# Risk of Malnutrition in Digestive System Cancers: A Systematic Review and Meta-Analysis

## TL;DR

This study identifies risk factors for malnutrition in digestive system cancers, emphasizing the need for standardized assessment methods.

## Contribution

The study provides a comprehensive meta-analysis linking age, cancer stage, and inflammation to malnutrition risk in gastrointestinal cancers.

## Key findings

- Older age is significantly associated with increased malnutrition risk across all gastrointestinal cancers.
- Tumor location affects malnutrition-related complication risk in pancreatic and colorectal cancers.
- Inflammatory biomarkers like C-reactive protein are linked to malnutrition risk at baseline.

## Abstract

Cancer cachexia accounts for up to 22% of cancer-related deaths. The highest prevalence of malnutrition is reported in pancreatic and upper gastrointestinal malignancies. Malnutrition risk, malnutrition diagnosis, and cachexia are consistently associated with adverse clinical outcomes. The aim of this systematic review and meta-analysis was to identify risk factors contributing to these nutritional conditions. For risk assessment, symptom-based screening tools were used, the biological composite score was used to assess the malnutrition-related complication risk, and the diagnosis of malnutrition was determined according to the GLIM criteria. Definitions of cachexia varied across the included articles. Our findings indicate that age, cancer stage, and systemic inflammation are significantly associated with malnutrition risk, while site-specific differences are revealed in colorectal and pancreatic cancers. In esophageal cancer, different types of assessment tools produced discordant results regarding neoadjuvant therapy as a risk factor for malnutrition. These results highlight the need for standardised and context-appropriate approaches to the assessment of malnutrition and cachexia in gastrointestinal cancers.

Background/Objectives: Incidence of malnutrition varies greatly among gastrointestinal (GI) cancer patients and has a major impact on prognosis. We performed a meta-analysis to identify risk factors for malnutrition risk, malnutrition diagnosis, and cachexia in patients with GI cancer. Methods: A systematic search was performed on 31 October 2025 on the PubMed (Medline), Embase, and Cochrane Library databases. Eligible studies reported on risk factors for malnutrition risk, malnutrition diagnosis, malnutrition-related complication risk and cachexia in adult patients with GI cancer. Articles on neuroendocrine tumours, primary cancer outside the GI tract, and the paediatric population were excluded. The random-effects model yielded the pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the investigated risk factors. Results: A total of 37,624 records were identified. Data from 262,525 patients from 578 articles were included in the analysis. Older age (≥65) was associated with higher odds for malnutrition risk across all GI cancers. In gastric cancer, males had a lower odds for malnutrition risk (OR 0.84; 95% CI 0.75–0.95); however, the sex difference across other cancer types was heterogeneous, and mostly not significant. Tumour location influenced the odds for malnutrition-related complication risk in pancreatic ductal adenocarcinoma (head vs. body/tail—OR 1.48; 95% CI 0.98–2.23) and colorectal cancer (colon vs. rectal—OR 1.39; 95% CI 1.07–1.81; right-sided vs. left-sided—OR 1.54; 95% CI 1.34–1.77). Increased C-reactive protein alone indicated higher odds for malnutrition risk at baseline. Conclusions: Inflammatory biomarkers and tumour characteristics may indicate malnutrition risk in GI cancer at baseline. There is a great need for standardised and harmonised approaches in nutritional status assessment in GI cancer.