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

Background Patients undergoing pancreatoduodenectomy for periampullary malignant neoplasms face a high nutritional risk due to both the underlying disease and the post-operative anatomical and functional changes. Assessing nutritional status in this context is challenging, as traditional biomarkers are influenced by systemic inflammation, and food intake can be compromised by prolonged gastrointestinal symptoms. Studies that integrate clinical, biochemical, and dietary data in a longitudinal approach are still scarce. Aim To describe and compare the evolution of food intake and clinical-laboratory biomarkers, including nutritional, metabolic, inflammatory, hematological, vitamin, and mineral parameters, in patients who underwent pancreatoduodenectomy for the treatment of periampullary malignant neoplasms. Evaluations were conducted in the pre-operative period and at three and six months after hospital discharge, in relation to a control group. Methods This is a prospective, longitudinal, and controlled cohort study conducted at the Hospital das Clínicas of Ribeirão Preto Medical School, University of São Paulo ((HCFMRP-USP) between July 2023 and December 2024 and the study was approved by the Research Ethics Committee (CAAE: 64695422.6.0000.5440 and 63993522.3.0000.5440), and was registered at ClinicalTrials ID: NCT07159672 (https://clinicaltrials.gov/study/NCT07159672). The study included 24 patients who underwent pancreatoduodenectomy and 20 controls matched by age and gender. Food intake was assessed using a quantitatively adapted Food Frequency Questionnaire, and clinical-nutritional biomarkers (total proteins, albumin, C-reactive protein, hemoglobin, ferritin, vitamins, and minerals) were evaluated at three distinct time points in the surgical group (pre-operative, and at 3 and 6 months after discharge). The control group was evaluated at a single time point. Statistical analyses included longitudinal models and adjusted regressions. Results Energy intake significantly decreased after surgery (pre-operative: 3444 ± 1130 kcal; 3 months: 1988 ± 826 kcal; p < 0.001), with no spontaneous recovery at 6 months. There was a sustained drop in the intake of essential macro and micronutrients, and serum levels of vitamin E remained reduced during follow-up (p < 0.001). Although not all associations between intake and biomarkers reached statistical significance, clinically relevant correlations were highlighted between iron and hematological parameters, as well as between vitamin E and its serum concentration. Conclusion Nutritional assessment of patients undergoing pancreatoduodenectomy for periampullary malignant neoplasms requires the integration of clinical and nutritional data. The multiparametric longitudinal approach proposed in this study applies to different clinical contexts and can contribute to the planning of personalized nutritional strategies in complex surgical-oncological scenarios.