FAST Score
Combines two FibroScan readings (liver stiffness and a fat measure) with your AST level. It estimates the chance of MASH with significant fibrosis.
AI Summary MAFLD and MASH scores turn routine data, such as age, BMI, blood sugar, liver enzymes, and sometimes FibroScan or MRI results, into a number that estimates fatty liver or scarring risk. Low, intermediate, and high results guide follow-up. Scores do not diagnose; biopsy remains the reference when results are unclear. Healthy habits matter at every level, and high results usually lead to a specialist visit.
Source: www.liverdirectory.com
MAFLD / MASH Scores
Medically Reviewed.
MAFLD and MASH scores are non-invasive tools. They turn everyday results, such as age, body mass index (BMI), blood sugar, and liver enzymes, into one number that helps your care team judge risk.
This page introduces the group and links to a detailed guide for each score.
Below, you will find key facts, a side-by-side comparison, what low, intermediate, and high results mean, and answers to common questions.
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Fatty Liver Risk Basics
What Are MAFLD and MASH Scores?
A MAFLD or MASH score is a number calculated from routine health data. Depending on the score, the inputs can include age, BMI, blood sugar, the liver enzyme AST, and results from a FibroScan or MRI. The number estimates risk. It does not diagnose a disease.
MAFLD (metabolic dysfunction–associated fatty liver disease) and MASLD (metabolic dysfunction–associated steatotic liver disease) describe extra fat in the liver that is linked to metabolic problems such as obesity, type 2 diabetes, high blood pressure, and abnormal blood fats. MASLD was formerly called NAFLD. MASH (metabolic dysfunction–associated steatohepatitis, formerly NASH) is the more serious form. In MASH, the fat causes inflammation, liver damage, and scarring, which doctors call fibrosis.
The scores do two different jobs. Some estimate how likely it is that fatty liver is present. Others estimate the risk of MASH or significant fibrosis. Unlike a liver biopsy, they need no tissue sample, so doctors can safely repeat them over time.
Key Facts About MAFLD and MASH Scores
- Risk, not diagnosis: These scores estimate the chance of fatty liver or scarring. Your doctor reads them with your history, exam, and other tests.
- Preferred first step: Non-invasive tests are preferred for staging fibrosis in MASLD. Blood-based options include the FIB-4 index.
- Biopsy still has a role: Liver tissue testing remains the gold standard for diagnosing MASH. Doctors consider it when non-invasive results are unclear.
- Accuracy varies by stage: Non-invasive tests detect cirrhosis more accurately than they separate middle stages of fibrosis.
- Follow-up timing: Rechecking every 2 to 3 years is suggested when there is no baseline fibrosis and risk factors are stable. Yearly checks are suggested when fibrosis is significant.
Choosing the Right Score
How the Scores Compare
Each score answers a slightly different question and uses different inputs. Your care team chooses the one that fits the data available.
| Score | What It Estimates | What Goes Into It | Scan in the Formula? |
|---|---|---|---|
| MAFLD Score | Likelihood of fatty liver | Age, BMI, and blood sugar status | No |
| SAFE Score | Fibrosis risk in people with fatty liver | Age, BMI, diabetes, AST, ALT, globulin, and platelets | No |
| FAST Score | Risk of MASH with significant fibrosis | FibroScan stiffness, FibroScan fat measure (CAP), and AST | Yes, FibroScan |
| MAST Score | Risk of MASH or significant fibrosis | MRI fat measure (MRI-PDFF), MR elastography stiffness, and AST | Yes, MRI |
| cTAG Score | Risk of significant fibrosis in MASH | MRI marker cT1, AST, and glucose | Yes, MRI |
Hepatic Steatosis Index, Fatty Liver Index, and BARD Score each have their own guide linked below.
Score Guides by Type
The Scores in This Group
Choose a score to see how it is calculated and how to read it.
SAFE Score
Uses blood tests and simple clinical facts to estimate fibrosis risk in people who already have fatty liver. It needs no scan.
MAFLD Score
Estimates how likely it is that fat has built up in the liver because of metabolic risk factors, using age, BMI, and blood sugar status.
MAST Score
Pairs two MRI measurements of liver fat and stiffness with your AST level to estimate the risk of significant fibrosis or MASH.
cTAG Score
Combines an MRI marker called cT1 with AST and glucose to flag people with MASH who may have significant fibrosis. It is also used to select people for clinical trials.
Hepatic Steatosis Index (HSI)
A score related to hepatic steatosis, which means fat buildup in liver cells. Its detailed guide is linked here.
Fatty Liver Index (FLI)
A score used in the assessment of fatty liver. Its detailed guide is linked here.
BARD Score
A score used in the assessment of fatty liver and scarring. Its detailed guide is linked here.
Low to High Risk
What Your Result Means
Each score has its own cutoffs. A result in the middle usually means more testing, not a diagnosis.
| Score | Low Risk | Intermediate | High Risk |
|---|---|---|---|
| MAFLD Score | Below −1.455 | −1.455 to 0.676 | Above 0.676 |
| SAFE Score | Below 0 | 0 to 99 | 100 or higher |
| FAST Score | Below 0.35 | 0.35 to 0.67 | Above 0.67 |
| MAST Score | Below 0.165 | 0.165 to 0.242 | Above 0.242 |
| cTAG Score | Below 34% | 34% to 49% | 50% or higher |
Low results usually mean routine monitoring and healthy habits. Intermediate results often lead to closer follow-up or another test. High results usually lead to a specialist visit. Your doctor interprets the number in context.
Who Should Consider Testing
When Your Doctor May Order a Score
Scores are most useful when fatty liver is possible but you have no symptoms yet. Fatty liver often causes none until late.
Your Doctor May Suggest a Score if You:
- Have risk factors for fatty liver, such as obesity, type 2 diabetes, or high triglycerides
- Want to check for early liver fat before symptoms appear
- Need your liver health tracked over time
- Are checking how lifestyle changes or treatment affect liver fat or scarring
- Have a known fatty liver and need to know whether scarring is likely
Score Limitations
What Scores Can and Cannot Tell You
A Score Is Not a Diagnosis
Scores are estimates. A low score makes significant disease less likely, but it does not rule out every problem. A high score does not prove you have MASH or scarring.
Accuracy Depends on the Stage
Non-invasive tests, including blood-based scores and stiffness scans, work best at spotting cirrhosis. They are less precise at telling adjacent middle stages of fibrosis apart.
Each Score Answers One Question
Some scores only estimate fat. The FIB-4 index, for example, measures scarring risk and does not measure fat or inflammation. No single score covers everything.
Biopsy Is Still the Reference
A liver biopsy is considered when non-invasive results are unclear or when advanced disease needs confirming. Histology, meaning tissue under the microscope, remains the gold standard for diagnosing MASH.
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Follow-Up and Care
After Your Result
Your result points to the next step. Ask your doctor what it means for you.
- Low risk: Keep up healthy habits. If you have no baseline fibrosis and your metabolic risk factors are stable, rechecking with non-invasive scores every 2 to 3 years is suggested.
- Intermediate risk: Your doctor may add another test, such as a stiffness scan (FibroScan) or an MRI measure of liver fat (MRI-PDFF). Sequential testing, which means imaging after a blood test, improves diagnostic confidence.
- High risk: Expect a specialist visit. If fibrosis is significant or metabolic conditions are not controlled, yearly monitoring is suggested.
Lifestyle at Every Level
Healthy habits are the base of care, whatever your result.
- Exercise: Aim for 150 to 240 minutes a week of moderate-to-vigorous aerobic exercise. This can lower liver fat by about 30%.
- Food: Avoid ultra-processed foods, added sugars, and excess saturated fat.
Read more about fatty liver disease.
Medicine for MASH
In March 2024, the FDA approved resmetirom (Rezdiffra) for adults with MASH and moderate-to-advanced fibrosis who do not have cirrhosis. Your specialist decides whether it fits your situation.
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Your Questions Answered
Answers to Common MAFLD / MASH Scores Questions
What is a MAFLD score?
A MAFLD score is a calculation that estimates how likely it is that fat has built up in your liver because of metabolic factors. The MAFLD Score uses age, BMI, and whether you have impaired fasting glucose or diabetes. It is non-invasive, quick, and can be repeated over time.
Can a score diagnose MASH?
No. Scores estimate risk and guide next steps. Liver biopsy remains the gold standard for diagnosing MASH, and doctors consider it when non-invasive results are unclear.
What does an intermediate result mean?
An intermediate result usually means your doctor needs more information. It is not a diagnosis. For FIB-4, for example, scores between about 1.3 and 2.6 are called indeterminate and may need further testing, such as a stiffness scan.
How often should I be rechecked?
It depends on your scarring risk. Every 2 to 3 years is suggested for people with no baseline fibrosis and stable metabolic risk factors. Yearly checks are suggested when fibrosis is significant or metabolic conditions are uncontrolled. People with cirrhosis need follow-up every 6 months, including liver cancer screening.
Do I need a scan to get a score?
Not always. The MAFLD and SAFE scores use clinical facts and blood tests. The FAST score needs a FibroScan. The MAST and cTAG scores need an MRI. Your doctor picks the score based on the data available.
Can lifestyle changes improve my score?
Lifestyle changes can lower liver fat, which is what many of these scores try to reflect. Moderate-to-vigorous aerobic exercise for 150 to 240 minutes a week can reduce liver fat by about 30%. Avoiding ultra-processed foods and added sugars also helps. Ask your doctor how your own score may change.
What is the difference between MAFLD and MASLD?
MASLD is the newer name for what was called NAFLD, and MASH replaced NASH. MAFLD is a related term created to give fatty liver a positive diagnosis based on metabolic factors. Doctors use the terms a little differently, so ask your care team which one applies to you.
Medical disclaimer: LiverDirectory provides educational information and a directory of providers. It does not provide medical advice, diagnosis, or treatment. Always consult a licensed physician regarding any medical condition.