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Data were collected before, and at 6, 24 and 36\u00a0months 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>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\u2009=\u200939) 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\u20138.35] vs 0.60 [0.30\u20131.30] \u00b5g\/ml; p\u2009&lt;\u20090.001; serum amyloid-alpha: 6.94 [4.80\u201315.16] vs 3.70 [2.30\u20136.00] \u00b5g\/ml; p\u2009&lt;\u20090.001; leptin: 64.6 [50.95\u201385.91] vs 18.95 [11.05\u201333.38] pg\/ml; p\u2009&lt;\u20090.001; MMP-9: 22.2 [18.2\u201331.3] vs 16.8 [13.2\u201323.1] ng\/ml; p\u2009&lt;\u20090.001; ApoA1: 535.47\u2009\u00b1\u2009150.94 (SD) vs 261.33\u2009\u00b1\u2009112.75 (SD) \u00b5g\/ml; p\u2009&lt;\u20090.001), whereas adiponectin (2.20 [1.70\u20132.75] vs 4.80 [3.50\u20137.00] \u00b5g\/ml; p\u2009&lt;\u20090.001) and angiopoietin-1 (ANGPT-1: 14.3 [10.4\u201322.55] vs 26.15 [21.2\u201333.9] ng\/ml; p\u2009&lt;\u20090.001) levels remained higher three years after MBS. Additionally, depressive symptoms remained low three years after MBS (median [IQR] BDI score: 9 [5.25\u201313] vs 4 [2\u20137]; p\u2009&lt;\u20090.001), whereas physical activity returned to baseline.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion and Relevance<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s11695-025-08198-5","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T04:01:18Z","timestamp":1756353678000},"page":"3888-3900","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Sustained Improvement of Cognition, Mood and Plasma Markers Three Years After Metabolic Bariatric Surgery. 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