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Incidence and risk factors of nonalcoholic fatty liver disease after pancreaticoduodenectomy in Korea: a multicenter retrospective cohort study
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Chang-Sup Lim
 , Hongbeom Kim, In Woong Han, Won-Gun Yun, Eunchae Go, Jaewon Lee, Kyung Chul Yoon, So Jeong Yoon, Sang Hyun Shin, Jin Seok Heo, Yong Chan Shin, Woohyun Jung
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Ann Clin Nutr Metab 2024;16(3):125-133. Published online December 1, 2024
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DOI: https://doi.org/10.15747/ACNM.2024.16.3.125
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 Abstract
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- Purpose: This study aimed to investigate the incidence, risk factors, and clinical course of nonalcoholic fatty liver disease (NAFLD) following pancreaticoduodenectomy, focusing on the role of adjuvant chemotherapy and other metabolic changes.
Methods: A retrospective analysis was conducted on 189 patients who underwent pancreaticoduodenectomy between 2013 and 2016. NAFLD was diagnosed using computed tomography (CT) imaging, defined as a liver-to-spleen attenuation ratio <0.9. Sarcopenia and sarcopenic obesity were assessed using preoperative CT scans. Logistic regression analysis was performed to identify risk factors for NAFLD development.
Results: The cumulative incidence of NAFLD increased over time, with rates of 15.9% at one year, 20.4% at three years, and 35.2% at five years post-pancreaticoduodenectomy. Adjuvant chemotherapy was identified as the only significant independent predictor of NAFLD development (odds ratio, 2.74; 95% confidence interval, 1.16-6.70; P=0.023). No significant associations were found between NAFLD and pancreatic enzyme replacement therapy (PERT), sarcopenia, or sarcopenic obesity. Serial analysis of NAFLD status in long-term survivors revealed dynamic changes, with some patients experiencing spontaneous remission or recurrence.
Conclusion: NAFLD is a common, progressive complication following pancreaticoduodenectomy, particularly in patients receiving adjuvant chemotherapy. Although no significant associations with PERT or sarcopenia were observed, these areas warrant further investigation. Long-term monitoring and targeted management strategies are recommended to address NAFLD in this population. Future prospective studies are needed to elucidate the natural history and contributing factors of NAFLD after pancreaticoduodenectomy.
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Association of routine early supplemental parenteral nutrition with postoperative complications after pancreaticoduodenectomy: a single-center retrospective cohort study
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Soo Yeun Lim, Kwang Jun Ryu, Hochang Chae, Hyeong Seok Kim, So Jeong Yoon, Hongbeom Kim, Sang Hyun Shin, Jin Seok Heo, In Woong Han
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Received March 17, 2026 Accepted September 28, 2026 Published online November 3, 2026
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DOI: https://doi.org/10.15747/ACNM.26.0053
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Abstract
- Purpose
The benefit of routinely providing early supplemental parenteral nutrition (PN) after pancreaticoduodenectomy (PD) remains uncertain. This study examined whether routine supplemental PN on postoperative days 1–3 was associated with postoperative complications. The primary endpoint was major complications (Clavien–Dindo grade III or higher) within 90 days.
Methods
This retrospective study analyzed 927 patients who underwent PD at a single tertiary center from 2014 to 2020: 161 received routine early supplemental PN and 766 did not. Supplemental PN was provided on postoperative days 1–3 alongside progressive oral feeding. Exploratory subgroup and interaction analyses examined diabetes mellitus and sarcopenia status.
Results
Major complication rates did not differ between groups (24.2% vs. 23.5%: adjusted odds ratio [OR], 1.13; 95% confidence interval [CI], 0.61–2.10; P=0.919). Grade B/C postoperative pancreatic fistula (POPF; 22.4% vs. 10.7%, P<0.001) and delayed gastric emptying (DGE; 9.3% vs. 4.3%, P=0.012) were more frequent with supplemental PN in unadjusted comparisons. Neither association remained significant after adjustment for treatment period and baseline differences (adjusted OR, 1.73; 95% CI, 0.86–3.47; P=0.126 for POPF and adjusted OR, 2.50; 95% CI, 0.78–8.03; P=0.125 for DGE). Hospital stay was similar between groups (12.5 days vs. 12.1 days; P=0.547). Diabetes mellitus modified the association between supplemental PN and major complications (P for interaction=0.006), whereas sarcopenia did not.
Conclusion
After adjustment, routine early supplemental PN after PD showed no clear evidence of benefit or harm for 90-day major complications. The higher unadjusted rates of POPF and DGE were attenuated by adjustment. The exploratory findings require prospective validation.
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