Introduction/Purpose Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB) entail risks of vitamin and mineral deficiencies, and guidelines recommend lifelong supplementation. It remains unclear if postoperative intake of micronutrients differs between surgical methods. This exploratory cross-sectional substudy aimed to evaluate whether the reported intake of vitamins and minerals in diet and supplements differs between SG and RYGB one year after surgery. Methods Between April 2017 and May 2023, 285 participants from the randomized controlled multicenter trial "Bypass Equipoise Sleeve Trial" (BEST) were consecutively included at seven metabolic bariatric surgery centers in Sweden. The intake of vitamins and minerals from diet and supplements was self-reported at one-year follow-up and calculated in Dietist Net (R). The Goldberg cut-off method was used to exclude under-reporters. Results One year after surgery, the reported daily energy intake was 1673 kcal and 1651 kcal, after SG and RYGB, respectively. Compared with reference data on Swedish dietary habits from 2010 to 2011, participants reported daily intakes from diet below the daily recommended intake (RI) for a greater number of micronutrients. The reported intake of vitamin C from diet was 53 mg (SG) versus 72 mg (RYGB) (p = 0.001). Following both procedures most participants reported supplement intake consistent with the recommendations. The reported intake from supplements was 580 Retinol equivalents (RE) (SG) versus 656 RE (RYGB) for vitamin A (p = 0.017), and 374 & micro;g (SG) versus 436 & micro;g for folic acid (p = 0.014). Conclusion Overall, the reported intake of energy and vitamins and minerals from diet and supplements did not differ between SG and RYGB one year after bariatric surgery. Minor differences were observed, with a higher intake of vitamin C from diet, and vitamin A and folic acid from supplements after RYGB.

Background: Bariatric surgery increases the risk of anemia, but long-term data from large cohorts are sparse, and it is unclear if certain groups are at a higher risk. Objectives: Define factors associated with anemia at 5 years of follow-up after bariatric surgery. Setting: Data from a national quality register. Methods: This cross-sectional study uses Scandinavian Obesity Surgery Registry data on primary Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) procedures in Sweden from 2007 to 2020. Hemoglobin and ferritin were analyzed preoperatively and up to 10 years postoperatively. Factors associated with anemia were evaluated using hemoglobin and ferritin samples 5 years postsurgery. Results: The study included 73,612 patients (RYGB: 80.7%, SG: 19.3%). Hemoglobin and/or ferritin data were available for 18,993 patients 5 years postsurgery, of whom 3508 patients (18.5%) had anemia and 691 patients (27.0%) subnormal ferritin levels. Anemia and subnormal ferritin were more prevalent after RYGB than SG (19.6% versus 11.3%, adjusted odds ratio [aOR] = .58 and 24.1% versus 15.6%, aOR = .43). Females had a higher prevalence of anemia than males (20.6% versus 11.1%, aOR = .50). Young age was associated with a higher risk of anemia (31.0%), as was large postoperative weight loss (highest quartile 25.2%). Results regarding iron supplementation were not conclusive. Conclusions: The prevalence of anemia, likely secondary to iron deficiency, increases up to 10 years post bariatric surgery. Female sex, young age at surgery, large weight loss, and undergoing RYGB were associated with an increased risk of anemia, indicating a need for targeted strategies for vitamin and mineral supplementation in these groups. (Surg Obes Relat Dis 2026;22:744-752.) (c) 2026 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

IntroductionPoor adherence to recommended vitamin and mineral supplementation after bariatric surgery is common and challenging for healthcare professionals to identify. There are several questionnaires for self-reporting of adherence to chronic medication, but none has so far been evaluated for assessment of adherence to vitamin and mineral supplementation after bariatric surgery. The aim of this study was to assess the accuracy of the 5-item Medication Adherence Report Scale (MARS-5) in measuring adherence to vitamin and mineral supplementation post bariatric surgery (gastric bypass or sleeve gastrectomy).MethodThe psychometric properties of MARS-5 for vitamin and mineral supplementation were validated in two cohorts: one at 1 year post bariatric surgery (n = 120) and the other at 2 years post-surgery (n = 211). MARS-5 was compared to pharmacy refill data for vitamin B12 and combined calcium/vitamin D as reference.ResultsCorrelation analyses demonstrated that the MARS-5 had acceptable validity compared to objectively measured adherence rates from pharmacy refill data (calculated as continuous, multiple-interval measures of medication availability/gaps-coefficient ranged from 0.49 to 0.54). Internal reliability (Cronbach's alpha) was high: 0.81 and 0.95, respectively. There was a clear ceiling effect where one out of three had a maximum score on MARS-5.ConclusionMARS-5 demonstrated acceptable psychometric properties for assessment of adherence to vitamin and mineral supplementation post bariatric surgery.

Background: Roux-en-Y gastric bypass (RYGB) is one of the most common bariatric procedures. Internal herniation may lead to small bowel ischemia requiring small bowel resection, resulting in short bowel syndrome.

Objective: To determine the incidence of extensive small bowel resection in patients operated with RYGB. We also aimed to look for early clinical warning signs among patients requiring extensive small bowel resection.

Setting: Cohort from national quality registers.

Methods: All patients having undergone RYGB between January 2007 to June 2019 were analyzed in the Scandinavian Obesity Surgery Registry (SOReg). We identified patients with small bowel obstruction (SBO) for whom small bowel resection was necessary. Additionally, we assessed clinical signs in these patients.

Results: The study included 57,255 patients having undergone RYGB. Closure of the mesenteric openings was performed in 78%. Surgery for SBO was required in 3659 (6%) of patients, and small bowel resection in 188 (.3%). Extensive small bowel resection, resulting in less than 1.5 meters of remaining small bowel, was required in 7 patients (.01%). All patients with extensive small bowel resection presented with abdominal pain and had confirmed internal herniation as the cause of the small bowel resection, and 2 of 7 patients died. Closure of mesenteric defects was not associated with a reduction in overall small bowel resection rates (P = .89) CONCLUSION: Surgery for SBO after RYGB was common (6%). The risk of extensive small bowel resection leading to short bowel was low (.01%). Patients with abdominal pain after RYGB should be assessed for internal hernia, as it can be devastating.

Obesity and its concomitant comorbidities have a myriad of detrimental effects on health, fertility, and quality of life. Bariatric surgery is an effective treatment for inducing weight loss and reduction of obesity-related comorbidities including subfertility. The aim of this study was to explore the expectations and experiences of women with a desire to have children as a motivation for undergoing bariatric surgery. An inductive qualitative design was used. Fourteen women were interviewed, and transcriptions were analysed with thematic analysis. Two themes emerged: (i) Motherhood and Femininity and (ii) A Normal Life. Participants found no other solution than to seek bariatric surgery to be able to become pregnant and carry a child to term. Coping physically with pregnancy and being an active mother were important factors. Overall, postoperative expectations were met, and the women experienced the effects of normalised sex hormone levels, were more physically mobile, and were released from the previous social hindrances that obesity caused them. This study has clinical implications for providing support and information to women with subfertility considering bariatric surgery and to better understand their experiences of life after bariatric surgery.

Background 

Poor adherence to the lifelong vitamin and mineral supplementation post bariatric surgery is common and can be a challenge for healthcare professionals to recognize. There are several questionnaires for self-reporting of adherence to chronic medication, but none has been evaluated for assessment of adherence to vitamin and mineral supplementation post bariatric surgery.

Aim: 

To assess the accuracy of the 5-item Medication Adherence Report Scale (MARS-5) in measuring adherence to vitamin and mineral supplementation post bariatric surgery. 

Method: 

We validated the psychometric properties of MARS-5 for vitamin and mineral supplementation in two cohorts: one at 1 year post bariatric surgery (n=120) and one at 2 years post-surgery (n=211). The validity was compared to pharmacy refill data for vitamin B12 and combined Calcium/vitamin D as reference.

Results: 

Correlation analyzes demonstrated that the MARS-5 demonstrated acceptable validity compared to objectively measured adherence rate from pharmacy refill data calculated as continuous, multiple-interval measures of medication availability/gaps (coefficient ranged from 0.49 to 0.54). Internal reliability (Cronbach's α) was high: 0.81 and 0.95, respectively.  A ceiling effect was seen, where one out of three scored max in MARS-5.

Conclusion: 

MARS-5 demonstrated acceptable, but not optimal, psychometric properties for assessment of adherence to vitamin and mineral supplementation post bariatric surgery. We encourage further validation of other questionnaires for assessing adherence of vitamin and mineral supplementation post bariatric surgery.

Introduction:  Previous studies suggest insufficient adherence to vitamin and mineral supplementation after bariatric surgery. 

Objective: This trial evaluated a smartphone application’s effectiveness in improving adherence to vitamin and mineral supplementation postoperatively. 

Methods: A two-arm, randomized controlled trial comprising 140 patients undergoing bariatric surgery (gastric bypass or sleeve gastrectomy). Participants were randomized 1:1 post-surgery to 12-week intervention, using the smartphone application PromMera, or standard care. The PromMera application was designed to promote vitamin and mineral use and physical activity after bariatric surgery. The primary end point was adherence to vitamin and mineral supplementation, objectively assessed with pharmacy claim data the first-year post-surgery. Additional endpoints were adherence subjectively assessed with change in MARS-5 score, measured pre-intervention, and at 18 weeks and one year post surgery and development of nutritional deficiencies one-year post-surgery.

Results: Initiation rate and overall adherence to supplementation were high in both groups. Change in objectively measured adherence rate from before intervention to 1 year post surgery, measured with pharmacy refill data, did not differ between groups for vitamin B12  (-9.6% [SD 27%] vs. -9.3% [SD 30%]; p=0.48) or calcium/vitamin D (-12.3% [SD 29%] vs. -11.5% [SD 32%]; p=0.44). A modest effect on the secondary end point (subjectively measured adherence, using the Medication Adherence Report Scale-5 [MARS-5]) was seen immediately after the intervention (intervention group 0.00 [SD 1.3] vs. control group -1.2 [SD 3.5]; p=0.021), but this effect did not persist 1 year post surgery. No differences were detected in the prevalence of biochemical deficiencies.

Conclusions The use of the smartphone application PromMera did not obtain a lasting improvement in adherence to vitamin and mineral supplementation one year post bariatric surgery.

Peptide drugs and biologics provide opportunities for treatments of many diseases. However, due to their poor stability and permeability in the gastrointestinal tract, the oral bioavailability of peptide drugs is negligible. Nanoparticle formulations have been proposed to circumvent these hurdles, but systemic exposure of orally administered peptide drugs has remained elusive. In this study, we investigated the absorption mechanisms of four insulin-loaded arginine-rich nanoparticles displaying differing composition and surface characteristics, developed within the pan-European consortium TRANS-INT. The transport mechanisms and major barriers to nanoparticle permeability were investigated in freshly isolated human jejunal tissue. Cytokine release profiles and standard toxicity markers indicated that the nanoparticles were nontoxic. Three out of four nanoparticles displayed pronounced binding to the mucus layer and did not reach the epithelium. One nanoparticle composed of a mucus inert shell and cell-penetrating octarginine (ENCP), showed significant uptake by the intestinal epithelium corresponding to 28 +/- 9% of the administered nanoparticle dose, as determined by super-resolution microscopy. Only a small fraction of nanoparticles taken up by epithelia went on to be transcytosed via a dynamin-dependent process. In situ studies in intact rat jejunal loops confirmed the results from human tissue regarding mucus binding, epithelial uptake, and negligible insulin bioavailability. In conclusion, while none of the four arginine-rich nanoparticles supported systemic insulin delivery, ENCP displayed a consistently high uptake along the intestinal villi. It is proposed that ENCP should be further investigated for local delivery of therapeutics to the intestinal mucosa.

Objective

Few studies have been carried out concerning the influence of bariatric surgery on female sexuality and hormones, particularly utilizing hormone-based questionnaires. The effect of bariatric surgery on sex hormone levels, sexual function and health-related quality of life (HRQL) in women was analyzed in this study. Participants were included in a single-center study at a regional hospital in Sweden, with a duration of one-year follow-up.

Methods

One hundred non-smoking women, undergoing laparoscopic Roux-en-Y gastric bypass, were included in the study. Blood assay for sex-hormone binding globulin (SHBG), testosterone, estrogen, progesterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) was analyzed. Participants completed the Female Sexual Function Index (FSFI), Women’s Health Questionnaire (WHQ) and Psychological General Well-being Inventory (PGWB) parallel to lab testing.

Results

At one-year follow-up, several significant results were found concerning hormones and questionnaires. Testosterone decreased and SHBG increased, N = 68/100. Desire, arousal, orgasm, satisfaction and total score domains for the FSFI increased after one year, N = 53/100. WHQ domains concerning depressed mood, somatic symptoms, memory, anxiety, sexual behavior and attractiveness improved after one year, N = 47/100. All domains in the PGWB (N = 52), including anxiety, depressed mood, positive well-being, self-control, general health, vitality and total score improved at follow-up. Spearman’s Rho coefficient analysis found correlation between testosterone/WHQ-sexual problems (0.3), SHBG/WHQ-general health (0.3) and SHBG/FSFI-arousal (−0.3).

Conclusions

Bariatric surgery normalizes levels of sex-hormones in women, and results in improved sexual function, health-related quality of life and psychological well-being.

Background: Pulmonary recruitment maneuver (PRM) at the end of laparoscopic gynecologic surgery has been shown to reduce postoperative pain. This prospective, randomized, controlled clinical trial aimed to investigate postoperative pain (primary endpoint) and nausea when performing a ventilator-piloted PRM at the end of laparoscopic bariatric surgery. Settings: A secondary-level public hospital in Sweden. Methods: After giving written consent, patients undergoing elective laparoscopic bariatric surgery were randomized to receive routine exsufflation (control group) or a ventilator-piloted PRM to remove residual carbon dioxide from the abdomen at the end of surgery. Pain and nausea intensities were recorded at 4, 12, 24, 36, and 48 hours after surgery using a questionnaire with numeric rating scales. Postoperative consumption of analgesics and antiemetics was also evaluated. Results: There were 150 randomly assigned patients recruited, 79 to PRM intervention and 71 controls. Pain intensity was significantly lower in the PRM group than in the control group 24 hours postoperatively (numeric rating scale 2 [1-3] versus 3 [2-5]; P =.002). Pain during the first 24 hours did not increase in the PRM group as it did in the control group (P =.045). Opioid requirements were significantly lower in the PRM group than in the control group (5.0 mg [2-10] versus 9.0 mg [5-15]; P =.025). The PRM did not affect incidence or intensity of nausea and vomiting. Conclusions: A ventilator-piloted PRM reduced postoperative pain intensity and opioid requirement after laparoscopic bariatric surgery. The heterogeneity of the study population and the large number of hospital staff involved indicate good generalizability of the results. (Surg Obes Relat Dis 2018;14:386-392.) (C) 2018 American Society for Metabolic and Bariatric Surgery. This is an open access article under the CC BY-NC-ND license.