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 5 .035) and 6-months (35%; P , .001). Psychomotor speed and selective attention (75% versus 48%; P 5 .004) as well as bimanual and visuomotor coordination (90% vs. 74%; P 5 .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.