The patient PATHWAY

NUSLI

Malnutrition and sarcopenia are now well-established complications of chronic liver disease, affecting 25% to more than 75% of patients depending on the liver damage (particularly in cases of decompensated cirrhosis). Lack of muscle (sarcopenia) and loss of muscle function (called fragility) are risk factors for excess mortality in patients with cirrhosis. Patients are then at greater risk of developing infections and responding less well to treatments during complications of liver disease. This is why it is important to assess nutritional and muscular status from the initial management of the patient, but also during follow-up. The earlier malnutrition and sarcopenia are detected, the more effective their management will be.



We created the NUSLI (NUtrition Sarcopenia & LIver) working group in collaboration with the Hepato-gastroenterology department and the Transversal Denutrition Unit (UTDN) of our hospital structure.

The NUSLI patient pathway

The NUSLI care pathway, dedicated to patients with chronic liver disease with malnutrition/sarcopenia, has been designed to meet the following needs:


  • Characterization of the nutritional and muscular status of patients with chronic liver disease. These disorders may include significant weight loss, severe anorexia, loss of muscle mass and/or muscle function.
  • Each patient is seen by several specialists: consultation with a hepatologist, a nutritionist and a dietician, with a therapeutic education consultation.
  • Clinical tests to assess sarcopenia and a biological assessment are performed. A measurement of lean and fat mass is performed with an impedance scale. Specific imaging can be performed if necessary to better assess muscle mass while assessing specific liver complications.
  • Consultation with a senior hepatologist: understand the overall history of the patient's liver disease, assess its severity, and especially trace the nutritional and muscular history to better interpret the current context. Carry out sarcopenia tests.
  • Consultation with a senior nutritionist: assess the patient's overall nutritional status using phenotypic and etiological criteria for malnutrition. Assessment of their needs and intake. Measurement of lean and fat mass.
  • Consultation with a dietician: interview with the patient about their eating habits to better advise them and optimize their intake (strengthening meals, adding proteins, adding nutritional supplements) while adapting to the patient's daily lifestyle.
  • Additional assessment with: standard biology, dosage of vitamins and trace elements to look for deficiencies to supplement, objective measurement of lean/fat mass with impedancemetry, a scanner with measurement of muscle mass.



A multidisciplinary consultation meeting is held with all the results to determine the patient's nutritional and muscular status. We offer treatment tailored to each patient, with supplementation of vitamin and trace element deficiencies, as well as a prescription for muscle strengthening through physiotherapy and adapted physical activity. If necessary, we prescribe oral nutritional supplements and, if we deem it necessary, we discuss with the patient the implementation of enteral nutrition, which will be done during a short hospitalization.

We can re-evaluate patients remotely to assess the benefit of initial care and the need to strengthen measures.

The patients targeted by this structure are patients with chronic liver disease, mainly with cirrhosis /- liver transplant project or with primary liver cancer, but also patients with chronic liver disease without reaching the stage of cirrhosis but with signs of malnutrition and/or sarcopenia (weight loss, anorexia, loss of muscle strength reported by the patient, their entourage or the referring physician). Any patient can be assessed by our structure, whether they are followed within our department, our hospital structure or by a department of an external health structure.


This structure offers multidisciplinary care over 1 day of HDJ with a unitary and fluid circuit allowing a characterization of the nutritional and muscular state of the patient, making it possible to optimize the overall care of the patient, particularly in the case of a liver transplant project or primary liver cancer.

You can submit your requests to our referring physician, Dr. Sultanik, by sending an email to: philippe.sultanik@aphp.fr. We can then quickly offer the patient an examination in a day hospital.