{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:18:41Z","timestamp":1788153521985,"version":"build-2803163510"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To explore the relationship between early postoperative nutritional status and time-to-chemotherapy (TTC) in gastrointestinal cancer patients and provide a reference for nutritional intervention and reasonable chemotherapy arrangements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study enrolled consecutive patients who underwent radical gastrointestinal cancer surgery with planned adjuvant chemotherapy at a tertiary hospital in Dalian, China (June 2023\u2013June 2025). Nutritional indicators included BMI, NRS-2002 score, and serum albumin concentration and their associations with TTC were analyzed using restricted cubic splines (RCS) and multivariable regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      RCS analysis revealed an approximately linear dose\u2013response relationship between the NRS-2002 score and TTC. Based on multivariate regression, each 1-point increase prolonged TTC by 2.36\u202fdays and conferred a 57% higher risk of chemotherapy delay. Conversely, BMI and serum ALB levels exhibited nonlinear associations with TTC (U-shaped and inverted L-shaped, respectively). Exploratory inflection points derived from RCS were BMI\u202f\u2265\u202f23.82\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      and serum albumin \u226538.37\u202fg\/L. Multivariable-adjusted associations suggested that patients above these inflection points tended to have a 4-day shorter TTC, with a 42% reduction in chemotherapy-delay risk (BMI only).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Postoperative nutritional indicators are closely related to TTC. The inflection point values of BMI and serum albumin derived from this study are hypothesis-generating findings and should not be regarded as validated clinical targets for routine clinical application. Targeted nutritional management may help optimize chemotherapy timing and guide clinical nursing work.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1896619","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T04:28:59Z","timestamp":1788150539000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between postoperative nutritional status and time to initiation of adjuvant chemotherapy in gastrointestinal cancers: a restricted cubic spline analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Na","family":"Liu","sequence":"first","affiliation":[{"name":"School of Nursing, Dalian Medical University","place":["Dalian, Liaoning, China"]},{"name":"The Second Affiliated Hospital of Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng","family":"Sun","sequence":"additional","affiliation":[{"name":"School of Nursing, Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Guan","sequence":"additional","affiliation":[{"name":"School of Nursing, Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Xu","sequence":"additional","affiliation":[{"name":"School of Nursing, Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Nursing, Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"XiaoXiang","family":"Liu","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bolun","family":"Zhao","sequence":"additional","affiliation":[{"name":"School of Nursing, Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J 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