Nutritional support for cancer cachexia: A systematic review and meta-analysis of randomized controlled trials

Background & aims Cancer cachexia is a debilitating syndrome associated with poor prognosis. Nutritional support is a cornerstone of management, but its effectiveness remains uncertain due to inconsistent evidence. We synthesized the effects of nutritional support on key outcomes in patients with cancer cachexia. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), following PRISMA guidelines (PROSPERO: CRD42024570706). We searched four electronic databases for RCTs evaluating any nutritional support in adults with cancer cachexia. Outcomes included body weight and body composition, biochemical markers, handgrip strength, quality of life, and appetite. A random-effects model pooled the data, reported as mean differences (MD) or standardized mean differences (SMD). Results 32 RCTs were included. Nutritional support was associated with modest increases in body weight (MD: 1.43 kg; 95% CI: 0.55–2.31 kg), fat-free mass (MD: 1.11 kg; 95% CI: 0.16–2.05 kg), fat mass (MD: 1.00 kg; 95% CI: 0.41–1.59 kg) and C-reactive protein (MD: −1.47 mg/L; 95% CI −2.55 to −0.39). However, CRP results were not robust in sensitivity analysis. No effects were observed handgrip strength, albumin, transferrin, quality of life, or appetite. The evidence base was limited by a predominant high risk of bias across the included studies. Conclusions Nutritional support in patients with cancer cachexia provides small body composition improvements. However, most body composition measures were performed through bioimpedance assessments, which limits their robustness. Additionally, this approach seem insufficient to reverse metabolic alterations or improve function alone. The certainty of this evidence highlights the need for higher quality, rigorously conducted trials. © 2026 The Author(s).