A prospective cohort study of dietary intake and clinical–nutritional biomarkers in patients with periampullary malignancies undergoing pancreatoduodenectomy in Southeast Brazil

Purpose Patients undergoing pancreatoduodenectomy for periampullary malignancies are at high nutritional risk. The aim was to characterize longitudinal changes in reported dietary intake, clinical–nutritional biomarkers, and inflammatory–nutritional indices after surgery and contextualize them through cross-sectional comparisons with age- and sex-similar controls. Methods This prospective longitudinal cohort included 24 patients and 20 contextual controls. Patients were assessed preoperatively and at 3 and 6 months after discharge; controls were assessed once. Dietary intake was estimated using an adapted food frequency questionnaire (FFQ). FFQ-reported energy surplus was intake minus the 25 kcal/kg/day requirement based on the European Society for Clinical Nutrition and Metabolism (ESPEN). Longitudinal analyses, contextual comparisons, and exploratory adjusted diet–biomarker regressions were performed. Results Of 24 patients assessed preoperatively, 18 and 16 were reassessed at 3 and 6 months. Median reported energy intake decreased from 2625 to 2011 and 1948 kcal/day, respectively. FFQ-reported energy surplus and intakes of macronutrients, fiber, calcium, iron, and selenium decreased, whereas zinc and vitamins A and E showed no detected longitudinal change. C-reactive protein, ferritin, liver enzymes, and serum vitamin E decreased. Glasgow Prognostic Score (GPS) and C-reactive protein-to-albumin ratio (CAR) decreased, the C-reactive protein–albumin–lymphocyte (CALLY) index increased, and the Prognostic Nutritional Index (PNI) showed no detected longitudinal change. Diet–biomarker associations were limited and inconsistent, although iron intake was positively associated with hemoglobin preoperatively in both adjusted models. Conclusion During the first 6 months after pancreatoduodenectomy, reduced reported dietary intake persisted despite attenuation of systemic inflammation, while biochemical and inflammatory–nutritional indices followed divergent trajectories. These trajectories describe patients alive and available for follow-up.