Sustained Improvement of Cognition, Mood and Plasma Markers Three Years After Metabolic Bariatric Surgery. The BARICO Study

Background: The primary aim of this study is to investigate the impact of MBS induced weight loss on cognition, and secondary investigate the impact of this weight loss on adipokines, inflammatory factors, vascular markers, mood and physical activity three years after MBS. Methods: This observational study assessed data from 107 patients with severe obesity (aged 35 to 55 years) from the BARICO (BAriatric surgery Rijnstate and Radboudumc neuroImaging and Cognition in Obesity) study, eligible for Roux-en-Y gastric bypass. Data were collected before, and at 6, 24 and 36 months after MBS. The primary outcome was long-term cognitive improvement, assessed using the 20% change index, which compares postoperative to preoperative test scores across cognitive domains. Mood and physical activity were assessed using the Beck Depression Inventory (BDI) and the Baecke questionnaire, respectively. Results: In total, 107 participants (mean [SD] age, 46.8 [5.6] years; 91 [85%] female) were included. Three years after MBS, global cognition was at least 20% higher in 38.6% (n = 39) of the participants. Compared to baseline, inflammatory factors, leptin, matrix metalloproteinase-9 (MMP-9), and apolipoprotein A1 (ApoA1) levels remained lower (median [IQR] C-reactive protein: 4.51 [2.96–8.35] vs 0.60 [0.30–1.30] µg/ml; p < 0.001; serum amyloid-alpha: 6.94 [4.80–15.16] vs 3.70 [2.30–6.00] µg/ml; p < 0.001; leptin: 64.6 [50.95–85.91] vs 18.95 [11.05–33.38] pg/ml; p < 0.001; MMP-9: 22.2 [18.2–31.3] vs 16.8 [13.2–23.1] ng/ml; p < 0.001; ApoA1: 535.47 ± 150.94 (SD) vs 261.33 ± 112.75 (SD) µg/ml; p < 0.001), whereas adiponectin (2.20 [1.70–2.75] vs 4.80 [3.50–7.00] µg/ml; p < 0.001) and angiopoietin-1 (ANGPT-1: 14.3 [10.4–22.55] vs 26.15 [21.2–33.9] ng/ml; p < 0.001) levels remained higher three years after MBS. Additionally, depressive symptoms remained low three years after MBS (median [IQR] BDI score: 9 [5.25–13] vs 4 [2–7]; p < 0.001), whereas physical activity returned to baseline. Conclusion and Relevance: Three years after MBS, weight loss remains associated with improved cognition and general health, evidenced by lower blood pressure, lower medication use, less systemic inflammation, lower leptin and higher adiponectin levels, and improved vascular markers.