Global prevalence and moderating factors of malnutrition in colorectal cancer survivors: A meta-analysis

Hidayat Arifin; Yu-Hao Chu; Ruey Chen; Chiu-Kuei Lee; Doresses Liu; Christina Yeni Kustanti; Tintin Sukartini; Kondwani Joseph Banda; Kuei-Ru Chou

doi:10.1007/s11764-025-01747-y

Global prevalence and moderating factors of malnutrition in colorectal cancer survivors: A meta-analysis

J Cancer Surviv. 2025 Jan 29. doi: 10.1007/s11764-025-01747-y. Online ahead of print.

Authors

Hidayat Arifin^{1

2

3}, Yu-Hao Chu⁴, Ruey Chen^{1

5

6}, Chiu-Kuei Lee^{1

5}, Doresses Liu^{1

7

8}, Christina Yeni Kustanti⁹, Tintin Sukartini^{3

10}, Kondwani Joseph Banda^{1

11}, Kuei-Ru Chou^{12

13

14

15

16}

Affiliations

¹ School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
² Department of Basic Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia.
³ Research Group in Medical-Surgical Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia.
⁴ School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan.
⁵ Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan.
⁶ Post-Baccalaureate Program in Nursing, Taipei Medical University, College of Nursing, Taipei, Taiwan.
⁷ Department of Medical Quality, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
⁸ Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan.
⁹ Study Program of Nursing Science, Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum, Yogyakarta, Indonesia.
¹⁰ Department of Advance Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia.
¹¹ Endoscopy Unit, Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
¹² School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan. kueiru@tmu.edu.tw.
¹³ Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan. kueiru@tmu.edu.tw.
¹⁴ Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan. kueiru@tmu.edu.tw.
¹⁵ Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan. kueiru@tmu.edu.tw.
¹⁶ Research Center for Neuroscience, Taipei Medical University, Taipei, Taiwan. kueiru@tmu.edu.tw.

PMID: 39878855
DOI: 10.1007/s11764-025-01747-y

Abstract

Purpose: This meta-analysis aims to estimate the global prevalence of severe, moderate, overall malnutrition and moderating factors of malnutrition in colorectal cancer (CRC) survivors.

Methods: A comprehensive search was conducted in Embase, CINAHL, Medline-OVID, PubMed, Scopus, and Web of Science from inception to February 8, 2024, without language, region, or publication date restrictions. A generalized linear mixed model and random-effects model were used to examine the pooled prevalence, and moderator analyses were implemented to investigate variations in the pooled prevalence.

Results: In 35 studies involving 9,278 colorectal cancer survivors, the global prevalence was 12.10% for severe malnutrition (95% confidence interval (CI): 7.28-16.92; n = 507), 33.13% for moderate malnutrition (95% CI: 28.93-37.34; n: 2,192), and 47.78% for overall malnutrition (95% CI: 41.60-53.96; n: 3,812). Asia showed higher rates of severe malnutrition 16.67% (95% CI: 4.66-28.68, n: 232) and overall malnutrition 53.17% (95% CI: 39.66-66.69, n: 1,913), whereas low-middle income countries demonstrated higher rates of overall malnutrition 67.46% (95% CI: 30.25-100.00, n: 82). Male sex, colon cancer, advanced stage, metastasis, chemotherapy, surgery, adjuvant treatment, smoking, alcohol consumption, hypertension, and diabetes significantly moderated overall malnutrition prevalence.

Conclusions: This meta-analysis reports detailed data on the global prevalence of CRC survivors experience malnutrition, highlighting that health-care professionals should consider the identified moderating factors.

Implications for cancer survivors: Addressing malnutrition in CRC survivors is critical, as early and proactive nutritional management can enhance recovery, improve quality of life, and potentially reduce cancer-related complications associated with malnutrition.

Keywords: Colon cancer; Colorectal cancer; Malnutrition; Meta-analysis; Rectal cancer.