In multivariate analysis, BMI ≥ 25 kg/m2 (OR 3.17), Alb < 3.5 g/dl (OR 1.77), absence of DM (OR 1.75), distal extrahepatic bile duct carcinoma (OR 4.05), and carcinoma of the papilla of Vater (PVC) (OR 5.19) were independent risk factors for POPF after PD. Here, ALB is linked to diabetes mellitus.