Nutritional Therapy in Pancreatic Cancer: Mechanisms, Clinical Applications, and Future Perspectives

BACKGROUND: Pancreatic cancer is frequently complicated by malnutrition, cancer cachexia, pancreatic exocrine insufficiency (PEI), and sarcopenia, all of which adversely affect treatment tolerance, quality of life, and survival. OBJECTIVE: To review the pathophysiology, assessment, and contemporary nutritional management of pancreatic cancer, with a focus on cachexia, PEI, body composition, and personalized nutritional care. METHODS: This narrative review summarizes evidence from clinical guidelines, randomized trials, observational studies, and expert consensus statements regarding nutritional assessment and interventions in pancreatic cancer. RESULTS: Malnutrition in pancreatic cancer is multifactorial and extends beyond inadequate dietary intake. Cancer cachexia represents the central metabolic syndrome driving progressive nutritional decline, whereas PEI is a unique and potentially reversible contributor to malnutrition. Early nutritional screening, comprehensive assessment, and body composition evaluation are essential for identifying patients at risk. Nutritional counseling, oral nutritional supplements, pancreatic enzyme replacement therapy (PERT), exercise-based rehabilitation, and multimodal cachexia-directed interventions constitute the foundation of current nutritional management. Perioperative nutritional optimization and treatment-specific strategies may further improve outcomes. CONCLUSIONS: Effective nutritional care requires early recognition of nutritional risk, systematic assessment of cachexia, PEI, and sarcopenia, and individualized interventions integrated throughout the treatment continuum.