Fibrotic NASH Index (FNI) for NAFLD/NASH Fibrosis Prediction
Non-invasive index for predicting fibrotic NASH (F2-F4 fibrosis) in patients with non-alcoholic fatty liver disease. Alternative to liver biopsy for identifying patients with advanced NAFLD needing specialist monitoring.
Score interpretation
FNI within low-risk range -- fibrotic NASH (F >= 2) less likely
→ MASLD/NAFLD lifestyle management: Mediterranean diet (PREDIMED study), aerobic exercise 150 min/week, 7-10% weight loss target; treat metabolic risk factors (SGLT2 inhibitor or GLP-1 RA if diabetes -- LEAN trial: liraglutide reduced liver fat); repeat liver fibrosis assessment in 2-3 years; routine LFTs annually; hepatology referral if ALT persistently > 2x ULN; screen for metabolic syndrome components.
Elevated FNI -- consider hepatology referral for further evaluation of NASH/MASLD fibrosis
→ Hepatology referral; non-invasive fibrosis assessment (parallel): FIB-4 index (age x AST / (platelets x sqrt ALT)); NAFLD Fibrosis Score; transient elastography (FibroScan) if available -- LSM >= 8 kPa: significant fibrosis; LSM >= 12.5 kPa: advanced fibrosis/cirrhosis; consider liver biopsy if: transient elastography unavailable or indeterminate, diagnosis in doubt, clinical trial eligibility; MASLD management per EASL guidelines; emerging therapies: resmetirom (NASH-approved in US, investigational in EU); GLP-1 RA (semaglutide reduces liver fat and inflammation -- ESSENCE trial); screen for HCC if cirrhosis confirmed (USS 6-monthly + AFP); variceal surveillance if advanced fibrosis.
Interpretation bands for the Fibrotic NASH Index. Apply clinical judgement and local guidance.
References
- Palekar NA et al. A simple score for predicting fibrotic NASH using clinical and histologic data. Dig Dis Sci. 2006;51(9):1558-1563.
- EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388-1402.
Related
Curated clinical cross-links plus same-class fallbacks.
- Trimetazidine · Metabolic Anti-Anginal
- Methotrexate (Dermatology — Psoriasis) · Disease-Modifying Antirheumatic / Immunosuppressant
- L-Carnitine · Antidote / Metabolic Agent
- Acetazolamide (Ménière's Disease) · Carbonic Anhydrase Inhibitor (Diuretic)
- Zinc acetate · Zinc salt (Wilson's disease)
- Sulfasalazine · Aminosalicylate / Disease-Modifying Antirheumatic Drug (DMARD)
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.