Impact of Metabolic Dysfunction-Associated Steatotic Liver Disease and Associated Comorbidities on Cognitive and Health-Related Quality-of-Life Outcomes in a Mixed Metabolic Dysfunction-Associated Steatotic Liver Disease-Type 2 Diabetes Mellitus Cohort

INTRODUCTION: Metabolic dysfunction-associated steatotic liver disease (MASLD) coexists with multiple comorbidities that contribute to impaired vascular function, worsening cognitive impairment, and quality of life. The aim of this study was to evaluate the impact of MASLD and related comorbidities on cognitive function and health-related quality of life (HRQoL). METHODS: A total of 601 overweight/obese patients with MASLD and/or type 2 diabetes mellitus were included. Liver stiffness (LS) measurement and steatosis were assessed by transient elastography and controlled attenuation parameter (CAP), respectively. Cognitive function and HRQoL were evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status and Short Form (36) Health Survey (SF-36) questionnaires. RESULTS: MASLD-related comorbidities were found to significantly and clinically affect cognitive function and HRQoL. Patients with severe steatosis (CAP ≥ 300 dB/m, n = 378) exhibited median cognitive scores falling into the abnormal range ( P = 0.056), with statistically significant lower scores in physical functioning ( P < 0.001), vitality ( P = 0.011), general health ( P = 0.001), and immediate memory ( P = 0.034), as well as a trend toward lower visuospatial/construction scores ( P = 0.058) than CAP <300 dB/m. Among patients with significant or high LS (LS ≥ 8 kPa, n = 69), lower physical functioning ( P < 0.001), higher physical limitations ( P = 0.004), and worse general health ( P = 0.011) were observed compared with those with LS < 8 kPa. In the multivariate adjusted analyses, CAP ≥ 300 dB/m was significantly associated with cognitive impairment (odds ratio: 1.42, 95% confidence interval 1.0; 2.0, P = 0.045), whereas LS ≥ 8 kPa was associated with higher physical limitations (odds ratio: 1.9, 95% confidence interval 1.1; 3.2, P = 0.019). DISCUSSION: Our findings highlight the relationship between MASLD severity and impairment in cognitive function and HRQoL, underscoring its multifactorial nature. Specifically, severe hepatic steatosis may be a risk factor of cognitive decline, whereas significant or high LS seems to greatly affect HRQoL.