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This single-center study conducted in Turkey aims to assess the impact of preoperative nutritional status based on global leadership initiative on malnutrition criteria on 30-day postoperative surgical outcomes in patients undergoing pancreaticoduodenectomy (PD) for pancreatic head adenocarcinoma. A retrospective analysis was conducted on patients who underwent PD. Patients were classified into 2 groups based on preoperative nutritional assessments of global leadership initiative on malnutrition criteria: malnourished (n = 23; 46%) and nonmalnourished (n = 27; 54%). Preoperative data, including demographics, comorbidities, intraoperative data, final pathological results, and postoperative 30-day outcomes, including overall and major (Clavien-Dindo > II) complications, length of hospital stay (LOS), and 30-day mortality rates, were recorded and compared. A total of 50 patients were included in the study. Demographics, American Society of Anesthesiologists scores, and comorbidities were similar between the groups (P > .05). The mean Clavien-Dindo grade was 3 in the malnourished group and 2 in the nonmalnourished group (P = .001). Malnourished patients had a significantly higher rate of major complications (73.9%) compared to nonmalnourished patients (14.8%)(P = .001). The median LOS was similar between the 2 groups. The rate of postoperative transfusions was higher in the malnourished group (P = .033). Postoperative 30-day mortality was significantly higher in the malnourished group (26.1%) compared to the nonmalnourished group (0%) (P = .006). Multivariate logistic regression analysis confirmed that malnutrition was an independent predictor of postoperative major complications (OR: 16.3, 95% CI: 3.9-66.8, P = .001). Preoperative malnutrition is a strong predictor of 30-day postoperative major complications and mortality following PD in patients with pancreatic head adenocarcinoma.