BMI, AST/ALT Ratio, and Diabetes Score (BARD Score)

The score ranges from 0 to 4.

Type 2 Diabetes is the single most important clinical risk factor for the progression of fatty liver to cirrhosis. Even without other factors, a diabetic patient requires close liver monitoring.

While a low score rules out fibrosis, a high score (2–4) does NOT guarantee it. Roughly 50% of patients with a high BARD score will actually have low-stage disease.

If the BARD score is indeterminate, check the platelet count. Thrombocytopenia is a much more specific marker for advanced fibrosis and portal hypertension.

Developed by Dr. Stephen Harrison, a leading figure in NASH research and a former US Army physician. The BARD score was designed to be "field-ready" for clinicians without specialized equipment.

The BARD score was developed when "NAFLD" was the standard term. Recently, the medical community has shifted toward "MASLD" (Metabolic-Associated Steatotic Liver Disease) to better reflect the underlying metabolic drivers used in this score.