Nutritional and inflammatory factors in colorectal cancer: Considerations for practice

Abstract

We respond to the article by Andreescu et al. While affirming the value of markers such as serum albumin, C-reactive protein, and neutrophil-to-lymphocyte ratio in predicting clinical outcomes, we underscore key limitations in the original study, including its retrospective design and absence of standardized malnutrition criteria or nutritional intervention data. Drawing on current literature and findings from our institutional analysis of 70 colorectal cancer-related nutrition websites, we emphasize the persistent gap between clinical research and patient education. Our analysis revealed that patient-facing materials are of borderline fair quality and often exceed recommended readability levels. We advocate for prospective studies, interventional trials, and multidisciplinary collaboration to improve the integration of nutritional care in colorectal cancer management and to enhance the accessibility and quality of patient education.

Key Words: Colorectal cancer; Nutritional markers; Inflammatory markers; Prognosis; Patient education; Malnutrition; Biomarkers; Clinical outcomes

Core Tip: This letter underscores the prognostic relevance of nutritional and inflammatory markers in colorectal cancer, while highlighting the gap between clinical evidence and patient education. Bridging this gap requires robust and prospective research along with the development of accessible, evidence-based resources for patients. Translating these insights into practical guidance is of utmost importance to improve outcomes and support informed patient care.

TO THE EDITOR

We read with great interest the article by Andreescu et al[1], which provides valuable evidence linking malnutrition and systemic inflammation to poorer clinical outcomes in colorectal cancer (CRC). The authors effectively highlight the clinical utility of nutritional and inflammatory markers, such as serum albumin, C-reactive protein, and the neutrophil-to-lymphocyte ratio in stratifying patient risk and guiding therapeutic decisions.

We are in agreement with the authors that the study offers important insights into the prognostic value of nutritional and inflammatory markers in CRC and that there may be some inherent limitations of the study design which could influence the interpretation of the findings. In addition to the retrospective and registry-based approach, factors such as dietary intake, socioeconomic background, or functional status, could also affect nutritional markers and outcomes. The absence of standardized criteria for malnutrition and limited information on nutritional interventions make it challenging to explore potential causal relationships. We support the authors’ call for prospective studies that incorporate direct assessments of nutritional status and interventional trials that evaluate the efficacy of targeted nutritional strategies.

This emphasis on nutritional and inflammatory markers aligns with an expanding literature base that recognizes their prognostic and therapeutic potential in CRC. For instance, Song et al[2] emphasized the preventive role of dietary factors in CRC development, particularly through their influence on systemic inflammation and tumor progression. Tez[3] more recently provided a comprehensive overview of inflammatory and nutritional markers as both prognostic tools and potential guides for personalized therapy. Additionally, Cai et al[4] demonstrated the prognostic value of composite indices, such as the prognostic nutritional index, in CRC subgroups, including patients with obstructive tumors and peritoneal metastasis.

Despite this growing body of clinical evidence, there remains a notable gap in patient education and resource accessibility. To explore this, we conducted an institutional analysis evaluating the quality and readability of online patient-facing content related to CRC and nutrition[5]. We analyzed 70 publicly accessible websites using the DISCERN instrument. A validated tool for assessing the quality of consumer health information. The average DISCERN score was 37.4, indicating borderline “fair” quality on a 15-75 scale, with only 15.4% of patient-targeted websites citing scientific sources, compared to 94% of provider-facing resources (P < 0.00001). To provide further clarity, a DISCERN score below 39 typically falls into the “poor” or “fair” range. Furthermore, the average reading level was grade 9.8, significantly higher than the American Medical Association and National Institutes of Health recommendations for health materials (grade 6-8). Our sample included websites identified through top search engine results for terms like “CRC nutrition” and “diet after CRC diagnosis”, and assessments were conducted independently by two trained reviewers.

This disconnect between the clinical importance of nutritional and inflammatory markers, as emphasized by Andreescu et al[1], and the inadequate quality and accessibility of patient education materials presents a broader public health challenge. Translating prognostic insights into actionable improvements in patient outcomes will require not only robust prospective research but also coordinated efforts in public health communication. Developing evidence-based, accessible, and engaging nutritional guidance for CRC patients is a necessary step in aligning patient understanding with clinical practice.

We commend the authors for drawing attention to this crucial aspect of CRC care and encourage the need for further research that integrates nutritional assessment and intervention into oncology workflows. Future studies should prioritize multidisciplinary collaboration, engaging oncologists, dietitians, patient educators, and health communication experts, and include randomized controlled trials that evaluate the impact of nutritional interventions on clinical outcomes.

Nutritional and inflammatory markers provide valuable prognostic information in CRC[5]; however, current research and clinical practices must address methodological limitations and improve patient education. Bridging the gap between scientific findings and patient comprehension through prospective studies, multidisciplinary collaboration involving oncologists, dietitians, patient educators, and communication experts, as well as randomized controlled trials of nutritional interventions, will support better integration of nutritional care into oncology. These efforts are essential to ultimately improve outcomes for patients with CRC.

ACKNOWLEDGEMENTS

We thank our colleagues and research staff at the George Washington University for their contributions to the evaluation of online CRC nutrition resources.