Effect of graded nutritional intervention on elderly colorectal cancer patients’ postop status

Abstract

BACKGROUND

Colorectal cancer (CRC) is a globally prevalent gastrointestinal malignant cancer, especially in elderly patients. Currently, surgery resection remains the primary treatment due to its favorable therapeutic outcomes. However, postoperative deterioration in nutritional status and quality of life (QoL) remains a concern. The geriatric nutritional risk index (GNRI), which is calculated based on serum albumin levels and the ratio of normal body weight to ideal body weight, is easily accessible and accurate, making it increasingly popular in clinical practice.

AIM

To investigate the impact of GNRI-guided tiered nutritional interventions on postoperative nutritional recovery and QoL in elderly CRC patients.

METHODS

A retrospective analysis was conducted on 135 elderly CRC patients undergoing radical resection at our hospital from September 2022 to December 2024. Participants were divided into two cohorts: The research group (n = 61) received GNRI-based graded nutritional support, while the control group (n = 65) received conventional nutritional intervention. Clinical indicators, such as postoperative passage of gas by anus, incidence/duration of postoperative fever, hospitalization length and costs, were compared between the two groups. Nutritional biomarkers, including hemoglobin, prealbumin, transferrin, and Patient-Generated Subjective Global Assessment scores were assessed on postoperative day 1 and post-intervention (day 1 after intervention). The Generic QoL Inventory-74 was employed to assess physical function, social function, material life, and psychological function in the two groups. Immunoglobulin (Ig) (IgG, IgA, IgM) and inflammatory markers [nuclear factor kappa B, interleukin (IL)-1, tumor necrosis factor-α, IL-8] were compared between groups. Complication rates were also monitored.

RESULTS

The research group showed significantly faster postoperative passage of gas by anus, fewer instances of fever, reduced fever duration, shorter hospitalization duration, and lower costs compared with the control group (P < 0.05). Following intervention, the research group exhibited higher levels of hemoglobin, prealbumin, and transferrin, and lower Patient-Generated Subjective Global Assessment scores vs the control group (P < 0.05). Scores for physical function, social function, material life, and psychological function showed substantial improvement (P < 0.05). Levels of IgG, IgA, and IgM were significantly elevated in the research group (P < 0.05), while nuclear factor kappa B, IL-1, tumor necrosis factor-α, and IL-8 levels were noticeably lowered vs the control group (P < 0.05). The incidence of overall complications within the research group reached 24.59%, notably lower than that (43.08%) observed in the control group (P < 0.05).

CONCLUSION

GNRI-based graded nutritional intervention in elderly CRC patients can significantly improve postoperative recovery, enhance their nutritional status and QoL, promote immune function recovery, attenuate inflammation, and lower the incidence of postoperative complications. This protocol represents a clinically viable strategy for optimizing postoperative care.

Key Words: Geriatric nutritional risk index; Graded nutritional intervention; Elderly colorectal cancer; Postoperative; Nutritional status; Quality of life

Core Tip: A total of 135 elderly colorectal cancer patients subjected to radical resection at our hospital between September 2022 and December 2024 were involved in the retrospective study. In this research, comparisons were made regarding clinical indicators, nutritional status, quality of life, immune function, inflammatory factor levels, and the incidence of complications between the two groups. Results showed geriatric nutritional risk index - based graded nutritional intervention improved clinical indicators, nutrition, and quality of life, promoted immune recovery, alleviated inflammation, reduced complications, confirming its reliability as a postoperative strategy.

INTRODUCTION

The global rise in colorectal cancer (CRC) incidence, driven by aging populations and shifting dietary patterns, has established CRC as a critical public health challenge. Currently, it is the third leading cause of cancer-related deaths, with individuals aged 65-74 years diagnosed[1]. In China, this burden is particularly pronounced, with 517000 new cases and 245000 deaths reported in 2018 alone - representing 28% of global CRC-related mortality during that period[2]. While surgical resection remains the most widely used and effective treatment for elderly CRC patients[3,4], postoperative recovery is often complicated by surgical trauma. Tumor progression and metastasis exacerbate systemic resource depletion, leading to reduced dietary intake, chronic pain, and subsequent declines in nutritional and immune resilience[5,6], negatively affecting prognosis and diminishing quality of life (QoL). Therefore, it is crucial to implement effective interventions for improving patient outcomes.

The geriatric nutritional risk index (GNRI), a validated tool combining serum albumin and body weight metrics, is designed to identify and predict nutritional risks in the elderly. Previous studies have confirmed its prognostic utility for the prognosis of elderly patients with various solid tumors, including pancreatic, esophageal, gastrointestinal cancers, and non-small cell lung cancer[7-9]. Notably, Zhang et al[10] found that elderly gastric cancer surgery patients with lower GNRI scores were more likely to develop postoperative complications compared with those with higher GNRI scores (odds ratio = 1.768; 95% confidence interval: 1.445-2.163, P < 0.001), highlighting GNRI as a valuable predictor of long-term prognosis and complications in gastric cancer surgery patients. However, clinical implementation of GNRI-guided care often overlooks the heterogeneity of malnutrition risk among individuals.

This study investigates the clinical utility of GNRI-driven graded nutritional interventions in elderly CRC patients undergoing radical resection at our institution. By conducting the preoperative nutritional risk assessments, we aim to develop and apply the tailored nutritional intervention strategies and evaluate its effects on postoperative recovery, immune restoration, inflammatory modulation, and long-term QoL - addressing a critical gap in personalized perioperative care.

MATERIALS AND METHODS

Patients

This retrospective study included 135 elderly CRC patients subjected to radical resection at our hospital between September 2022 and December 2024. The inclusion criteria were as follows: (1) Aged ≥ 65 years; (2) Confirmed primary CRC diagnosis via clinical and histopathological evaluation; (3) Completion of radical CRC surgery; and (4) Availability of complete clinical and follow-up data. The exclusion criteria were as follows: (1) Patients undergoing preoperative chemotherapy, radiotherapy, or neoadjuvant radiotherapy; (2) Patients with other primary or secondary malignancies; (3) Patients with concomitant hematological diseases, autoimmune diseases, or infectious diseases; (4) Patients who had undergone emergency surgery recently; (5) Patients requiring a second surgery due to local recurrence; (6) Patients with severe underlying diseases or malnutrition; and (7) Patients who had received nutritional preparations prior to admission. This study received ethical approval from the Ethics Committee of our hospital and was conducted in keeping with the ethical guidelines set forth in the Declaration of Helsinki by the World Medical Association.

Baseline data

Baseline characteristics of patients, such as age, sex, tumor location, and clinical staging, were retrospectively collected from the electronic medical record system. Based on the case selection criteria mentioned above, 126 patients were analyzed. Of these, 71 were male and 55 were female, with their ages ranging from 65 years to 89 years and a mean age of (73.48 ± 5.12) years. The patients were allocated into two groups according to the type of nutritional intervention: The research group received GNRI-based graded nutritional intervention (n = 61), and the control group was subjected to conventional nutritional support (n = 65).

Study methods

The control group received conventional nutritional intervention. Nurses provided explanations about the disease and surgery, conducted nutritional screening, and organized meal schedules for the patients. They also informed the patients about potential postoperative complications and advised them to consume high-nutrient and digestible foods. Nutritional education materials, such as pamphlets on dietary and nutrition knowledge, were distributed, and postoperative dietary guidance posters for CRC patients were displayed in the hospital’s bulletin boards.

In the research group, 61 patients received GNRI-based graded nutritional intervention. The specific approach was as follows: (1) Nutritional risk assessment: Nursing staff performed nutritional risk assessments using the GNRI tool, where GNRI was calculated as: GNRI = 1.489 × albumin (g/L) + 41.7 × (actual body weight/ideal body weight). Ideal body weight for males = height (cm) – 100 - [(height - 150)/4]; for females = height (cm) - 100 - [(height - 150)/2.5]. Patients with a GNRI below 82 were assigned to the high-risk group (30 patients), those with a GNRI of 82-91 to the medium-risk group (22 patients), and those with a GNRI between 92 and 98 to the low-risk group (9 patients). Dietary intervention measures were then tailored for each group based on risk levels; (2) Dietary intervention for low nutritional risks: For patients in the low-risk group, data such as age, body weight, daily activity level, and occurrence of complications were collected. Their daily protein and calorie requirements were calculated, along with their water and sodium intake based on dialysis frequency, urine volume, and biochemical markers. Energy supply was provided at 30-35 kcal/kg/day, protein intake was controlled at 0.8-1 g/kg/day, with at least 30% of protein from high-quality sources, and salt intake was limited to 3-4 g/day; (3) Dietary intervention for medium nutritional risks: For patients in the medium-risk group, energy supply was adjusted to 35-40 kcal/kg/day based on physical activity, with protein intake set at 0.9-1.1 g/kg/day and at least 40% of protein from high-quality sources. Salt intake was the same as in the low-risk group. Dietary health education was enhanced in the hospital, using methods such as visual dialogue and scenario simulations to educate patients on the importance of dietary adjustments in managing their primary diseases. Patients were advised to avoid high-sodium foods like pickled vegetables and cured meats, and high-potassium foods such as oranges, apples, and bananas. A telephone follow-up system was also established to provide regular guidance on home dietary practices; and (4) Dietary intervention for high nutritional risks: For patients in the high-risk group, energy supply was set at 40-45 kcal/kg/day based on physical activity, and protein intake was adjusted to 1.0-1.2 g/kg/day, with more than 50% of protein from high-quality sources. Additionally, compound α-Ketoacid (0.08-0.12 g/kg/day) was administered. Dietary health education was reinforced both inside and outside the hospital. Building on the strategies for the medium-risk group, a food diary system was implemented, where patients or their families were asked to record their dietary intake over three days, including fruits, vegetables, staple foods, meats, water, and seasoning usage. A professional nutritionist assessed the dietary structure, made necessary adjustments, and provided remote guidance on dietary changes through nursing staff. Feedback and adjustments were made every three days.

Assessment criteria

Postoperative clinical indicators: Postoperative clinical indicators, including time to passage of gas by anus, number of fever episodes, duration of fever, length of hospital stay, and hospitalization costs, were compared between the two groups.

Nutritional status: Fasting blood samples were drawn from the elbow vein of patients in both groups before intervention (day 1 after surgery) and after intervention (day 1 after intervention completion), respectively. Hemoglobin (Hb), prealbumin (PAB), and transferrin (TRF) levels were measured using a fully automatic biochemical analyzer. Additionally, the nutritional status of both groups was assessed with the use of the Patient-Generated Subjective Global Assessment (PG-SGA). This scale covers functional status, symptoms and signs, dietary conditions, and body weight, with a total score ranging from 0 to 35. A lower score denotes better nutritional status.

QoL: Preceding and following intervention, the Generic QoL Inventory-74[11] was harnessed to evaluate the QoL of patients in both groups. This scale comprises four dimensions: Physical function, social function, material life, and psychological function. Scores for each dimension range from 0 to 100, with higher scores indicating better QoL.

Immune response: Fasting venous blood samples were harvested from both groups preceding and following intervention. After centrifugation, the supernatant was collected and mixed well with antibodies. Subsequent to a water bath for 20 minutes, an immunoturbidimetric assay was performed to determine the levels of immunoglobulin (Ig) G, IgA, and IgM to confirm the immune function of the patients[12].

Inflammatory responses: Prior to and following the intervention, enzyme-linked immunosorbent assay (ELISA)[13] was performed to measure the sera levels of nuclear factor kappa B (NF-κB), interleukin (IL)-1, tumor necrosis factor-α (TNF-α), and IL-8 of both groups.

Postoperative complications: The incidence of complications such as nausea and vomiting, abdominal distension and diarrhea, abnormal blood glucose levels, wound infections, anastomotic fistula, and pulmonary infections were observed and recorded for both groups of patients.

Statistical analysis

All data in this study were analyzed using SPSS22.0 software. Measurement data were represented as mean ± SD, and intergroup comparisons were performed using t-tests. Enumeration data were presented as percentages, with the χ² test applied. A P-value < 0.05 was regarded as statistical significance.

RESULTS

Baseline data

The research group encompassed 61 patients, including 35 males and 26 females, with an average age of 73.66 ± 4.82 years. Among them, 31 had colon cancer and 30 had rectal cancer. Tumor-node-metastasis (TNM) staging was as follows: 26 cases in stage I and 35 cases in stage II. Educational attainment included junior high school or lower (n = 16), senior high school (n = 28), and university-level education (n = 17). In the control group (n = 65, 36 males and 29 females, mean age 73.31 ± 5.76 years) consisted of 39 colon cancer and 26 rectal cancer cases, with TNM staging of 32 stage I and 33 stage II tumors. Educational levels were junior high school or lower (n = 14), senior high school (n = 30), and university or higher education (n = 30). No statistically significant differences were observed between groups in sex, age, tumor type, TNM stage, or educational background (P > 0.05), confirming baseline comparability (Table 1).

Table 1 Comparison of baseline data between the two groups.

Group	n	Sex (cases)		Age (years), mean ± SD	Tumor type (cases)		Clinical staging (cases)		Education level (cases)
		Male	Female		Colon cancer	Rectal cancer	Stage I	Stage II	Junior high school or lower	Senior high school	University or higher
Research group	61	35	26	73.66 ± 4.82	31	30	26	35	16	28	17
Control group	65	36	29	73.31 ± 5.76	39	26	32	33	14	30	21
χ2/t	-	0.051		0.369	1.074		0.553		0.497
P value	-	0.822		0.713	0.300		0.457		0.780

Clinical indicators

The postoperative time to passage of gas by anus, number of fever cases, duration of fever, length of hospital stays, and costs for the research group were 52.63 ± 8.22 hours, 6 cases, 49.68 ± 6.01 days, 6.51 ± 0.73 days, and 42500 ± 6600 RMB, respectively, all of which were significantly lower than those in the control group (P < 0.05). See Table 2.

Table 2 Clinical indicators of the two groups, mean ± SD.

Group	n	Postoperative time to passage of gas by anus (hour)	Fever (cases)	Duration of fever (hour)	Length of hospital stay (day)	Hospitalization costs (ten thousand yuan)
Research group	61	52.63 ± 8.22	6	49.68 ± 6.01	6.51 ± 0.73	4.25 ± 0.66
Control group	65	67.45 ± 7.68	15	64.33 ± 5.37	8.47 ± 0.95	5.33 ± 0.79
χ2/t	-	10.463	3.972	14.447	12.925	6.224
P value	-	< 0.001	0.046	< 0.001	< 0.001	< 0.001

Nutritional status

No significant were observed in baseline nutritional markers, including the levels of Hb, PAB, TRF, and PG-SGA between the two groups pre-intervention (P > 0.05). Following intervention, the research group demonstrated significantly elevated levels of Hb (121.67 ± 13.13 g/L), PAB (245.54 ± 23.01 mg/L), and TRF (2.31 ± 0.20 g/L) compared with the control group (P < 0.05). The PG-SGA score for the research group attained 4.55 ± 0.48, significantly lower than that observed in the control group (P < 0.05). Refer to Table 3. Our findings indicated that GNRI-based graded nutritional intervention significantly enhanced postoperative nutritional status relative to conventional care.

Table 3 Comparison of nutritional status between the two groups, mean ± SD.

Group	n	Hb (g/L)		PAB (mg/L)		TRF (g/L)		PG-SGA (points)
		Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention
Research group	61	102.33 ± 10.52	121.67 ± 13.13	152.32 ± 18.71	245.54 ± 23.01	1.41 ± 0.15	2.31 ± 0.20	10.29 ± 1.33	4.55 ± 0.48
Control group	65	104.28 ± 9.47	113.46 ± 14.85	151.78 ± 16.52	210.37 ± 22.41	1.42 ± 0.13	1.98 ± 0.12	10.31 ± 1.48	5.81 ± 0.56
t	-	1.095	3.279	0.172	8.690	0.401	11.311	0.080	13.519
P value	-	0.276	0.001	0.864	< 0.001	0.689	< 0.001	0.967	< 0.001

Hb: Hemoglobin; PAB: Prealbumin; TRF: Transferrin; PG-SGA: Patient-Generated Subjective Global Assessment.

QoL

Prior to intervention, there were no significant difference between the two groups regarding physical function, social function, material life, and psychological function (P > 0.05). Post-intervention, the research group scored 71.35 ± 6.31 in physical function, 69.71 ± 5.69 in social function, 74.85 ± 6.84 in material life, and 78.45 ± 9.12 in psychological function, all of which were significantly higher than the control group (P < 0.05), as presented in Figure 1, suggesting that GNRI-based graded nutritional intervention improved the postoperative QoL in elderly CRC patients.

Figure 1 Quality of life between the two groups. ^aP < 0.05, compared with the research group following intervention. NS: vs the research group prior to intervention, P > 0.05.

Immune response

Preceding intervention, no significant difference were found between the two groups in terms of IgG, IgA, and IgM levels (P > 0.05). Following intervention, the research group demonstrated IgG levels of 8.40 ± 0.87 g/L, IgA levels of 1.64 ± 0.18 g/L, and IgM levels of 1.51 ± 0.19 g/L, all of which were significantly higher than those observed in the control group (P < 0.05), as exhibited in Table 4, implying that GNRI-based graded nutritional intervention improved the restore of immune function in patients after surgery.

Table 4 Comparison of immune response between the two groups, mean ± SD.

Group	n	IgG (g/L)		IgA (g/L)		IgM (g/L)
		Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention
Research group	61	6.25 ± 0.59	8.40 ± 0.87	1.32 ± 0.15	1.64 ± 0.18	1.23 ± 0.11	1.51 ± 0.19
Control group	65	6.21 ± 0.68	7.31 ± 0.91	1.36 ± 0.13	1.41 ± 0.13	1.20 ± 0.09	1.32 ± 0.15
t	-	0.352	6.864	1.602	8.260	1.680	6.250
P value	-	0.726	< 0.001	0.112	< 0.001	0.096	< 0.001

Ig: Immunoglobulin G.

Inflammatory indicators

Pre-intervention analysis revealed no significant differences in inflammatory markers between groups in terms of NF-κB, IL-1, TNF-α, and IL-8 Levels (P > 0.05). Following intervention, the research group exhibited NF-κB levels of 13.21 ± 1.02 U/L, IL-1 Levels of 32.18 ± 3.88 g/L, TNF-α levels of 22.12 ± 2.08 μg/L, and IL-8 levels of 48.71 ± 6.94 μg/L, all of which were significantly reduced than those within the control group (P < 0.05), as detailed in Table 5. These findings demonstrate that GNRI-stratified nutritional intervention significantly attenuated postoperative inflammatory responses compared to conventional nutritional support, suggesting enhanced recovery potential through modulation of systemic inflammation.

Table 5 Comparison of inflammatory indicators between the two groups, mean ± SD.

Group	n	NF-κB (U/L)		IL-1 (g/L)		IL-8 (μg/L)		TNF-α (μg/L)
		Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention
Research group	61	17.55 ± 1.83	13.21 ± 1.02	50.48 ± 5.92	32.18 ± 3.88	29.28 ± 2.50	22.12 ± 2.08	61.35 ± 6.14	48.71 ± 6.94
Control group	65	17.63 ± 1.25	15.08 ± 1.23	51.12 ± 6.48	40.75 ± 4.11	29.85 ± 2.63	25.81 ± 2.16	60.89 ± 5.87	52.64 ± 7.18
t	-	0.288	9.257	0.578	12.018	1.245	9.756	0.430	3.120
P value	-	0.774	< 0.001	0.565	< 0.001	0.215	< 0.001	0.668	< 0.001

NF-κB: Nuclear factor kappa B; IL: Interleukin; TNF-α: Tumor necrosis factor-α.

Complications

Nausea and vomiting, abdominal distension and diarrhea, abnormal blood glucose levels, incision infections, anastomotic fistulas, and pulmonary infections are the most prevalent postoperative complications in elderly patients with CRC. The overall complication rate in the research group attained 24.59%, significantly lower than the 43.08% observed in the control group (P < 0.05; Figure 2).

Figure 2 Complications in the two groups.

DISCUSSION

Individuals aged ≥ 60 years constitute a high-risk population for CRC due to age-related physiological changes. Progressive declines in intestinal mucosal regenerative capacity, coupled with cumulative DNA damage and impaired repair mechanisms, significantly elevate susceptibility to oncogenic mutations and tumorigenesis[14,15]. Besides, Colon cancer was highly associated with high-fat diets, insufficient fiber intake, and colon polyps while rectal cancer was significantly linked to excessive intake of proteins and animal fats, insufficient fiber consumption, and rectal polyps. For CRC patients, radical resection is considered the gold standard for treatment[16]. With the advancement of minimally invasive techniques, laparoscopic CRC resection has become the predominant treatment method, offering enhanced surgical outcomes and rapid postoperative recovery[17]. Nonetheless, elderly patients often experience a decline in organ and system functions, leading to a delayed rehabilitation compared with middle-aged and young patients. Postoperative nutritional consumption increases, metabolism strengthens, and gastrointestinal surgeries further disrupt the patients' diets. Consequently, many patients undergo a reduction in nutritional levels post-surgery, negatively impacting recovery and prognosis[18,19]. This nutritional-surgical association emphasizes the critical need for targeted perioperative interventions in geriatric oncology care.

To address these clinical challenges, the GNRI has emerged as a valuable assessment tool. Originally developed by American clinicians in 2005, GNRI provides a simple and accurate method for quantifying the nutritional status of elderly patients and predicting morbidity and mortality risks during hospitalization. This index has demonstrated significant prognostic value in various benign and malignant diseases[20-22]. For instance, Xu et al[23] analyzed data from 3239 CRC patients through 8 retrospective studies and found that a low GNRI score could be served as an important predictor for postoperative complications and long-term low survival rates in Asian CRC patients. With GNRI-based graded nutritional intervention for CRC patients, it enables personalized risk-adapted intervention strategies in clinics. This approach addresses a critical gap in geriatric surgical oncology, where standardized nutritional protocols often fail to account for individual risk variability[24,25]. By implementing GNRI-based stratification, we aim to investigate the effects of GNRI-based graded nutritional intervention on the postoperative nutritional status and QoL in elderly CRC individuals.

Our findings demonstrated that GNRI-stratified nutritional intervention yielded superior outcomes compared to conventional care in elderly CRC patients across multiple postoperative parameters. The intervention group showed accelerated surgical recovery (shorter time to first flatus, reduced febrile episodes, and decreased fever duration), significant reductions in hospital stay length and treatment costs, improved nutritional biomarkers (elevated Hb, PAB, and TRF levels with better PG-SGA scores), enhanced QoL across all measured domains (physical, social, material, and psychological functioning), strengthened immune response (increased IgG, IgA, and IgM levels), reduced systemic inflammation (lower NF-κB, IL-1, TNF-α, and IL-8 concentrations), decreased overall complication rates. These findings indicated that GNRI-based graded nutritional intervention effectively improves postoperative recovery while mitigating inflammatory responses and complication risks in elderly CRC patients. Our findings align with previous research by Liao et al[26], which discovered GNRI as an independent predictor of surgical complications and survival outcomes, with lower GNRI scores correlating with lower overall survival and disease-free survival rates. Similarly, Mao et al[27] emphasized the prognostic indicator of GNRI for CRC patients undergoing surgery. Patients with low GNRI scores displayed poor disease-free survival and higher complication rates. Therefore, patients may benefit from the personalized treatment strategies based on GNRI.

The superiority of GNRI-stratified nutritional intervention may be attributed to precision nutritional assessment and risk-adapted interventions. This systematic approach enables clinicians to objectively assess patients’ malnutrition risk levels, implement tiered nutritional support protocols based on individualized risk stratification, adjust nutritional intake appropriately[28]. The intervention's effectiveness is further enhanced through innovative patient engagement strategies, such as scenario simulations and visual dialogues. This comprehensive framework fosters patient empowerment through nutritional literacy, active participation in treatment adherence and sustainable dietary behavior modification. Ultimately, this promotes the establishment of a healthy, effective, and sustainable optimized nutritional diet structure[29], contributing to enhanced nutritional status, strengthened immune function, better recovery capacity, reduced inflammation, improved QoL, and a lower incidence of complications.

This study introduces several important innovations to perioperative nutritional management in elderly CRC patients. For intervention model, we developed and implemented a graded nutritional intervention model based on the GNRI, which demonstrated superior clinical outcomes compared to conventional nutritional support approaches. However, there are several limitations. The retrospective study design may introduce potential selection biases, and our single-center experience with a limited sample size restricts the generalizability of findings. Additionally, due to the sample size limitations, we did not control for or stratify patients by educational level, which could represent an important confounding variable in nutritional intervention studies. Future studies should be conducted with prospective experiments with large sample sizes and multiple centers to validate our findings. Additional studies should also evaluate the cost-effectiveness of this intervention and assess its real-world implementation feasibility across diverse healthcare settings.

CONCLUSION

In summary, GNRI-based graded nutritional intervention can effectively improve clinical indicators, enhance nutritional status and QoL in elderly CRC patients, promote immune function recovery, alleviate inflammation, and reduce the incidence of postoperative complications, highlighting the importance of potential postoperative intervention approach.