Metabolic dysfunction–associated steatotic liver disease as a risk factor for cognitive decline: Findings from the ELSA‐Brasil cohort

INTRODUCTION: Metabolic dysfunction-associated steatotic liver disease (MASLD) has been linked to adverse brain outcomes. We aim to evaluate whether MASLD is associated with cognitive impairment/decline. METHODS: We analyzed data from the Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil study). Global cognitive performance was assessed at baseline and follow-up. Associations between MASLD and cognition were tested using Poisson regression and linear mixed-effects models (LMMs). RESULTS: MASLD was present in 13.6% (n = 918/6754) of participants at baseline. MASLD was not associated with incident cognitive impairment (Relative Risk: 1.01; 95% confidence interval [CI]: 0.83-1.23; p = 0.91). In LMMs, in a fully adjusted model, MASLD was not associated with cognitive decline (estimate: 0.039; 95% CI: -0.109 to 0.031; p = 0.2721) but was associated with the memory domain at the baseline. DISCUSSION: MASLD is not independently associated with cognitive impairment or cognitive decline in middle-aged adults. HIGHLIGHTS: Metabolic dysfunction-associated steatotic liver disease (MASLD) is not independently associated with cognition in the longitudinal analysis. Hepatic steatosis is not independently associated with cognition. The effect on cognition is dependent on vascular and metabolic risk factors.