Precision nutrition in gastric cancer: current advances and future directions

Patients with gastric cancer frequently experience malnutrition, weight loss, and sarcopenia from diagnosis through treatment and follow-up. These conditions are not solely attributable to inadequate intake but are closely related to systemic inflammation, metabolic reprogramming, treatment-related toxicities, and altered digestion and absorption after gastrectomy. This review summarizes the theoretical basis, assessment approaches, stage-specific intervention strategies, and current evidence limitations of precision nutrition in gastric cancer. It focuses on nutritional risk screening, diagnosis of malnutrition based on the Global Leadership Initiative on Malnutrition (GLIM) criteria, computed tomography (CT)-based body composition analysis, energy and protein provision, support pathways including oral nutritional supplements, enteral nutrition, and parenteral nutrition, as well as emerging areas such as immunonutrition, microbiota-targeted interventions, AI-assisted body composition analysis, and multi-omics integration. Current evidence suggests that precision nutrition in gastric cancer should remain grounded in standardized nutritional assessment and guideline-recommended supportive strategies. Prospective, multicenter studies are needed to clarify the benefits and scope of nutritional interventions across different nutritional phenotypes.