Association between malnutrition and prognosis in colorectal cancer: a systematic review and meta-analysis.
Chao Gao, Xiu-Ning Zhang
Kernaussage
Malnutrition defined by GLIM criteria is associated with poorer overall survival (HR 1.23), increased postoperative complications (RR 1.36-1.61), 30-day mortality (RR 2.03), 30-day readmission (RR 1.34), and prolonged hospital stay (MD 2.30 days) in colorectal cancer patients.
Abstract
Malnutrition is prevalent in colorectal cancer (CRC) and may adversely influence oncologic prognosis and perioperative recovery. This systematic review and meta-analysis quantified associations between malnutrition diagnosed by the Global Leadership Initiative on Malnutrition (GLIM) criteria and clinical outcomes in CRC. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed, Embase, Web of Science Core Collection, and The Cochrane Library were searched through December 31, 2025. Observational cohort studies enrolling adults with CRC and reporting outcomes according to GLIM-defined malnutrition were included. Study quality was assessed using the Newcastle-Ottawa Scale. Pooled hazard ratios (HRs), risk ratios (RRs), and mean differences (MDs) with 95% confidence intervals (CIs) were synthesized using random-effects models. Nine cohort studies involving 4,771 patients were included. GLIM-defined malnutrition was associated with poorer overall survival (HR 1.23, 95% CI 1.12-1.33; I² = 56.4%). It was also associated with increased postoperative infectious complications (RR 1.61, 95% CI 1.51-1.98; I² = 0.0%), major complications (RR 1.36, 95% CI 1.18-1.60), overall postoperative complications (RR 1.44, 95% CI 1.25-1.56), 30-day mortality (RR 2.03, 95% CI 1.35-3.31), and 30-day readmission (RR 1.34, 95% CI 1.01-1.64). Malnutrition was further associated with prolonged length of hospital stay (MD 2.30 days, 95% CI 1.40-3.10). Sensitivity and subgroup analyses supported the robustness of the findings. GLIM-defined malnutrition is associated with inferior survival, increased postoperative morbidity, and greater healthcare utilization in CRC. These findings support routine nutritional screening followed by GLIM-based assessment for perioperative risk stratification and clinical management in this population. https://www.crd.york.ac.uk/prospero/, identifier CRD420261324729.
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