Protein intake after the initiation of chemotherapy is an independent prognostic factor for overall survival in patients with unresectable pancreatic cancer: A prospective cohort study

Clin Nutr. 2021 Jul;40(7):4792-4798. doi: 10.1016/j.clnu.2021.06.011. Epub 2021 Jun 17.


Background & aims: This study was conducted to investigate the nutritional status and longitudinal dietary intake during the course of chemotherapy, and their relationships with the survival in patients with unresectable pancreatic cancer.

Methods: A prospective cohort study was conducted in 38 patients with unresectable pancreatic cancer receiving chemotherapy between January 2018 and November 2019. Subjective global assessment was used to assess the nutritional status, and the dietary intake was assessed monthly, for up to 12 months, using a brief self-administered diet history questionnaire. The primary outcome was overall survival, and the secondary outcome was progression-free survival. Cox regression analysis was performed to identify independent prognostic factors.

Results: Moderate or severe malnutrition was found in 34.2% of the participants. Daily protein intake was significantly higher in the survivor group than in the deceased group at one month after the initiation of chemotherapy (1.4 ± 0.7 g/kg/day vs. 0.9 ± 0.5 g/kg/day, p = 0.019), while the baseline nutritional intakes were similar between the two groups. Univariate analysis identified weight loss >3.5%, energy intake <25 kcal/kg/day, protein intake <1.1 g/kg/day, and malnutrition as possible poor prognostic factors. Multivariate analysis identified protein intake <1.1 g/kg/day (hazard ratio [HR]: 9.03, 95%CI: 1.45-56.32, p = 0.018) as an independent poor prognostic factor.

Conclusions: Insufficient protein intake was identified as an independent poor prognostic factor in patients with unresectable pancreatic cancer receiving chemotherapy. Improving the dietary protein intake could be a useful therapeutic approach in patients with advanced pancreatic cancer receiving chemotherapy.

Keywords: Chemotherapy; Food frequency questionnaire; Nutritional status; Protein intake; Unresectable pancreatic cancer.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antineoplastic Agents / therapeutic use*
  • Diet / mortality*
  • Diet Surveys
  • Dietary Proteins / analysis*
  • Eating / physiology*
  • Energy Intake
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Malnutrition / etiology
  • Malnutrition / mortality
  • Middle Aged
  • Nutrition Assessment
  • Nutritional Status
  • Pancreatic Neoplasms / drug therapy
  • Pancreatic Neoplasms / mortality*
  • Pancreatic Neoplasms / physiopathology
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Survival Rate
  • Weight Loss


  • Antineoplastic Agents
  • Dietary Proteins