Nutritional status and adjuvant chemotherapy in gastric cancer: An underestimated determinant of treatment success

Table 1 Nutritional risk factors, clinical impact, and implications for adjuvant chemotherapy in gastric cancer

Nutritional domain	Clinical indicators	Biological/functional impact	Consequences on chemotherapy	Clinical implications
Weight loss	> 10% body weight loss	Energy depletion, catabolism	Increased toxicity	Consider treatment delay and nutritional support
Sarcopenia	Reduced skeletal muscle mass (CT-based)	Impaired drug metabolism, frailty	Dose-limiting toxicity	Adjust dosing strategy, monitor closely
Reduced oral intake	Caloric/protein deficit	Negative energy balance	Poor tolerance to therapy	Early nutritional supplementation
Systemic inflammation	Elevated CRP, hypoalbuminemia	Catabolic state, immune dysfunction	Increased complications	Anti-inflammatory and nutritional strategies
Hypoalbuminemia	Albumin < 3.5 g/dL	Reduced physiological reserve	Treatment interruption	Risk stratification before therapy
Global malnutrition (GLIM criteria)	Combined phenotypic + etiologic criteria	Multisystem impairment	Reduced RDI	Multidisciplinary management

GLIM: Global Leadership Initiative on Malnutrition; CT: Computed tomography; CRP: C-reactive protein; RDI: Relative dose intensity.