The MasLD patient PATHWAY

MASLD (Foie gras)

Metabolic syndrome is the leading cause of chronic liver disease with alcohol in France. Metabolic hepatic steatosis, which affects 20% of the French population, is the hepatic manifestation of dysmetabolic syndrome. It is a pathological entity that includes different liver lesions with, in increasing order of severity: steatosis (NAFLD: non-alcoholic fatty liver disease), steatohepatitis (MASLD: Metabolic associated steatohepatitis), fibrosis, and finally cirrhosis. At the stage of advanced fibrosis/cirrhosis, the risk of liver complications (decompensated cirrhosis, hepatocellular carcinoma) is considerably increased, 20 to 40 times higher compared to patients without liver fibrosis. However, these patients do not only run a hepatic risk since they present numerous comorbidities that are part of the metabolic syndrome: a risk of atheromatous lesions (particularly carotid and coronary), cardiovascular events, arterial hypertension, nephropathy, atherogenic dyslipidemia.

These polypathologies associated with NAFLD call for diagnostic and lesion exploration as well as comprehensive management, which goes beyond the liver pathology for which the patients were initially referred.

The care pathway dedicated to patients with metabolic steatosis of the liver

was designed to meet the following needs:

1. Identification of severe forms of liver damage (antifibrosis assessment – serum biomarkers, pulse elastometry by FibroScan and Aixplorer), liver biopsy puncture;
2. Exploration of comorbidities associated with metabolic steatosis (cardiovascular (CV) risk screening: coronary CT scan and calcium score measurement, exercise test, screening for diabetes and atherogenic dyslipidemia, assessment of insulin resistance and abnormal fat distribution DXA and biomarkers;
3. Therapeutic education on the disease and risk factors, dietary advice and education for adapted physical activity;
4. Individualized medicine with global stratification of hepatic, metabolic and CV risk and development of an individualized therapeutic and monitoring plan.

The patients targeted by this structure are patients with suspected or confirmed NASH, seen in the hepato-gastroenterology department but also in other departments within the PSL - nutrition department, diabetology, cardiology and CV prevention, infectious diseases - HIV, bariatric surgery or post-liver transplant patients.

In practice, this care circuit takes place in 2 HDJ and includes the following explorations:

This structure offers multidisciplinary care and a unitary and fluid circuit allowing for better risk stratification (hepatic, CV and metabolic), early implementation of prevention strategies and targeted access to specific care. Each patient will benefit from personalized care adapted to their needs, provided by the multidisciplinary team of our hospital:

• Dietary and physical activity advice
• Bariatric surgery
• Participation in therapeutic trials with innovative molecules in development for MASLD

Doctors who treat MASLD