Editorial: The role of nutrition in enhancing surgical recovery and outcomes

2 Dang et al. conducted a prospective observational study including three widely used nutritional indices -the Mini Nutritional Assessment (MNA), the Prognostic Nutritional Index (PNI), and the Geriatric Nutritional Risk Index (GNRI) -for predicting postoperative delirium (POD) in 303 elderly patients undergoing non-cardiac surgery. MNA emerged as the superior predictor (AUC = 0.741), outperforming both PNI and GNRI. A combined model incorporating age, C-reactive protein (CRP), and MNA achieved an AUC of 0.810, providing a clinically actionable tool for preoperative risk stratification of POD.Li et al. investigated the GNRI as a predictor of perioperative cardiovascular events (PCEs) in a multicenter retrospective analysis including 7,272 older patients with coronary artery disease undergoing non-cardiac surgery. GNRI demonstrated an independent and inverse linear association with PCEs, with at-risk patients (GNRI < 98) facing a significantly higher rate of PCEs.A combined scoring model integrating GNRI with the Revised Cardiac Risk Index (RCRI) significantly outperformed either index alone (AUC 0.768 vs. 0.694 for RCRI alone), suggesting that nutritional status adds prognostic information beyond traditional cardiac risk factors. These findings advocate for the routine incorporation of GNRI into preoperative cardiovascular assessment protocols, particularly for older surgical patients.Tingxuan Wang et al. demonstrated that a low Prognostic Nutritional Index (PNI) was an independent predictor of postoperative pneumonia following hematoma evacuation for intracerebral hemorrhage, with a combined predictive model incorporating low PNI, low admission score of Glasgow Coma Scale, obstructive lung disease, hypoproteinemia, and tracheotomy achieving an AUC of 0.87. In a markedly different population, Gu et al. evaluated PNI in 3,082 neonates and infants undergoing cardiac surgery, establishing it as an independent predictor of in-hospital mortality (AUC = 0.745).Beyond nutritional indices, body composition parameters derived from routine computed tomography imaging, as well as laboratory-based markers, have emerged as powerful, objective At the level of specific nutritional components, Tang et al. reported that the combined postoperative administration of vitamin B1 and B12, but not either vitamin alone, significantly reduced time to first flatus after rectal cancer surgery in multivariate analysis, suggesting a synergistic effect that may operate through modulation of gut microbiota and autonomic nervous system function. 6 their association with postoperative complications in a systematic review and meta-analysis of 39 studies. Immunonutrition was associated with a reduction in infectious complications (OR = 0.36) and showed a probable reduction in SSIs (OR = 0.35). The authors advocate for prioritization of immunonutrition in high-risk surgical settings based on current RCT evidence, while calling for standardization of outcome definitions and formulation protocols to facilitate future research.Yue Xu et al. demonstrated that structured quantitative dietary guidance following transjugular intrahepatic portosystemic shunt (TIPS) placement in cirrhotic patients significantly reduced overall mortality (5.6% vs. 21.1%), liver-related mortality (1.9% vs. 15.8%) and hepatic encephalopathy occurrence (13.0% vs. 36.8%).Finally, Shan et al. presented a case report illustrating the exceptional complexity of nutritional management in a patient with 96% total body surface area burns and acute kidney injury requiring 95 consecutive days of continuous renal replacement therapy, in whom a dynamically individualized nutritional strategy guided by indirect calorimetry and multidisciplinary collaboration was instrumental in achieving survival to discharge.The studies included in this Research Topic reinforce the concept that perioperative nutrition is not an adjunctive intervention, but a fundamental determinant of surgical outcomes. Across diverse surgical populations and clinical settings, nutritional status consistently emerged as a predictor of postoperative complications, functional recovery, treatment tolerance, and survival. Importantly, the evidence presented extends beyond traditional malnutrition screening, highlighting the growing relevance of objective body composition analysis, dynamic metabolic monitoring, and integrated nutritional risk assessment tools. The contributions further demonstrate that nutritional interventions are most effective when embedded within multimodal perioperative care pathways. A recurring theme throughout this collection is the need to move from static and isolated nutritional assessments toward continuous, personalized, and multidisciplinary nutritional care integrated across the entire surgical trajectory. Several studies emphasized the importance of tailoring nutritional therapy to specific patient populations, including older adults, oncology patients, critically ill individuals, and patients with chronic liver disease or severe burns.