Effects of Dietary Interventions on Nutritional Status in Patients with Gastrointestinal Cancers: A Systematic Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

1. The literature search strategy is detailed, but the rationality of the search strategy can be supplemented, such as why these databases and search terms were selected, and how to ensure the comprehensiveness of the search. In addition, a detailed description of the screening process for search results can be considered, including how to exclude literature that does not meet the inclusion criteria. At the same time, it is recommended to clarify how to handle literature that does not meet the inclusion criteria but is relevant to the study, such as whether additional searches were conducted or authors were contacted for more information.
2. The section on data extraction and analysis methods is relatively brief. It is recommended to supplement specific data extraction tables or templates, as well as the specific steps and statistical methods of data analysis. In addition, consider incorporating assessment methods for bias risk, such as using the Cochrane bias risk assessment tool.
3. The Results section provides a detailed list of the results of multiple studies, but some of the results are described in a lengthy manner. It is recommended to streamline and integrate them appropriately. Meanwhile, consider using charts (such as forest plots, tables, etc.) to present research results more intuitively, making it easier for readers to understand and compare.
4. When interpreting the results, it is recommended to objectively analyze the similarities and differences of the results, and explore possible reasons and influencing factors. In addition, consider including discussions on the clinical significance and practical application value of the research results, as well as suggestions for future research directions.
5. The discussion section should highlight the highlights and contributions of this research, such as supplementing or challenging existing knowledge. Meanwhile, consider incorporating comparisons with similar studies to highlight the uniqueness and innovation of this research. The future research direction can be more specific and feasible, such as proposing specific research designs or collaborative plans.

Author Response

Esteemed Reviewer,

Thank you very much for your detailed and thoughtful feedback. The authors sincerely appreciate the time, effort and consideration dedicated to evaluating our manuscript.

Laura Vicaș et al.

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

Major Comments

1. Methodological Rigor and Transparency

Although the authors state that the review follows PRISMA guidelines and provide a PROSPERO registration number, several key methodological elements remain insufficiently described or problematic.

• Data extraction was performed by a single researcher, which introduces a substantial risk of selection and extraction bias. Best practice for systematic reviews requires at least two independent reviewers with a consensus process.

• There is no formal risk of bias or quality assessment of included studies (e.g., Newcastle–Ottawa Scale, ROBINS-I, or Cochrane RoB tools). Without this, it is difficult to judge the strength of the evidence or weigh conflicting findings.

• The rationale for including cross-sectional studies alongside RCTs and meta-analyses is not sufficiently justified, especially since causal inference is repeatedly discussed in the Results and Conclusions.

Clarifying these issues would substantially strengthen the credibility of the review.

2. Scope and Focus of the Review

The stated objective is to evaluate the impact of dietary interventions on nutritional status in patients with digestive cancers. However, the manuscript often extends beyond this scope, discussing:

• Cancer prevention and population-level dietary patterns,

• Lifestyle factors and physical activity,

• Microbiota, metabolic syndrome, and prediabetes,

• General cancer survivorship outcomes.

While these topics are relevant, their inclusion dilutes the central message. The review would benefit from a clearer conceptual framework, explicitly separating:

• Nutritional interventions during active cancer treatment,

• Postoperative and post-treatment nutritional support,

• Prevention and survivorship-related dietary patterns.

A sharper focus would improve coherence and reader engagement.

3. Overlapping Results and Discussion

The section titled “Results and discussions” repeatedly blends data presentation, interpretation, and background explanation, making it difficult to distinguish evidence from interpretation.

• Many paragraphs restate well-known mechanisms (e.g., inflammation, cytokines, muscle loss) without clearly linking them to specific findings from included studies.

• Tables are comprehensive but often summarize heterogeneous studies without synthesis, leading to descriptive rather than analytical conclusions.

• Contradictory findings are reported but not sufficiently explored or explained.

Separating Results (what the studies show) from Discussion (what it means, why results differ, and clinical implications) would significantly improve readability and scientific depth.

4. Lack of Quantitative Synthesis and Evidence Hierarchy

While the authors correctly note that heterogeneity precluded meta-analysis, the manuscript still lacks a clear hierarchy of evidence.

• Randomized controlled trials and high-quality meta-analyses are often discussed alongside small observational studies without differentiation.

• Effect sizes, confidence intervals, or magnitude of benefit are rarely emphasized, even when available in cited studies.

• Statements such as “nutritional interventions improve outcomes” are sometimes too generalized, given that mortality benefits are inconsistent across studies.

A structured summary highlighting what is strongly supported, what is promising, and what remains uncertain would enhance clinical relevance.

Minor Comments

• There are numerous typographical and formatting issues, including inconsistent hyphenation, spelling errors (“Methodes”), and irregular table formatting.

• Some figures (e.g., mechanistic diagrams) are conceptually helpful but scientifically generic, and their novelty is limited.

• The reference list is extensive but occasionally repetitive, and some references are cited multiple times for similar claims.

• The Author Contributions section is detailed but contains minor grammatical inconsistencies.

Careful language editing and formatting revision are strongly recommended.

Author Response

Esteemed Reviewer,

Thank you very much for your detailed and thoughtful feedback. The authors sincerely appreciate the time, effort and consideration dedicated to evaluating our manuscript.

Laura Vicaș et al. 

Author Response File: Author Response.docx

Reviewer 3 Report

Comments and Suggestions for Authors

Manuscript biomedicines-4072088

„The impact of dietary interventions on nutritional status in patients with gastrointestinal cancers: a review” for Biomedicines

 

Comments:

1. Major comment: The description is general, without clear nutritional recommendations.

Please analyze the text in the context of the sometimes repeated information. Furthermore, it would be advisable to organize the text into subsections.

2. I also ask the authors to address the following minor points in the text:

Does the stage of the disease have a significant relationship with patients' malnutrition, and what possible nutritional remedies could be used?

Are there reports linking cancer metastasis with dietary modifications? Should these modifications be the same as for patients without metastasis?

Is patient age a significant parameter in modifying nutritional recommendations?

Is the method of nutrient administration (oral, intravenous, etc.) important?

Is there a connection between surgical intervention methods and the need to modify the nutritional regimens of cancer patients?

Are there specific analyses of selected parameters that could help in providing nutritional recommendations for specific patients, e.g., muscle mass loss, adipocyte level changes, etc.

Please also mention pre- and postoperative nutrition as this impacts patient outcome.

Author Response

Esteemed Reviewer,

Thank you very much for your detailed and thoughtful feedback. The authors sincerely appreciate the time, effort and consideration dedicated to evaluating our manuscript.

Laura Vicaș et al.

Author Response File: Author Response.docx

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

I would like to thank the authors for making corrections as suggested.