Abstract / Summary
Abstract Background Malnutrition and weight loss are prevalent in patients with gastric cancer throughout the treatment trajectory, impairing prognosis. Although individualized nutritional counseling is recommended, the comparative efficacy of emerging digital health (mHealth) versus conventional face-to-face delivery modes remains to be synthesized. Methods We searched PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov up to December 31, 2025 for randomized controlled trials (RCTs) comparing individualized nutritional counseling with usual care. Primary outcomes were nutritional status (PG-SGA score) and body weight. Secondary outcomes included quality of life (QoL) and biochemical markers. Data were pooled using random-effects models. Results Nine RCTs ( n = 963) were included. Counseling significantly improved PG-SGA scores overall (WMD = -1.16 [-1.50, -0.83], P < 0.001), with efficacy observed in both subgroups. While overall weight change was insignificant ( P = 0.129), subgroup analysis revealed a distinct divergence: face-to-face counseling significantly preserved body weight (WMD = 2.65 kg [1.62, 3.68], P < 0.001), whereas mHealth did not ( P = 0.661). Conversely, regarding QoL (Overall SMD = 0.84, P < 0.001), the mHealth subgroup demonstrated significant improvement (SMD = 0.30 [0.07, 0.53], P = 0.011), while the face-to-face subgroup did not reach statistical significance ( P = 0.055). No significant differences were observed in albumin or hemoglobin levels. Conclusion Individualized nutritional counseling improves subjective nutritional status and QoL compared to usual care. Subgroup results suggest that interventions delivered face-to-face, which often involved higher clinical intensity, were associated with better weight preservation, whereas structured mHealth interventions consistently enhanced quality of life. A stratified care model utilizing face-to-face sessions for weight maintenance and mHealth for long-term symptom management is recommended. PROSPERO registration number: CRD420261290589