x<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\">\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\">2<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\">2-4 foci\/200x<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\">\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\">3<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\">&gt;4 foci\/200x<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\">\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 14.6667%;\" rowspan=\"3\" valign=\"top\">\n<p class=\"MsoNormal\">Hepatocyte Ballooning<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\">0<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\">None<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\">\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\">1<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\">Few balloon cells<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\">The term &#8220;few&#8221; means rare but definite ballooned hepatocytes as well as cases that are diagnostically borderline<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\">2<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\">Many cells\/prominent ballooning<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\">Most cases with prominent ballooning also had Mallory&#8217;s hyalin, but Mallory&#8217;s hyaline is not scored separately for the NAS<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 99.7577%;\" colspan=\"4\" valign=\"top\">\n<p class=\"MsoNormal\"><strong> Fibrosis Stage (Evaluated separately from NAS)<\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 14.6667%;\" valign=\"top\">\n<p class=\"MsoNormal\">Fibrosis<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\">0<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\">None<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\">\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 14.6667%;\" valign=\"top\">\n<p class=\"MsoNormal\">\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\">1<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\">Perisinusoidal or periportal<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\">\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 14.6667%;\" valign=\"top\">\n<p class=\"MsoNormal\">\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\">1A<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\">Mild, zone 3, perisinusoidal<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\">&#8220;delicate&#8221; fibrosis<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 14.6667%;\" valign=\"top\">\n<p class=\"MsoNormal\">\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\">1B<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\">Moderate, zone 3, perisinusoidal<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\">&#8220;dense&#8221; fibrosis<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 14.6667%;\" valign=\"top\">\n<p class=\"MsoNormal\">\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\">1C<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\">Portal\/periportal<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\">This category is included to accommodate cases with portal and\/or peri portal fibrosis without accompanying pericellular\/perisinusoidal fibrosis<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 14.6667%;\" valign=\"top\">\n<p class=\"MsoNormal\">\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\">2<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\">Perisinusoidal and portal\/periportal<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\">\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 14.6667%;\" valign=\"top\">\n<p class=\"MsoNormal\">\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\">3<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\">Bridging fibrosis<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\">\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 14.6667%;\" valign=\"top\">\n<p class=\"MsoNormal\">\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 8.12123%;\" align=\"center\" valign=\"top\">\n<p class=\"MsoNormal\">4<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 13.091%;\" valign=\"top\">\n<p class=\"MsoNormal\">Cirrhosis<\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 63.8788%;\" valign=\"top\">\n<p class=\"MsoNormal\">\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"MsoNormal\">Total NAS score represents the sum of scores for steatosis, lobular inflammation, and ballooning, and ranges from 0-8. Diagnosis of NASH (or, alternatively, fatty liver not diagnostic of NASH) should be made first, then NAS is used to grade activity. In the reference study, NAS scores of 0-2 occurred in cases largely considered not diagnostic of NASH, scores of 3-4 were evenly divided among those considered not diagnostic, borderline, or positive for NASH. Scores of 5-8 occurred in cases that were largely considered diagnostic of NASH.<\/p>\n<p>&nbsp;<\/p>\n<p class=\"MsoNormal\"><strong>References:<\/strong><\/p>\n<\/div>\n<div class=\"Section1\">\n<ol>\n<li>\n<p class=\"MsoNormal\" align=\"justify\">Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, Ferrell LD, Liu YC, Torbenson MS, Unalp-Arida A, Yeh M, McCullough AJ, Sanyal AJ; Nonalcoholic Steatohepatitis Clinical Research Network. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005 Jun;41(6):1313-21. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/15915461\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/p>\n<\/li>\n<\/ol>\n<\/div>\n<div class=\"Section1\"><\/div>\n<div class=\"Section1\">Created: May 11, 2007<\/div>\n<p><\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[53],"tags":[1735,1734,51,1733,1413,891,1725,1732,795,524,1731,1033,1730,794,494,507],"class_list":["post-2567","post","type-post","status-publish","format-standard","hentry","category-gastroenterology","tag-alcoholic","tag-alcoholica","tag-disease","tag-fatty","tag-gastroenterology","tag-graso","tag-higado","tag-histological","tag-histologico","tag-liver","tag-nafld","tag-no","tag-nonalcoholic","tag-scoring","tag-sistema","tag-system"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2567","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=2567"}],"version-history":[{"count":4,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2567\/revisions"}],"predecessor-version":[{"id":9387,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2567\/revisions\/9387"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=2567"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=2567"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=2567"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}