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This narrative review summarizes nutritional deficiencies linked to pancreatic, biliary, and hepatic cancers and the barriers created by organ malfunction or surgical anatomical 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\nNazanin Khajoueinejad 1, Christina Santiago 2, Kea Turner 3,4 and Jose M. Pimiento 1, *  \nAcademic Editor: Young-Eun Cho  \nReceived: 2 November 2025  \nRevised: 20 November 2025  \nAccepted: 9 December 2025  \nPublished: 14 December 2025  \nCitation: Khajoueinejad, N.;  \nSantiago, C.; Turner, K.; Pimiento, J.M. Nutritional Support for Gastrointestinal Cancer Patients: New (and Old) Frontiersin Management, a Narrative Review. Nutrients 2025, 17, 3917. [https://doi.org/10.3390/](https://doi.org/10.3390/)[ ](https://doi.org/10.3390/)nu17243917  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://creativecommons.org/](https://creativecommons.org/)[ ](https://creativecommons.org/)[licenses/by/4.0/](licenses/by/4.0/)) .  \n1 Department of Gastrointestinal Surgery, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA  \n2 Department of Nutrition Therapy, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA  \n3 Division of Health Systems, Policy, and Innovation, The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC 27599, USA; [kea.turner@unc.edu](kea.turner@unc.edu)  \n4 Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA  \n* [Correspondence: jose.pimiento@moffitt.org](Correspondence: jose.pimiento@moffitt.org)  \nAbstract  \nMalnutrition in patients with gastrointestinal (GI) cancers can be the result of functional and/or anatomical changes in the alimentary tract, secondary to malignancy or oncologic therapies. Understanding the underlying mechanisms of malnutrition in these patients is imperative in providing appropriate interventions that can not only improve quality of life for these individuals, but also improve their tolerance of oncologic treatment and progression towards remission or cure. In this narrative review, we address common nutritional deficiencies associated with GI malignancies, including pancreatic, biliary, and hepatic cancers. Furthermore, we address common issues related to these deficiencies and causes of nutrition barriers as they relate to organ malfunction or surgical alterations of anatomy. Recommendations for counseling, dietary modifications, nutritional supplements, and pharmacologic interventions are provided based on individual barriers and the vital role of multidisciplinary care is highlighted. Additionally, we highlight novel techniques, such as the role of psychosocial care, prehabilitation, digital health, and machine learning, which can improve nutritional outcomes, provide patient-directed care, and improve risk stratification for this complex and multifaceted issue that faces patients diagnosed with GI cancers.  \nKeywords: malnutrition; gastrointestinal cancer; dietary modifications; nutritional counseling; tumor cachexia; nutritional rehabilitation  \n1. Introduction  \nGastrointestinal (GI) cancers, taken as a whole, correspond to the second cause of cancer death in the United States [1,2] . These malignancies include esophagus, gastric, liver, bile duct, small bowel, pancreas, colon, rectal, and anal cancer [1] . The incidence and prevalence of malnutrition depend on the site of cancer and the anatomic and metabolic alterations that result from it (Table 1) .  \nTable 1. Reported incidence of malnutrition per cancer type.  \n\n| Cancer Location | Incidence of Malnutrition | References |\n| --- | --- | --- |\n| Esophageal | 22–73% | [3–5] |\n| Gastric | 10–50% | [6] |\n| Pancreatic | 9–52% | [5,6] |\n| Liver | 7–20% | [5] |\n| Colorectal | 23% | [7] |\n\nAs has been extensively described, GI malignancies can affect the usual alimentary processes [8,9], alterations of the usual central regulation systems of sat","cbCaircxieVRI5AG","https://ap.wps.com/l/cbCaircxieVRI5AG","pdf",348953,"English","# Abstract\n# Introduction\n# Methods\n# Nutritional Challenges Based on Cancer Site and Cancer Treatment","[{\"question\":\"What factors contribute to malnutrition in gastrointestinal cancer patients?\",\"answer\":\"Malnutrition can result from functional and/or anatomical alterations in the alimentary tract caused by malignancy or by oncologic therapies, along with downstream impacts on nutrition processing.\"},{\"question\":\"How does the review structure nutritional issues in GI cancers?\",\"answer\":\"It addresses common nutritional deficiencies associated with GI malignancies, including pancreatic, biliary, and hepatic cancers, and links nutrition barriers to organ malfunction or surgical changes.\"},{\"question\":\"Which interventions are discussed to improve nutritional outcomes?\",\"answer\":\"The review covers counseling, dietary modifications, nutritional supplements, pharmacologic interventions, and highlights novel approaches such as psychosocial care, prehabilitation, digital health, and machine learning.\"}]","Nutritional Support for Gastrointestinal Cancer Patients: New (and Old) Frontiers in Management - A Narrative Review | PDF",1790195492]