# Nutritional support in pancreatic cancer patients and its effect on nutritional status: an observational regional HPB network study investigating current practice

## TL;DR

This study shows that nutritional support improves preoperative nutrition in pancreatic cancer patients, but postoperative nutrition declines despite continued efforts.

## Contribution

The study evaluates real-world effectiveness of nutritional support in pancreatic cancer patients within a regional HPB network.

## Key findings

- 40% of patients were malnourished at baseline, with malnourished patients being younger, female, and having higher BMI.
- Nutritional support increased preoperative caloric and protein intake and body weight, but postoperative protein intake and muscle thickness decreased.
- Postoperative nutritional monitoring and support require improvement to maintain gains achieved preoperatively.

## Abstract

Preoperative malnutrition is associated with poor postoperative outcomes in patients with pancreatic cancer. This study evaluated the effectiveness of current practice in nutritional support for patients with pancreatic cancer.

Observational multicenter HPB network study conducted at the Isala Clinics Zwolle, Medical Spectrum Twente, Medical Center Leeuwarden, and University Medical Center Groningen between October 2021 and May 2023. Patients with a suspected pancreatic malignancy scheduled for surgery were screened for malnutrition using the Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire and referred to a dedicated dietician for nutritional support comprising pancreatic enzyme replacement therapy, dietary advice, and nutritional supplements to achieve adequate caloric and protein intake. At baseline, 1 day preoperatively, and 3 months postoperatively, the nutritional status and muscle thickness were evaluated.

The study included 30 patients, of whom 12 (40%) classified as malnourished (PG-SGA ≥ 4) at baseline. Compared to well-nourished patients, malnourished patients were younger, were predominantly female, and had a higher body mass index, despite having lost more body weight in the past 6 months. All malnourished patients and 78% of the well-nourished patients received nutritional support. Consequently, a preoperative increase in caloric and protein intake and body weight were observed. Postoperatively, despite a further increase in caloric intake, a considerable decrease in protein intake, body weight, and muscle thickness was observed.

Malnutrition is prevalent in patients undergoing pancreatic surgery. Nutritional support by a dedicated dietician is effective in enhancing patients’ preoperative nutritional status. However, postoperative monitoring of adequate nutritional intake in patients could be improved.

The online version contains supplementary material available at 10.1007/s00520-024-08683-0.