Effect of Post-Discharge Oral Nutritional Supplements on Nutritional Status in Patients after Gastrectomy: A Systematic Review and Meta-Analysis

Summary

This study evaluates post-discharge oral nutritional supplementation for patients with gastric cancer following gastrectomy. The evidence suggests that supplementation may mitigate postoperative weight loss during early-to-intermediate recovery, particularly after total gastrectomy, without an apparent increase in adverse events; however, effects on body composition, handgrip strength, laboratory markers, and durable long-term outcomes remain uncertain.

Abstract

Nutritional intervention after gastrectomy is central to postoperative recovery, but the optimal outpatient supplementation strategy remains uncertain. This systematic review assessed the efficacy and safety of oral nutritional supplementation (ONS) after hospital discharge in patients undergoing gastrectomy for gastric cancer. Eligible randomized controlled trials (RCTs) were identified from five databases through September 2025. Extracted outcomes included adverse events, laboratory indices, body composition, handgrip strength, and body-weight change. Seven RCTs involving 1,736 participants met the review criteria, although the number of trials contributing to each pooled outcome varied. ONS significantly attenuated absolute body-weight loss (WMD: 0.75 kg; 95% CI: 0.11 to 1.40) and percentage body-weight loss (WMD: 1.42; 95% CI: 0.78 to 2.07) compared with control care. Risk-of-bias assessment identified generally adequate randomization and allocation reporting in most trials, but certainty remains limited by the small number of trials, substantial heterogeneity in the primary weight outcome, and the absence of a formal GRADE assessment. No significant inter-group differences were found for body composition, handgrip strength, or laboratory markers. Adverse-event incidence was not significantly different between groups when analyzed with the fixed-effect model selected for minimal heterogeneity (RR: 1.17; 95% CI: 0.92 to 1.49). These findings suggest that post-discharge ONS may help reduce early to intermediate postoperative weight loss after gastrectomy without a clear safety penalty. Because most endpoints were assessed between 8 weeks and 3 months, the durability of benefit beyond this period remains unclear.

Introduction

Gastric cancer remains a substantial global health burden and an important cause of cancer-related mortality. According to GLOBOCAN 2022 estimates, gastric cancer continues to rank among the leading causes of cancer incidence and death worldwide¹. Although chemotherapy, targeted therapy, and immunotherapy have improved, gastrectomy remains a main curative option for locally advanced proximal tumors, diffuse-type disease, and selected other gastric cancers. It is also used prophylactically to reduce cancer risk in individuals carrying CDH1 mutations². However, removal of all or part of the stomach changes gastrointestinal....

Protocol

This systematic review and meta-analysis used only previously published aggregate data and did not involve direct contact with human participants or access to identifiable patient-level information. Institutional review board approval and informed consent were therefore not required. The software and databases used are listed in the Table of Materials.

Registration and search strategy
The review followed the PRISMA 2020 reporting framework during the planning, conduct, and reporting stages, and the preregistered PROSPERO protocol (CRD420251245644) was used to guide the eligibility criteria, outcomes, ....

Results

Search results and patient characteristics
Figure 1 presents the PRISMA 2020 screening workflow. Database searches identified 214 records (PubMed, n = 53; Web of Science, n = 64; Embase, n = 47; Cochrane Library, n = 27; China National Knowledge Infrastructure, n = 23). No register or other-source records were identified. After 65 duplicate records were removed, 149 records were screened. Seventy-nine records were excluded during title and abstract screening, leaving 70 .......

Discussion

Gastrectomy remains a major curative treatment for localized gastric cancer and has important implications for postoperative recovery and prognosis²⁹. Reduced gastric capacity, altered gastrointestinal motility, impaired nutrient absorption, and surgical stress can lead to inadequate energy intake, weight loss, and deterioration in nutritional status^30,31. These changes may affect postoperative complications, chemotherapy tolerance, treatm.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
China National Knowledge Infrastructure (CNKI)	CNKI	https://www.cnki.net/	Chinese-language literature database searched for eligible records
Cochrane Library	Cochrane / Wiley	https://www.cochranelibrary.com/	Systematic review and clinical trial database searched for eligible records
Cochrane Risk of Bias framework	Cochrane Methods	https://methods.cochrane.org/bias/	Domain-level risk-of-bias assessment for randomized controlled trials
Embase	Elsevier	https://www.embase.com/	Biomedical and pharmacological literature database searched for eligible records
EndNote	Clarivate	Version 21; https://endnote.com/	Reference management and citation formatting
GRADE approach	GRADE Working Group	https://www.gradeworkinggroup.org/	Certainty-of-evidence framework discussed in the limitations
PRISMA 2020 reporting guideline	PRISMA Statement	https://www.prisma-statement.org/	Reporting framework for the systematic review and PRISMA flow diagram
PROSPERO registry	Centre for Reviews and Dissemination, University of York	CRD420251245644; https://www.crd.york.ac.uk/prospero/	Prospective registration record for the systematic review protocol
PubMed	National Library of Medicine / NCBI	https://pubmed.ncbi.nlm.nih.gov/	Biomedical literature database searched for eligible trials
R package: meta	CRAN / R package authors	https://cran.r-project.org/package=meta	Meta-analysis functions for pooled effect estimates and forest plots
R package: metafor	CRAN / Wolfgang Viechtbauer	https://cran.r-project.org/package=metafor	Supplementary meta-analysis calculations and heterogeneity checks
R software	R Foundation for Statistical Computing	Version 4.5.1; https://www.r-project.org/	Statistical environment for meta-analysis and sensitivity checks
Web of Science	Clarivate	https://www.webofscience.com/	Citation and multidisciplinary literature database searched for eligible records