Surg Obes Relat Dis. 2026 May 19:S1550-7289(26)00698-2. doi: 10.1016/j.soard.2026.05.017. Online ahead of print.
ABSTRACT
BACKGROUND: Evidence suggests metabolic health plays a significant role in long-term cognitive outcomes. Whether this association stems from weight loss operations or other factors, remains controversial. Although a link between metabolic and bariatric surgery (MBS) and reduced likelihood of cognitive impairment has also been reported, a large-scale analysis of this association is lacking.
OBJECTIVE: To evaluate the association of prior metabolic surgery and the odds of cognitive impairment.
SETTING: Academic, university-affiliated; US.
METHODS: All adult (≥18 years) hospitalizations with a diagnosis of obesity were identified in the 2016-2022 Nationwide Inpatient Sample. The association of MBS with odds of cognitive impairment and its subclasses was characterized after doubly robust risk adjustment using entropy balancing followed by multivariable regression models.
RESULTS: Of 4,597,465 admissions with a diagnosis for obesity, 22.1% had a history of MBS. Following adequate risk-adjustment, prior MBS was associated with lower odds of Alzheimer's disease (AD) (adjusted odds ratio [AOR] .67, 95% confidence interval [CI] .59-.75) and vascular dementia (AOR .55, 95% CI .47-.64), but greater odds of Wernicke's Encephalopathy (AOR 5.03, 95% CI 3.76-6.72). These findings persisted across all age groups. Among the three classes of obesity, patients with a history of MBS with class III obesity had the lowest odds of dementia (AOR .66, 95% CI .60-.72).
CONCLUSIONS: Prior MBS is associated with lower odds ratio of AD and vascular dementia, among those with obesity. These findings suggest that MBS may reduce the odds of cognitive impairment across various demographics.
PMID:42303527 | DOI:10.1016/j.soard.2026.05.017