Pre-operative Habitual Dietary Fibre Stratifies 12-Week Immune–Inflammatory Recovery After Oesophagectomy: A Multicentre Prospective Cohort Study

Yang Li¹Yuan Chen^1,2Ling Wu³Hu Sun³Danqiong Wang¹Tao Li¹Na An¹Jingfang Yan^4*

• ¹Shanxi Bethune Hospital, Shanxi Medical University, Taiyuan, China
• ²Huazhong University of Science and Technology Tongji Medical College Tongji Hospital, Wuhan, China
• ³Tumor Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, China
• ⁴Shanxi Province Cancer Hospital/ Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China

Objectives: To test whether habitual pre-operative dietary fibre predicts 12-week immune–inflammatory recovery after oesophagectomy. Methods: We conducted a multicentre prospective cohort across three tertiary hospitals. Adults with resectable oesophageal cancer completed a validated FFQ; total fibre (energy-adjusted) was grouped into sex-specific quartiles. Prespecified week-12 endpoints were: (i) a favourable inflammatory profile (CRP within reference or ≥50% fall plus NLR ≤3.0) and (ii) lymphocyte recovery (≥30% rise or ≥1.5×10^9·L⁻¹). Robust Poisson models (clustered by site) estimated adjusted relative risks; dose–response was expressed per 10 g·day⁻¹. Longitudinal biomarker trajectories (baseline→post-operative day 7→week 12) used mixed-effects models. Results: Among 312 participants, event rates increased monotonically with higher fibre. Versus Q1, adjusted RRs for the favourable inflammatory profile were 2.36 (1.85–3.01) in Q3 and 2.62 (2.20–3.12) in Q4; for lymphocyte recovery, 1.63 (1.39–1.92) and 1.79 (1.65–1.95), respectively. Each +10 g·day⁻¹ of fibre associated with RR 1.56 (1.34–1.82) for the favourable profile and 1.30 (1.17–1.45) for lymphocyte recovery. CRP and NLR declined more steeply and lymphocyte counts rose more in higher-fibre groups (time×quartile p=1.68×10⁻⁴; 1.21×10⁻⁴; 2.26×10⁻¹⁰). Early infections and 30-day mortality did not differ convincingly (per-10 g RR 0.84, p=0.333; overall 1.0%). FFQ–record ICC for fibre was 0.87. Conclusions: Higher habitual fibre before surgery was associated with materially better week-12 immune–inflammatory recovery after oesophagectomy, with consistent dose–response and longitudinal signals across centres. Routine pre-operative fibre appraisal offers a low-cost, clinic-ready stratifier for counselling and prehabilitation; interventional studies should test whether augmenting habitual fibre improves recovery trajectories.