Zhang XL, Hong QQ, Lin LZ. Clinical effects of nutritional risk screening 2002-guided individualized nutritional intervention in postoperative colorectal cancer patients: A time-period comparison study. World J Gastrointest Surg 2026; 18(8): 119341 [DOI: 10.4240/wjgs.119341]
Corresponding Author of This Article
Li-Zhen Lin, MD, Associate Chief Physician, Department of Medical Oncology, The First Affiliated Hospital of Xiamen University, No. 55 Zhenhai Road, Xiamen 361003, Fujian Province, China. 200304133@163.com
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Gastroenterology & Hepatology
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Zhang XL, Hong QQ, Lin LZ. Clinical effects of nutritional risk screening 2002-guided individualized nutritional intervention in postoperative colorectal cancer patients: A time-period comparison study. World J Gastrointest Surg 2026; 18(8): 119341 [DOI: 10.4240/wjgs.119341]
World J Gastrointest Surg. Aug 27, 2026; 18(8): 119341 Published online Aug 27, 2026. doi: 10.4240/wjgs.119341
Clinical effects of nutritional risk screening 2002-guided individualized nutritional intervention in postoperative colorectal cancer patients: A time-period comparison study
Xiu-Lian Zhang, Qing-Qi Hong, Li-Zhen Lin
Xiu-Lian Zhang, Department of Colorectal Tumor Surgery, The First Affiliated Hospital of Xiamen University, Xiamen 361003, Fujian Province, China
Qing-Qi Hong, Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Xiamen University, Xiamen 361003, Fujian Province, China
Li-Zhen Lin, Department of Medical Oncology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, Fujian Province, China
Co-first authors: Xiu-Lian Zhang and Qing-Qi Hong.
Author contributions: Zhang XL and Hong QQ jointly responsible for study design, patient recruitment, and data collection from the Department of Colorectal Tumor Surgery and Department of Gastrointestinal Oncology Surgery respectively; Lin LZ from the Department of Medical Oncology provided expertise in oncological assessment and participated in data analysis and interpretation. All authors contributed to manuscript preparation, critical revision, and approved the final version for publication. Zhang XL and Hong QQ contributed equally to this work as co-first authors.
Institutional review board statement: This study was approved by the Medical Ethics Committee of The First Affiliated Hospital of Xiamen University (Approval No. 2023-KY-005). All procedures were conducted in accordance with the ethical principles of the Declaration of Helsinki.
Informed consent statement: The requirement for individual written informed consent was waived by the Medical Ethics Committee of The First Affiliated Hospital of Xiamen University, given the retrospective, observational design of this time-period comparison study and the use of anonymized clinical data extracted from electronic medical records. The waiver posed no additional risk to participants.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest to disclose. The study received no external funding, and no author has a financial relationship with any commercial entity that could be perceived as having an interest in the subject matter of this manuscript.
Data sharing statement: The data that support the findings of this study are available from the corresponding author (Lizhen Lin; 200304133@163.com) upon reasonable request. De-identified participant data, including the dataset used for statistical analyses, may be shared following approval by the Institutional Ethics Committee of The First Affiliated Hospital of Xiamen University and in compliance with applicable data protection regulations.
Corresponding author: Li-Zhen Lin, MD, Associate Chief Physician, Department of Medical Oncology, The First Affiliated Hospital of Xiamen University, No. 55 Zhenhai Road, Xiamen 361003, Fujian Province, China. 200304133@163.com
Received: March 13, 2026 Revised: April 17, 2026 Accepted: May 29, 2026 Published online: August 27, 2026 Processing time: 156 Days and 5 Hours
Abstract
BACKGROUND
Postoperative malnutrition prevalence among colorectal cancer (CRC) patients is high and has an essential impact on the recovery process and quality of life. Traditional models of nutritional management are not individualized and have limited efficacy. New insights have emerged from the application of enhanced recovery after surgery concept that can help us improve patients post-operative nutritional status.
AIM
To investigate the effects of nutritional risk (NR) assessment associated with individualized nutritional intervention on clinical applications in postoperative CRC patients.
METHODS
This was a quasi-experimental, time-period comparison study of postoperative CRC patients whose admission records to our hospital were from March 2023 to May 2024. Patients were then divided into two groups, a conventional group (n = 40 and from March-October 2023) and NR-guided intervention group (n = 40 and from November 2023-May 2024), based on when nutritional management protocols were implemented. Meanwhile conventional group was routinely treated with nutritional support protocol while the NR-guided intervention group implemented NR assessment [NR Screening 2002 (NRS-2002) scoring] and as well as personalized nutrition approaches, including preoperative nutrition screening, early postoperative enteral nutrition, oral Ensure supplement and individualized nutrient formulas adjustment. We assessed nutritional parameters [serum albumin (ALB), prealbumin (PA), hemoglobin], inflammatory markers (C-reactive protein, interleukin-6), gastrointestinal function recovery, length of stay and complication rates between the two groups. Multivariable regression analyses adjusted for potential confounders were conducted.
RESULTS
Serum ALB level on the 7th and the 14th day after operation were significantly higher in NR-guided intervention group than those of conventional group (P < 0.05), PA recovery was faster (P < 0.01). The NR-assisted intervention group had an earlier first flatus time compared to the conventional group (2.1 ± 0.8 days vs 3.2 ± 1.1 days, P < 0.01), and shorter first defecation time (3.2 ± 1.2 days vs 4.6 ± 1.5 days, P < 0.01). Patients in the NR-guided intervention group had also a decreased mean hospital stay (8.5 ± 2.3 days vs 11.7 ± 3.1 days, P < 0.01) and lower rate of postoperative complication (15.0% vs 35.0%, P < 0.05). There was a statistically significant difference in the occurrence of major complications, including postoperative infection and anastomotic leakage (P < 0.05).
CONCLUSION
This longitudinal comparative study demonstrated that the NRS-2002-guided individualized nutritional intervention significantly improved postoperative nutritional status, accelerated recovery of gastrointestinal function and shortened hospital stay, as well as reduced complication rates in CRC patients over this time period. Although these results imply possible benefits, causal relationships must be established via randomized controlled trials.
Core Tip: This quasi-experimental, period difference study examined the Nutritional Risk Screening 2002 (NRS-2002) instructed individualized nutritional intervention among postoperative colorectal cancer patients. The Overall intervention protocol included preoperative nutrition assessment via NRS-2002, initiation of enteral nutrition as soon as possible postoperatively, customized energy-protein supply for different risks stratification, and supplementary oral nutritional (ensure) input in addition to dynamic adjusted formula usage during the perioperative period. These interventions were correlated with faster gastrointestinal recovery, lower inflammatory response, short time of hospital stay and fewer complications. Despite these encouraging findings, more studies are needed to prove causation and derive specific dietary recommendations for the clinical setting, particularly randomized controlled trials.
