Effects of bariatric surgery on neurological disturbances and quality of life in patients with metabolic dysfunction-associated steatotic liver disease and obesity: a prospective longitudinal study.

BACKGROUND

Neurological impairment has been recognized in up to 70% of patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and obesity, which can lead to poor quality of life (QoL).

OBJECTIVES

To evaluate the impact of bariatric surgery on neurological alterations, QoL, and factors associated with neurological response.

SETTING

Tertiary University Hospital, Spain

METHODS

A prospective, longitudinal study was conducted in 53 patients undergoing bariatric surgery between 2021 and 2023. Psychometric tests and the SF-12 questionnaire were performed 1-month before and 3- and 6-months after surgery. Liver biopsy was performed during the intervention. A group of healthy controls was included at a 2:1 ratio, as a reference.

RESULTS

Mean age was 49 (SD 9) years, 68% were female and median body mass index was 45 (interquartile range [IQR] 39-49) kg/m2. No patients presented advanced fibrosis (F3-F4) and only 14% showed a nonalcoholic fatty liver disease (NAFLD) score >3 in liver biopsy. A total of 63% exhibited alterations in verbal fluency (Animal Naming Test -ANT-), with a significant improvement at 3- (36%; P = .035) and 6-months (35%; P < .001). Psychomotor speed and selective attention (75% versus 48%; P = .004) as well as bimanual and visuomotor coordination (90% vs. 74%; P = .021) showed a significant improvement after surgery. QoL increased globally, mainly in the physical sphere (P < .001). Older age, diabetes and IL-6 levels were associated with an altered ANT after surgery.

CONCLUSIONS

Neurological impairment is common in patients with MASLD and severe obesity. Cognitive, motor performance, and QoL improve after bariatric surgery. Age, diabetes, and inflammatory markers are predictors of poor response.