Postoperative nutritional interventions and recovery: Molecular mechanisms, clinical outcomes, and ERAS-based practice

Nutritional interventions play a key role in enhancing postoperative recovery through anti-inflammatory, immunoregulatory, and metabolic effects. However, evidence across different nutrients and surgical settings remains heterogeneous. This review aimed to summarize both the molecular mechanisms and clinical outcomes of nutritional strategies supporting recovery after surgery. Relevant studies were identified through systematic searches of the PubMed, Web of Science, and Scopus databases from January 2000 to February 2025, including randomized controlled trials (RCTs), systematic reviews, and meta-analyses focusing on enteral nutrition, parenteral nutrition, and immunonutrition. Evidence from more than 50 clinical studies indicates that enteral immunonutrition (EIN) reduces postoperative infectious complications by approx. 30% and shortens hospital stay by 2-3 days. Early enteral feeding within 24-48 h improves gastrointestinal recovery and lowers overall morbidity. Omega-3-enriched nutrition modulates inflammatory and immune responses without increasing the risk of adverse events. Emerging technologies, such as nutrigenomics and digital monitoring, further enable individualized nutritional management. Nutritional interventions represent a promising nonpharmacological approach to optimizing postoperative recovery by integrating molecular insights with clinical practice. Standardization of protocols and long-term evaluation remain priorities for advancing evidence-based, personalized nutrition within Enhanced Recovery After Surgery (ERAS)-aligned surgical care.