{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T17:33:33Z","timestamp":1790876013227,"version":"4.1.0"},"reference-count":188,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,26]],"date-time":"2025-07-26T00:00:00Z","timestamp":1753488000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Polish Ministry of Science and Higher Education","award":["0018\/DIA\/2019\/48"],"award-info":[{"award-number":["0018\/DIA\/2019\/48"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Colorectal cancer (CRC) remains a leading cause of cancer morbidity and mortality worldwide, especially in older adults where frailty complicates treatment outcomes. Multimodal prehabilitation\u2014comprising nutritional support, physical exercise, and psychological interventions\u2014has emerged as a promising strategy to enhance patients\u2019 resilience before CRC surgery. Clinical studies demonstrate that prehabilitation significantly reduces postoperative complications, shortens hospital stays, and improves functional recovery. Nutritional interventions focus on counteracting malnutrition and sarcopenia through tailored dietary counseling, protein supplementation, and immunonutrients like arginine and glutamine. Physical exercise enhances cardiorespiratory fitness and muscle strength while modulating immune and metabolic pathways critical for surgical recovery. Psychological support reduces anxiety and depression, promoting mental resilience that correlates with better postoperative outcomes. Despite clear clinical benefits, the molecular mechanisms underlying prehabilitation\u2019s effects\u2014such as inflammation modulation, immune activation, and metabolic rewiring\u2014remain poorly understood. This review addresses this knowledge gap by exploring potential biological pathways influenced by prehabilitation, aiming to guide more targeted, personalized approaches in CRC patient management. Advancing molecular insights may optimize prehabilitation protocols and improve survival and quality of life for CRC patients undergoing surgery.<\/jats:p>","DOI":"10.3390\/ijms26157242","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T10:51:14Z","timestamp":1753699874000},"page":"7242","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Molecular Mechanisms and Clinical Implications of Complex Prehabilitation in Colorectal Cancer Surgery: A Comprehensive Review"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2010-5136","authenticated-orcid":false,"given":"Jakub","family":"W\u0142odarczyk","sequence":"first","affiliation":[{"name":"Department of General and Oncological Surgery, Faculty of Medicine, Medical University of \u0141\u00f3d\u017a, Pomorska 251, 92-213 \u0141\u00f3d\u017a, Poland"},{"name":"Department of Surgery, Johns Hopkins Medicine, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,26]]},"reference":[{"key":"ref_1","first-page":"233","article-title":"Colorectal Cancer Statistics, 2023","volume":"73","author":"Siegel","year":"2023","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2326","DOI":"10.1200\/JCO.2018.78.8687","article-title":"Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: Asco Guideline for Geriatric Oncology","volume":"36","author":"Mohile","year":"2018","journal-title":"J. Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1016\/j.surg.2024.07.009","article-title":"A Systematic Review and Meta-Analysis of High-Quality Randomized Controlled Trials on the Role of Prehabilitation Programs in Colorectal Surgery","volume":"176","author":"Garoufalia","year":"2024","journal-title":"Surgery"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.clnu.2016.07.015","article-title":"ESPEN Guidelines on Nutrition in Cancer Patients","volume":"36","author":"Arends","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1016\/j.surg.2016.05.014","article-title":"The Ability of Prehabilitation to Influence Postoperative Outcome after Intra-Abdominal Operation: A Systematic Review and Meta-Analysis","volume":"160","author":"Moran","year":"2016","journal-title":"Surgery"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1007\/s00268-019-04950-y","article-title":"Prehabilitation Before Major Abdominal Surgery: A Systematic Review and Meta-Analysis","volume":"43","author":"Hughes","year":"2019","journal-title":"World J. Surg."},{"key":"ref_7","first-page":"295","article-title":"Impairment-Driven Cancer Rehabilitation: An Essential Component of Quality Care and Survivorship","volume":"63","author":"Silver","year":"2013","journal-title":"CA Cancer J. Clin."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.anclin.2014.11.002","article-title":"Prehabilitation to Enhance Perioperative Care","volume":"33","author":"Carli","year":"2015","journal-title":"Anesthesiol. Clin."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1001\/jamasurg.2023.0198","article-title":"Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery: The PREHAB Randomized Clinical Trial","volume":"158","author":"Molenaar","year":"2023","journal-title":"JAMA Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"107302","DOI":"10.1016\/j.ejso.2023.107302","article-title":"Prehabilitation in Colorectal Cancer Surgery Improves Outcome and Reduces Hospital Costs","volume":"50","author":"Sabajo","year":"2024","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"7822","DOI":"10.1245\/s10434-024-15593-2","article-title":"Effectiveness of Prehabilitation Modalities on Postoperative Outcomes Following Colorectal Cancer Surgery: A Systematic Review of Randomised Controlled Trials","volume":"31","author":"Steffens","year":"2024","journal-title":"Ann. Surg. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.12998\/wjcc.v8.i7.1188","article-title":"Sarcopenia in Patients with Colorectal Cancer: A Comprehensive Review","volume":"8","year":"2020","journal-title":"World J. Clin. Cases"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1053\/j.gastro.2018.05.012","article-title":"Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-Analysis","volume":"155","author":"Gillis","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"van Exter, S.H., Drager, L.D., van Asseldonk, M.J.M.D., Strijker, D., van der Schoot, N.D., van den Heuvel, B., Verlaan, S., and van den Berg, M.G.A. (2023). Adherence to and Efficacy of the Nutritional Intervention in Multimodal Prehabilitation in Colorectal and Esophageal Cancer Patients. Nutrients, 15.","DOI":"10.3390\/nu15092133"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1053\/j.gastro.2014.12.035","article-title":"Nutrients, Foods, and Colorectal Cancer Prevention","volume":"148","author":"Song","year":"2015","journal-title":"Gastroenterology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e39680","DOI":"10.1016\/j.heliyon.2024.e39680","article-title":"Cancer Prevention at the Microscopic Level with the Potent Power of Micronutrients","volume":"10","author":"Jahan","year":"2024","journal-title":"Heliyon"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2898","DOI":"10.1016\/j.clnu.2021.02.005","article-title":"ESPEN Practical Guideline: Clinical Nutrition in Cancer","volume":"40","author":"Muscaritoli","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_18","first-page":"454","article-title":"Immunonutritional Support as an Important Part of Multidisciplinary Anti-Cancer Therapy","volume":"45","author":"Daca","year":"2021","journal-title":"Cent. Eur. J. Immunol."},{"key":"ref_19","first-page":"351","article-title":"Effect of L-Arginine on Immune Function: A Meta-Analysis","volume":"23","author":"Kang","year":"2014","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Cruzat, V., Rogero, M.M., Keane, K.N., Curi, R., and Newsholme, P. (2018). Glutamine: Metabolism and Immune Function, Supplementation and Clinical Translation. Nutrients, 10.","DOI":"10.20944\/preprints201809.0459.v1"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"233","DOI":"10.3390\/dairy1030016","article-title":"Whey Proteins and Its Derivatives: Bioactivity, Functionality, and Current Applications","volume":"1","author":"Minj","year":"2020","journal-title":"Dairy"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1248\/bpb.32.366","article-title":"Novel Functions of Bovine Milk-Derived Alpha-Lactalbumin: Anti-Nociceptive and Anti-Inflammatory Activity Caused by Inhibiting Cyclooxygenase-2 and Phospholipase A2","volume":"32","author":"Yamaguchi","year":"2009","journal-title":"Biol. Pharm. Bull."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2303","DOI":"10.1002\/jsfa.7600","article-title":"The Potential of Food Protein-Derived Anti-Inflammatory Peptides against Various Chronic Inflammatory Diseases","volume":"96","author":"Majumder","year":"2016","journal-title":"J. Sci. Food Agric."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1007\/s12253-012-9509-9","article-title":"Whey Protein versus Whey Protein Hydrolyzate for the Protection of Azoxymethane and Dextran Sodium Sulfate Induced Colonic Tumors in Rats","volume":"18","author":"Attaallah","year":"2012","journal-title":"Pathol. Oncol. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"4275","DOI":"10.1111\/1750-3841.16724","article-title":"Antitumor Activity of a Whey Peptide-Based Enteral Diet in C26 Colon Tumor-Bearing Mice","volume":"88","author":"Liu","year":"2023","journal-title":"J. Food Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1186\/s12964-023-01271-5","article-title":"Chemopreventive Effect of a Milk Whey By-Product Derived from Buffalo (Bubalus Bubalis) in Protecting from Colorectal Carcinogenesis","volume":"21","author":"Cacciola","year":"2023","journal-title":"Cell Commun. Signal."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2515","DOI":"10.1002\/fft2.478","article-title":"Protein Nutritional Support: The Prevention and Regulation of Colorectal Cancer and Its Mechanism Research","volume":"5","author":"Feng","year":"2024","journal-title":"Food Front."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"6923","DOI":"10.1002\/cam4.2517","article-title":"Whey Protein Isolate Supplementation Improves Body Composition, Muscle Strength, and Treatment Tolerance in Malnourished Advanced Cancer Patients Undergoing Chemotherapy","volume":"8","author":"Cereda","year":"2019","journal-title":"Cancer Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"799","DOI":"10.3945\/jn.109.119222","article-title":"A Diet Containing Whey Protein, Free Glutamine, and Transforming Growth Factor-\u03b2 Ameliorates Nutritional Outcome and Intestinal Mucositis during Repeated Chemotherapeutic Challenges in Rats","volume":"140","author":"Boukhettala","year":"2010","journal-title":"J. Nutr."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Zhang, L., Liu, G., Huang, X., and He, F. (2025). Effects of Protein Supplementation on Muscle Mass, Muscle Strength, and Physical Performance in Older Adults with Physical Inactivity: A Systematic Review and Meta-Analysis. BMC Geriatr., 25.","DOI":"10.1186\/s12877-025-05885-x"},{"key":"ref_31","unstructured":"Medicine, I. (2002). Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids, National Academies Press."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"177615","DOI":"10.1016\/j.ejphar.2025.177615","article-title":"L-Arginine and Immune Modulation: A Pharmacological Perspective on Inflammation and Autoimmune Disorders","volume":"997","author":"Dimeji","year":"2025","journal-title":"Eur. J. Pharmacol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/978-3-030-74180-8_10","article-title":"Role of L-Arginine in Nitric Oxide Synthesis and Health in Humans","volume":"1332","author":"Wu","year":"2021","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2303259","DOI":"10.1002\/advs.202303259","article-title":"Nitric Oxide: Physiological Functions, Delivery, and Biomedical Applications","volume":"10","author":"Andrabi","year":"2023","journal-title":"Adv. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/j.imbio.2007.09.008","article-title":"Role of Arginine Metabolism in Immunity and Immunopathology","volume":"212","author":"Peranzoni","year":"2007","journal-title":"Immunobiology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/S0002-9610(02)00815-2","article-title":"Role of Nitric Oxide in Wound Repair","volume":"183","author":"Witte","year":"2002","journal-title":"Am. J. Surg."},{"key":"ref_37","first-page":"80","article-title":"The Role of L-Arginine Following Trauma and Blood Loss","volume":"10","author":"Loehe","year":"2007","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"27","DOI":"10.22141\/1608-1706.1.19.2018.127299","article-title":"L-Arginine Accelerates Wound Healing: New Mechanisms and Clinical Trial Data","volume":"19","author":"Savustianenko","year":"2018","journal-title":"TRAUMA"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"55867","DOI":"10.12775\/QS.2024.33.55867","article-title":"L-Arginine Supplementation in Endurance Athletes: A Systematic Review of Recovery Mechanisms and Performance Enhancement","volume":"33","author":"Zygmunt","year":"2024","journal-title":"Qual. Sport"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1845","DOI":"10.1042\/BCJ20160103","article-title":"Regulatory Principles in Metabolism-Then and Now","volume":"473","author":"Curi","year":"2016","journal-title":"Biochem. J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1002\/jcp.20339","article-title":"Molecular Mechanisms of Glutamine Action","volume":"204","author":"Curi","year":"2005","journal-title":"J. Cell. Physiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.jnutbio.2013.11.009","article-title":"Oral Supplementations with Free and Dipeptide Forms of L-Glutamine in Endotoxemic Mice: Effects on Muscle Glutamine-Glutathione Axis and Heat Shock Proteins","volume":"25","author":"Cruzat","year":"2014","journal-title":"J. Nutr. Biochem."},{"key":"ref_43","first-page":"309","article-title":"On the Origin of Cancer Cells","volume":"123","author":"Warburg","year":"1956","journal-title":"Science (1979)"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.1038\/s12276-020-00504-8","article-title":"Glutamine Reliance in Cell Metabolism","volume":"52","author":"Yoo","year":"2020","journal-title":"Exp. Mol. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2515S","DOI":"10.1093\/jn\/131.9.2515S","article-title":"Why Is L-Glutamine Metabolism Important to Cells of the Immune System in Health, Postinjury, Surgery or Infection?","volume":"131","author":"Newsholme","year":"2001","journal-title":"J. Nutr."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1177\/0115426503018005377","article-title":"Clinical Applications of L-Glutamine: Past, Present, and Future","volume":"18","author":"Wischmeyer","year":"2003","journal-title":"Nutr. Clin. Pract."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Hesterberg, R.S., Cleveland, J.L., and Epling-Burnette, P.K. (2018). Role of Polyamines in Immune Cell Functions. Med. Sci., 6.","DOI":"10.3390\/medsci6010022"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1002\/cbf.1165","article-title":"Glutamine-Dependent Changes in Gene Expression and Protein Activity","volume":"23","author":"Curi","year":"2005","journal-title":"Cell Biochem. Funct."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1152\/japplphysiol.00471.2002","article-title":"Glutamine Supplementation Further Enhances Exercise-Induced Plasma IL-6","volume":"95","author":"Hiscock","year":"2003","journal-title":"J. Appl. Physiol. (1985)"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/S0899-9007(01)00797-3","article-title":"Regulative Potential of Glutamine\u2014Relation to Glutathione Metabolism","volume":"18","author":"Roth","year":"2002","journal-title":"Nutrition"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s12964-024-02018-6","article-title":"Glutamine and Cancer: Metabolism, Immune Microenvironment, and Therapeutic Targets","volume":"23","author":"Nan","year":"2025","journal-title":"Cell Commun. Signal."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1101\/gad.312355.118","article-title":"PPAR\u03b3 Is a Nexus Controlling Alternative Activation of Macrophages via Glutamine Metabolism","volume":"32","author":"Nelson","year":"2018","journal-title":"Genes Dev."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1038\/ni.3796","article-title":"\u03b1-Ketoglutarate Orchestrates Macrophage Activation through Metabolic and Epigenetic Reprogramming","volume":"18","author":"Liu","year":"2017","journal-title":"Nat. Immunol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.suc.2011.04.004","article-title":"The Relationships of Nutrients, Routes of Delivery, and Immunocompetence","volume":"91","author":"Jayarajan","year":"2011","journal-title":"Surg. Clin. N. Am."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1038\/s42255-019-0084-1","article-title":"Entry of Glucose- and Glutamine-Derived Carbons into the Citric Acid Cycle Supports Early Steps of HIV-1 Infection in CD4 T Cells","volume":"1","author":"Clerc","year":"2019","journal-title":"Nat. Metab."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1111\/his.13334","article-title":"Altered Glutamine Metabolism in Breast Cancer; Subtype Dependencies and Alternative Adaptations","volume":"72","author":"McIntyre","year":"2018","journal-title":"Histopathology"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e2655","DOI":"10.1038\/cddis.2016.222","article-title":"Amino-Acid Transporters in T-Cell Activation and Differentiation","volume":"8","author":"Ren","year":"2017","journal-title":"Cell Death Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1002\/mnfr.201500884","article-title":"Prevention and Treatment of Cancers by Immune Modulating Nutrients","volume":"60","author":"Janakiram","year":"2016","journal-title":"Mol. Nutr. Food Res."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2547","DOI":"10.18632\/aging.101968","article-title":"MicroRNA Let-7 in B Lymphocyte Activation","volume":"11","author":"Jiang","year":"2019","journal-title":"Aging"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1866","DOI":"10.1248\/bpb.b18-00055","article-title":"LY341495, an MGluR2\/3 Antagonist, Regulates the Immunosuppressive Function of Myeloid-Derived Suppressor Cells and Inhibits Melanoma Tumor Growth","volume":"41","author":"Morikawa","year":"2018","journal-title":"Biol. Pharm. Bull."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"3865","DOI":"10.1172\/JCI131859","article-title":"Targeting Glutamine Metabolism Enhances Tumor-Specific Immunity by Modulating Suppressive Myeloid Cells","volume":"130","author":"Oh","year":"2020","journal-title":"J. Clin. Investig."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1136\/gut.42.6.779","article-title":"Mediation by NF-Kappa B of Cytokine Induced Expression of Intercellular Adhesion Molecule 1 (ICAM-1) in an Intestinal Epithelial Cell Line, a Process Blocked by Proteasome Inhibitors","volume":"42","author":"Jobin","year":"1998","journal-title":"Gut"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"G266","DOI":"10.1152\/ajpgi.00385.2002","article-title":"Enteral Glutamine Stimulates Protein Synthesis and Decreases Ubiquitin MRNA Level in Human Gut Mucosa","volume":"285","author":"Claeyssens","year":"2003","journal-title":"Am. J. Physiol. Gastrointest. Liver Physiol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1006\/cyto.2000.0813","article-title":"Influence of Glutamine on Cytokine Production by Human Gut in Vitro","volume":"13","author":"Lalaude","year":"2001","journal-title":"Cytokine"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1177\/0884533617721687","article-title":"Dietary Supplements Commonly Used by Cancer Survivors: Are There Any Benefits?","volume":"32","author":"Marian","year":"2017","journal-title":"Nutr. Clin. Pract."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1177\/0884533615611857","article-title":"Oral Glutamine in Preventing Treatment-Related Mucositis in Adult Patients With Cancer: A Systematic Review","volume":"31","author":"Sayles","year":"2016","journal-title":"Nutr. Clin. Pract."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1136\/gut.48.1.28","article-title":"Oral Glutamine in the Prevention of Fluorouracil Induced Intestinal Toxicity: A Double Blind, Placebo Controlled, Randomised Trial","volume":"48","author":"Daniele","year":"2001","journal-title":"Gut"},{"key":"ref_68","first-page":"3","article-title":"Why Should a Single Nutrient\u2014Glutamine\u2014Improve Outcome?: The Remarkable Story of Glutamine Dipeptides","volume":"1","author":"Alteheld","year":"2004","journal-title":"Clin. Nutr. Suppl."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1186\/s13054-015-1002-x","article-title":"Enteral Glutamine Supplementation in Critically Ill Patients: A Systematic Review and Meta-Analysis","volume":"19","author":"Dhaliwal","year":"2015","journal-title":"Crit. Care"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"e202400752","DOI":"10.1002\/mnfr.202400752","article-title":"Immunomodulatory Effects of Omega-3 Fatty Acids: Mechanistic Insights and Health Implications","volume":"69","author":"Bodur","year":"2025","journal-title":"Mol. Nutr. Food Res."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1002\/lite.201400055","article-title":"Nutrigenomic Effects of Omega-3 Fatty Acids","volume":"26","author":"Gladine","year":"2014","journal-title":"Lipid Technol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/B978-0-12-398397-8.00004-6","article-title":"Nutrigenomics and Nutrigenetics of \u03a93 Polyunsaturated Fatty Acids","volume":"108","year":"2012","journal-title":"Prog. Mol. Biol. Transl. Sci."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1089\/jmf.2005.8.133","article-title":"Omega-3 Fatty Acids in Health and Disease: Part 2--Health Effects of Omega-3 Fatty Acids in Autoimmune Diseases, Mental Health, and Gene Expression","volume":"8","author":"Shahidi","year":"2005","journal-title":"J. Med. Food"},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Venter, C., Eyerich, S., Sarin, T., and Klatt, K.C. (2020). Nutrition and the Immune System: A Complicated Tango. Nutrients, 12.","DOI":"10.3390\/nu12030818"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"e1663","DOI":"10.7717\/peerj.1663","article-title":"LPS- or Pseudomonas Aeruginosa-Mediated Activation of the Macrophage TLR4 Signaling Cascade Depends on Membrane Lipid Composition","volume":"4","author":"Schoeniger","year":"2016","journal-title":"PeerJ"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"6151","DOI":"10.4049\/jimmunol.173.10.6151","article-title":"Dietary Docosahexaenoic Acid Suppresses T Cell Protein Kinase C Theta Lipid Raft Recruitment and IL-2 Production","volume":"173","author":"Fan","year":"2004","journal-title":"J. Immunol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/s12944-016-0241-4","article-title":"Effect of N-3 Fatty Acids on the Expression of Inflammatory Genes in THP-1 Macrophages","volume":"15","author":"Barbier","year":"2016","journal-title":"Lipids Health Dis."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Jin, J., Lu, Z., Li, Y., Cowart, L.A., Lopes-Virella, M.F., and Huang, Y. (2018). Docosahexaenoic Acid Antagonizes the Boosting Effect of Palmitic Acid on LPS Inflammatory Signaling by Inhibiting Gene Transcription and Ceramide Synthesis. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0193343"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1111\/imm.12296","article-title":"The Fish Oil Ingredient, Docosahexaenoic Acid, Activates Cytosolic Phospholipase A2 via GPR120 Receptor to Produce Prostaglandin E2 and Plays an Anti-Inflammatory Role in Macrophages","volume":"143","author":"Liu","year":"2014","journal-title":"Immunology"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1111\/j.1365-2125.2012.04374.x","article-title":"Omega-3 polyunsaturated fatty acids and inflammatory processes: Nutritrion or pharmacology?","volume":"75","author":"Calder","year":"2013","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1038\/nature13479","article-title":"Pro-Resolving Lipid Mediators Are Leads for Resolution Physiology","volume":"510","author":"Serhan","year":"2014","journal-title":"Nature"},{"key":"ref_82","first-page":"1260","article-title":"Specialized Pro-Resolving Lipid Mediators in the Inflammatory Response: An Update","volume":"1801","author":"Bannenberg","year":"2010","journal-title":"Biochim. Biophys. Acta (BBA)\u2014Mol. Cell Biol. Lipids"},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Guti\u00e9rrez, S., Svahn, S.L., and Johansson, M.E. (2019). Effects of Omega-3 Fatty Acids on Immune Cells. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20205028"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.ejphar.2015.03.100","article-title":"N-3 Polyunsaturated Fatty Acids Modulate B Cell Activity in Pre-Clinical Models: Implications for the Immune Response to Infections","volume":"785","author":"Whelan","year":"2016","journal-title":"Eur. J. Pharmacol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/j.nut.2007.04.002","article-title":"Omega-3 Polyunsaturated Fatty Acids Affect Lipopolysaccharide-Induced Maturation of Dendritic Cells through Mitogen-Activated Protein Kinases P38","volume":"23","author":"Wang","year":"2007","journal-title":"Nutrition"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.lfs.2014.10.014","article-title":"Docosahexaenoic Acid Induces M2 Macrophage Polarization through Peroxisome Proliferator-Activated Receptor \u03b3 Activation","volume":"120","author":"Chang","year":"2015","journal-title":"Life Sci."},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Williams-Bey, Y., Boularan, C., Vural, A., Huang, N.N., Hwang, I.Y., Shan-Shi, C., and Kehrl, J.H. (2014). Omega-3 Free Fatty Acids Suppress Macrophage Inflammasome Activation by Inhibiting NF-\u039aB Activation and Enhancing Autophagy. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0097957"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1016\/j.immuni.2013.05.015","article-title":"Omega-3 Fatty Acids Prevent Inflammation and Metabolic Disorder through Inhibition of NLRP3 Inflammasome Activation","volume":"38","author":"Yan","year":"2013","journal-title":"Immunity"},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Vemulapalli, V., and Shirwaikar Thomas, A. (2025). The Role of Vitamin D in Gastrointestinal Homeostasis and Gut Inflammation. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26073020"},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Fekete, M., Lehoczki, A., Szappanos, \u00c1., Z\u00e1b\u00f3, V., Kaposv\u00e1ri, C., Horv\u00e1th, A., Farkas, \u00c1., Fazekas-Pongor, V., Major, D., and Lip\u00e9cz, \u00c1. (2025). Vitamin D and Colorectal Cancer Prevention: Immunological Mechanisms, Inflammatory Pathways, and Nutritional Implications. Nutrients, 17.","DOI":"10.3390\/nu17081351"},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Chen, Y., Zhang, J., Ge, X., Du, J., Deb, D.K., and Li, Y.C. (2013). Vitamin D Receptor Inhibits Nuclear Factor \u039aB Activation by Interacting with I\u03baB Kinase \u03b2 Protein. J. Biol. Chem., 288.","DOI":"10.1074\/jbc.M113.467670"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1038\/s12276-018-0038-9","article-title":"Exploring Vitamin D Metabolism and Function in Cancer","volume":"50","author":"Jeon","year":"2018","journal-title":"Exp. Mol. Med."},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Ghaseminejad-Raeini, A., Ghaderi, A., Sharafi, A., Nematollahi-Sani, B., Moossavi, M., Derakhshani, A., and Sarab, G.A. (2023). Immunomodulatory Actions of Vitamin D in Various Immune-Related Disorders: A Comprehensive Review. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.950465"},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Martens, P.J., Gysemans, C., Verstuyf, A., and Mathieu, C. (2020). Vitamin D\u2019s Effect on Immune Function. Nutrients, 12.","DOI":"10.3390\/nu12051248"},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Hafkamp, F.M.J., Taanman-Kueter, E.W.M., van Capel, T.M.M., Kormelink, T.G., and de Jong, E.C. (2022). Vitamin D3 Priming of Dendritic Cells Shifts Human Neutrophil-Dependent Th17 Cell Development to Regulatory T Cells. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.872665"},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Cartes-Vel\u00e1squez, R., Vera, A., Torres-Quevedo, R., Medrano-D\u00edaz, J., P\u00e9rez, A., Mu\u00f1oz, C., Carrillo-Bestagno, H., and Nova-Lamperti, E. (2024). The Immunomodulatory Role of Vitamin D in Regulating the Th17\/Treg Balance and Epithelial\u2013Mesenchymal Transition: A Hypothesis for Gallbladder Cancer. Nutrients, 16.","DOI":"10.3390\/nu16234134"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1111\/nyas.12440","article-title":"Vitamin D Effects on B Cell Function in Autoimmunity","volume":"1317","author":"Rolf","year":"2014","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Dankers, W., Colin, E.M., van Hamburg, J.P., and Lubberts, E. (2017). Vitamin D in Autoimmunity: Molecular Mechanisms and Therapeutic Potential. Front. Immunol., 7.","DOI":"10.3389\/fimmu.2016.00697"},{"key":"ref_99","doi-asserted-by":"crossref","unstructured":"Sun, J., and Zhang, Y.G. (2022). Vitamin D Receptor Influences Intestinal Barriers in Health and Disease. Cells, 11.","DOI":"10.3390\/cells11071129"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1093\/ecco-jcc\/jjab044","article-title":"Overexpression of Vitamin D Receptor in Intestinal Epithelia Protects Against Colitis via Upregulating Tight Junction Protein Claudin 15","volume":"15","author":"Chatterjee","year":"2021","journal-title":"J. Crohns Colitis"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1038\/s41385-022-00502-1","article-title":"Vitamin D Receptor Upregulates Tight Junction Protein Claudin-5 against Colitis-Associated Tumorigenesis","volume":"15","author":"Zhang","year":"2022","journal-title":"Mucosal Immunol."},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Bellerba, F., Muzio, V., Gnagnarella, P., Facciotti, F., Chiocca, S., Bossi, P., Cortinovis, D., Chiaradonna, F., Serrano, D., and Raimondi, S. (2021). The Association between Vitamin D and Gut Microbiota: A Systematic Review of Human Studies. Nutrients, 13.","DOI":"10.3390\/nu13103378"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1","DOI":"10.21926\/rpn.2502007","article-title":"The Crucial Role of Vitamin D in Regulating Gut Microbiota in Inflammatory Bowel Disease","volume":"5","author":"Bartolacci","year":"2025","journal-title":"Recent Prog. Nutr."},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Vernia, F., Valvano, M., Longo, S., Cesaro, N., Viscido, A., and Latella, G. (2022). Vitamin D in Inflammatory Bowel Diseases. Mechanisms of Action and Therapeutic Implications. Nutrients, 14.","DOI":"10.3390\/nu14020269"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1007\/s00394-015-0966-2","article-title":"Effects of High Doses of Vitamin D3 on Mucosa-Associated Gut Microbiome Vary between Regions of the Human Gastrointestinal Tract","volume":"55","author":"Bashir","year":"2016","journal-title":"Eur. J. Nutr."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1111\/apt.12706","article-title":"Higher Plasma Vitamin D Is Associated with Reduced Risk of Clostridium Difficile Infection in Patients with Inflammatory Bowel Diseases","volume":"39","author":"Ananthakrishnan","year":"2014","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_107","doi-asserted-by":"crossref","unstructured":"Popescu, G.A., Minca, D.G., Jafal, N.M., Toma, C.V., Alexandrescu, S.T., Costea, R.V., and Vasilescu, C. (2025). Multimodal Prehabilitation in Major Abdominal Surgery\u2014Rationale, Modalities, Results and Limitations. Medicina, 61.","DOI":"10.3390\/medicina61050908"},{"key":"ref_108","doi-asserted-by":"crossref","unstructured":"Chris Ugbolue, U., Percy Marshall, R., Alizadeh Pahlavani, H., and Khang Duy Ricky Le, C. (2025). Integration of Resistance Exercise into a Multimodal Approach to Prehabilitation for Patients with Sarcopenia Prior to Surgery: A Narrative Review. Front. Rehabil. Sci., 6.","DOI":"10.3389\/fresc.2025.1481233"},{"key":"ref_109","doi-asserted-by":"crossref","unstructured":"Su\u00e1rez-Alc\u00e1zar, M.P., Folch Ayora, A., Muriach, M., Recacha-Ponce, P., Garcia-Roca, M.E., Coret-Franco, A., Pastor-Mora, J.C., Salas-Medina, P., and Collado-Boira, E.J. (2025). Multimodal Prehabilitation in Colorectal Cancer: Improving Fitness, Lifestyle, and Post-Surgery Outcomes. Healthcare, 13.","DOI":"10.3390\/healthcare13091083"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"2057","DOI":"10.1152\/physrev.00054.2021","article-title":"Molecular responses to acute exercise and their relevance for adaptations in skeletal muscle to exercise training","volume":"103","author":"Egan","year":"2023","journal-title":"Physiol. Rev."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1038\/s41392-025-02141-x","article-title":"Energy Metabolism in Health and Diseases","volume":"10","author":"Liu","year":"2025","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1038\/s41580-023-00606-x","article-title":"Exercise Metabolism and Adaptation in Skeletal Muscle","volume":"24","author":"Smith","year":"2023","journal-title":"Nat. Rev. Mol. Cell Biol."},{"key":"ref_113","doi-asserted-by":"crossref","unstructured":"Damanti, S., Senini, E., De Lorenzo, R., Merolla, A., Santoro, S., Festorazzi, C., Messina, M., Vitali, G., Sciorati, C., and Rovere-Querini, P. (2024). Acute Sarcopenia: Mechanisms and Management. Nutrients, 16.","DOI":"10.3390\/nu16203428"},{"key":"ref_114","doi-asserted-by":"crossref","unstructured":"Tezze, C., Sandri, M., and Tessari, P. (2023). Anabolic Resistance in the Pathogenesis of Sarcopenia in the Elderly: Role of Nutrition and Exercise in Young and Old People. Nutrients, 15.","DOI":"10.20944\/preprints202308.0516.v1"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.smhs.2024.02.004","article-title":"Exercise and Nutrition Benefit Skeletal Muscle: From Influence Factor and Intervention Strategy to Molecular Mechanism","volume":"6","author":"Feng","year":"2024","journal-title":"Sports Med. Health Sci."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1038\/s41392-024-01756-w","article-title":"Peroxisome Proliferator-Activated Receptor Gamma Coactivator-1 (PGC-1) Family in Physiological and Pathophysiological Process and Diseases","volume":"9","author":"Qian","year":"2024","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_117","doi-asserted-by":"crossref","unstructured":"Wang, J., Jia, D., Zhang, Z., and Wang, D. (2025). Exerkines and Sarcopenia: Unveiling the Mechanism Behind Exercise-Induced Mitochondrial Homeostasis. Metabolites, 15.","DOI":"10.3390\/metabo15010059"},{"key":"ref_118","doi-asserted-by":"crossref","unstructured":"Novelli, G., Calcaterra, G., Casciani, F., Pecorelli, S., and Mehta, J.L. (2024). \u201cExerkines\u201d: A Comprehensive Term for the Factors Produced in Response to Exercise. Biomedicines, 12.","DOI":"10.3390\/biomedicines12091975"},{"key":"ref_119","doi-asserted-by":"crossref","unstructured":"Pervin, S., Reddy, S.T., and Singh, R. (2021). Novel Roles of Follistatin\/Myostatin in Transforming Growth Factor-\u03b2 Signaling and Adipose Browning: Potential for Therapeutic Intervention in Obesity Related Metabolic Disorders. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.653179"},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1007\/s11010-024-05120-y","article-title":"Therapeutic Applications and Challenges in Myostatin Inhibition for Enhanced Skeletal Muscle Mass and Functions","volume":"480","author":"Wetzlich","year":"2024","journal-title":"Mol. Cell. Biochem."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"2261","DOI":"10.1016\/j.drudis.2022.03.019","article-title":"The Role of Irisin in Metabolic Flexibility: Beyond Adipose Tissue Browning","volume":"27","author":"Shen","year":"2022","journal-title":"Drug Discov. Today"},{"key":"ref_122","doi-asserted-by":"crossref","unstructured":"Yoshida, T., and Delafontaine, P. (2020). Mechanisms of IGF-1-Mediated Regulation of Skeletal Muscle Hypertrophy and Atrophy. Cells, 9.","DOI":"10.3390\/cells9091970"},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"C164","DOI":"10.1152\/ajpcell.00344.2021","article-title":"Aerobic Exercise and Resistance Exercise Alleviate Skeletal Muscle Atrophy through IGF-1\/IGF-1R-PI3K\/Akt Pathway in Mice with Myocardial Infarction","volume":"322","author":"Feng","year":"2022","journal-title":"Am. J. Physiol. Cell Physiol."},{"key":"ref_124","doi-asserted-by":"crossref","unstructured":"Nara, H., and Watanabe, R. (2021). Anti-Inflammatory Effect of Muscle-Derived Interleukin-6 and Its Involvement in Lipid Metabolism. Int J. Mol. Sci., 22.","DOI":"10.3390\/ijms22189889"},{"key":"ref_125","doi-asserted-by":"crossref","unstructured":"Docherty, S., Harley, R., McAuley, J.J., Crowe, L.A.N., Pedret, C., Kirwan, P.D., Siebert, S., and Millar, N.L. (2022). The Effect of Exercise on Cytokines: Implications for Musculoskeletal Health: A Narrative Review. BMC Sports Sci. Med. Rehabil., 14.","DOI":"10.1186\/s13102-022-00397-2"},{"key":"ref_126","doi-asserted-by":"crossref","unstructured":"Novick, D., Chong, W.P., Ma\u0142kowska, P., and Sawczuk, M. (2023). Cytokines as Biomarkers for Evaluating Physical Exercise in Trained and Non-Trained Individuals: A Narrative Review. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241311156"},{"key":"ref_127","doi-asserted-by":"crossref","unstructured":"Li, M., Jiang, P., Wei, S., Wang, J., and Li, C. (2023). The Role of Macrophages-Mediated Communications among Cell Compositions of Tumor Microenvironment in Cancer Progression. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1113312"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"910","DOI":"10.7150\/ijbs.100948","article-title":"Immunosenescence, Physical Exercise, and Their Implications in Tumor Immunity and Immunotherapy","volume":"21","author":"Yu","year":"2025","journal-title":"Int. J. Biol. Sci."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1038\/s41392-024-01954-6","article-title":"Metabolic Regulation of the Immune System in Health and Diseases: Mechanisms and Interventions","volume":"9","author":"Hu","year":"2024","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"1824","DOI":"10.1016\/j.cell.2023.03.028","article-title":"Cachexia: A Systemic Consequence of Progressive, Unresolved Disease","volume":"186","author":"Ferrer","year":"2023","journal-title":"Cell"},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"112685","DOI":"10.1016\/j.exger.2025.112685","article-title":"Exercise and Exerkines: Mechanisms and Roles in Anti-Aging and Disease Prevention","volume":"200","author":"Lu","year":"2025","journal-title":"Exp. Gerontol."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1038\/s41392-024-01841-0","article-title":"Molecular Insights of Exercise Therapy in Disease Prevention and Treatment","volume":"9","author":"Walzik","year":"2024","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"296","DOI":"10.31083\/j.rcm2508296","article-title":"Effects of Aerobic Exercise on Cardiopulmonary Function in Postoperative Patients with Congenital Heart Disease: A Meta-Analysis","volume":"25","author":"Guo","year":"2024","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.bja.2019.03.027","article-title":"Optimising Organ Perfusion in the High-Risk Surgical and Critical Care Patient: A Narrative Review","volume":"123","author":"Parker","year":"2019","journal-title":"Br. J. Anaesth."},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"2244","DOI":"10.1016\/j.clnu.2022.07.041","article-title":"Advances in Muscle Health and Nutrition: A Toolkit for Healthcare Professionals","volume":"41","author":"Prado","year":"2022","journal-title":"Clin. Nutr."},{"key":"ref_136","first-page":"680","article-title":"Effects of Resistance Training on Muscle Strength, Endurance, and Motor Unit According to Ciliary Neurotrophic Factor Polymorphism in Male College Students","volume":"13","author":"Hong","year":"2014","journal-title":"J. Sports Sci. Med."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1080\/07853890.2018.1511918","article-title":"Implications of Low Muscle Mass across the Continuum of Care: A Narrative Review","volume":"50","author":"Prado","year":"2018","journal-title":"Ann. Med."},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1007\/s40520-023-02672-9","article-title":"Muscle Weakness Is More Strongly Associated with Functional Outcomes in Patients with Stroke than Sarcopenia or Muscle Wasting: An Observational Study","volume":"36","author":"Nozoe","year":"2024","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"a029769","DOI":"10.1101\/cshperspect.a029769","article-title":"Adaptations to Endurance and Strength Training","volume":"8","author":"Hughes","year":"2018","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"20503121231214650","DOI":"10.1177\/20503121231214650","article-title":"Relationship between Muscle Mass and Muscle Strength with Physical Performance in Older Adults: A Systematic Review","volume":"11","author":"Riviati","year":"2023","journal-title":"SAGE Open Med."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"zrad134","DOI":"10.1093\/bjsopen\/zrad134","article-title":"Preoperative Multimodal Prehabilitation before Elective Colorectal Cancer Surgery in Patients with WHO Performance Status I or II: Randomized Clinical Trial","volume":"7","author":"Bojesen","year":"2023","journal-title":"BJS Open"},{"key":"ref_142","first-page":"CD013259","article-title":"Prehabilitation versus No Prehabilitation to Improve Functional Capacity, Reduce Postoperative Complications and Improve Quality of Life in Colorectal Cancer Surgery","volume":"5","author":"Molenaar","year":"2023","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_143","doi-asserted-by":"crossref","unstructured":"Koh, F.H.X., Yik, V., Chin, S.E., Kok, S.S.X., Lee, H.B., Tong, C., Tay, P., Chean, E., Lam, Y.E., and Mah, S.M. (2024). Evaluating the Impact of Multimodal Prehabilitation with High Protein Oral Nutritional Supplementation (HP ONS) with Beta-Hydroxy Beta-Methylbutyrate (HMB) on Sarcopenic Surgical Patients\u2014Interim Analysis of the HEROS Study. Nutrients, 16.","DOI":"10.3390\/nu16244351"},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"100392","DOI":"10.1016\/j.advnut.2025.100392","article-title":"Prehabilitation Strategies: Enhancing Surgical Resilience with a Focus on Nutritional Optimization and Multimodal Interventions","volume":"16","author":"Ganapathy","year":"2025","journal-title":"Adv. Nutr."},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.bja.2021.12.007","article-title":"Prehabilitation, Enhanced Recovery after Surgery, or Both? A Narrative Review","volume":"128","author":"Gillis","year":"2022","journal-title":"Br. J. Anaesth."},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"2183","DOI":"10.1245\/s10434-023-14853-x","article-title":"Psychological Interventions in Prehabilitation Randomized Controlled Trials for Patients Undergoing Cancer Surgery: Sufficient or Suboptimal?","volume":"31","author":"Hirst","year":"2024","journal-title":"Ann. Surg. Oncol."},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1111\/anae.14507","article-title":"Psychological Factors, Prehabilitation and Surgical Outcomes: Evidence and Future Directions","volume":"74","author":"Levett","year":"2019","journal-title":"Anaesthesia"},{"key":"ref_148","first-page":"CD008646","article-title":"Psychological Preparation and Postoperative Outcomes for Adults Undergoing Surgery under General Anaesthesia","volume":"2016","author":"Powell","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_149","doi-asserted-by":"crossref","first-page":"112055","DOI":"10.1016\/j.jpsychores.2025.112055","article-title":"Preoperative Psychological Distress and Acute Postoperative Pain among Abdominal Surgery Patients","volume":"190","year":"2025","journal-title":"J. Psychosom. Res."},{"key":"ref_150","doi-asserted-by":"crossref","unstructured":"Baagil, H., Baagil, H., and Gerbershagen, M.U. (2023). Preoperative Anxiety Impact on Anesthetic and Analgesic Use. Medicina, 59.","DOI":"10.20944\/preprints202310.0394.v1"},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s44254-023-00019-1","article-title":"Preoperative Anxiety and Postoperative Adverse Events: A Narrative Overview","volume":"1","author":"Ni","year":"2023","journal-title":"Anesthesiol. Perioper. Sci."},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1016\/j.clnu.2018.06.982","article-title":"Trimodal Prehabilitation for Colorectal Surgery Attenuates Post-Surgical Losses in Lean Body Mass: A Pooled Analysis of Randomized Controlled Trials","volume":"38","author":"Gillis","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_153","doi-asserted-by":"crossref","unstructured":"Anghel, T., Melania, B.L., Costea, I., Albai, O., Marinca, A., Levai, C.M., and Hogea, L.M. (2025). Review of Psychological Interventions in Oncology: Current Trends and Future Directions. Medicina, 61.","DOI":"10.3390\/medicina61020279"},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1007\/s40140-021-00505-x","article-title":"Psychological Interventions Prior to Cancer Surgery: A Review of Reviews","volume":"12","author":"Grimmett","year":"2022","journal-title":"Curr. Anesthesiol. Rep."},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"294","DOI":"10.5603\/NJO.a2022.0036","article-title":"Prehabilitation as an Extra Approach to Usual Care for Cancer Patients","volume":"72","author":"Osowiecka","year":"2022","journal-title":"Nowotwory. J. Oncol."},{"key":"ref_156","first-page":"125","article-title":"Pain Catastrophizing, Kinesiophobia, Stress, Depression, and Poor Resiliency Are Associated With Pain and Dysfunction in the Hip Preservation Population","volume":"43","author":"Nasir","year":"2023","journal-title":"Iowa Orthop. J."},{"key":"ref_157","doi-asserted-by":"crossref","unstructured":"Sharif-Nia, H., Nazari, R., Hajihosseini, F., Froelicher, E.S., Osborne, J.W., Taebbi, S., and Nowrozi, P. (2025). The Relationship of Fear of Pain, Pain Anxiety, and Fear-Avoidance Beliefs with Perceived Stress in Surgical Patients with Postoperative Kinesiophobia. BMC Psychol., 13.","DOI":"10.1186\/s40359-025-02743-8"},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"e83","DOI":"10.1017\/gmh.2024.94","article-title":"Interventions for Improving Adherence to Psychological Treatments for Common Mental Disorders: A Systematic Review","volume":"11","author":"Biswal","year":"2024","journal-title":"Camb. Prism. Glob. Ment. Health"},{"key":"ref_159","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1146\/annurev-psych-030122-124119","article-title":"Stress Management Interventions to Facilitate Psychological and Physiological Adaptation and Optimal Health Outcomes in Cancer Patients and Survivors","volume":"74","author":"Antoni","year":"2022","journal-title":"Annu. Rev. Psychol."},{"key":"ref_160","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s44158-022-00057-4","article-title":"The Influence of Psychological Interventions on Surgical Outcomes: A Systematic Review","volume":"2","author":"Lanini","year":"2022","journal-title":"J. Anesth. Analg. Crit. Care"},{"key":"ref_161","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.biopsycho.2010.05.006","article-title":"Psychological Factors in Immunomodulation Induced by Cancer Surgery: A Review","volume":"85","author":"Garssen","year":"2010","journal-title":"Biol. Psychol."},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1002\/j.2040-4603.2016.tb00694.x","article-title":"Regulation of the Hypothalamic-Pituitary-Adrenocortical Stress Response","volume":"6","author":"Herman","year":"2016","journal-title":"Compr. Physiol."},{"key":"ref_163","doi-asserted-by":"crossref","unstructured":"James, K.A., Stromin, J.I., Steenkamp, N., and Combrinck, M.I. (2023). Understanding the Relationships between Physiological and Psychosocial Stress, Cortisol and Cognition. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1085950"},{"key":"ref_164","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.iac.2010.09.010","article-title":"The Impact of Psychological Stress on Wound Healing: Methods and Mechanisms","volume":"31","author":"Gouin","year":"2011","journal-title":"Immunol. Allergy Clin. N. Am."},{"key":"ref_165","doi-asserted-by":"crossref","unstructured":"Balakin, E., Yurku, K., Ivanov, M., Izotov, A., Nakhod, V., and Pustovoyt, V. (2025). Regulation of Stress-Induced Immunosuppression in the Context of Neuroendocrine, Cytokine, and Cellular Processes. Biology, 14.","DOI":"10.3390\/biology14010076"},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"39","DOI":"10.4236\/ojmp.2024.133004","article-title":"The Impact of Psychosocial Influences on Chronic Wound Healing","volume":"13","author":"Frasier","year":"2024","journal-title":"Open J. Med. Psychol."},{"key":"ref_167","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.3390\/neurolint16060115","article-title":"Mindfulness-Based Interventions and the Hypothalamic\u2013Pituitary\u2013Adrenal Axis: A Systematic Review","volume":"16","year":"2024","journal-title":"Neurol. Int."},{"key":"ref_168","doi-asserted-by":"crossref","unstructured":"Rajasundaram, S., Rahman, R.P., Woolf, B., Zhao, S.S., and Gill, D. (2022). Morning Cortisol and Circulating Inflammatory Cytokine Levels: A Mendelian Randomisation Study. Genes, 13.","DOI":"10.1530\/endoabs.81.EP47"},{"key":"ref_169","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12950-025-00442-0","article-title":"Comparison of the Inflammatory Biomarkers IL- 6, TNF-\u03b1, and CRP to Predict the Effect of Nutritional Therapy on Mortality in Medical Patients at Risk of Malnutrition: A Secondary Analysis of the Randomized Clinical Trial EFFORT","volume":"22","author":"Wunderle","year":"2025","journal-title":"J. Inflamm."},{"key":"ref_170","doi-asserted-by":"crossref","first-page":"403","DOI":"10.4103\/jfmpc.jfmpc_1191_20","article-title":"Role of Serum C-Reactive Protein and Interleukin-6 as a Predictor of Intra-Abdominal and Surgical Site Infections after Elective Abdominal Surgery","volume":"10","author":"Hajong","year":"2021","journal-title":"J. Family Med. Prim. Care"},{"key":"ref_171","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.jshs.2018.09.009","article-title":"The Compelling Link between Physical Activity and the Body\u2019s Defense System","volume":"8","author":"Nieman","year":"2019","journal-title":"J. Sport Health Sci."},{"key":"ref_172","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1038\/s41380-018-0237-8","article-title":"Healthy Dietary Indices and Risk of Depressive Outcomes: A Systematic Review and Meta-Analysis of Observational Studies","volume":"24","author":"Lassale","year":"2019","journal-title":"Mol. Psychiatry"},{"key":"ref_173","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.iac.2010.09.013","article-title":"The Adverse Effects of Psychological Stress on Immunoregulatory Balance: Applications to Human Inflammatory Diseases","volume":"31","author":"Marshall","year":"2011","journal-title":"Immunol. Allergy Clin. N. Am."},{"key":"ref_174","doi-asserted-by":"crossref","unstructured":"Shchaslyvyi, A.Y., Antonenko, S.V., and Telegeev, G.D. (2024). Comprehensive Review of Chronic Stress Pathways and the Efficacy of Behavioral Stress Reduction Programs (BSRPs) in Managing Diseases. Int. J. Environ. Res. Public Health, 21.","DOI":"10.3390\/ijerph21081077"},{"key":"ref_175","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1101\/gad.352180.124","article-title":"Circadian de(Regulation) in Physiology: Implications for Disease and Treatment","volume":"38","author":"Kramer","year":"2024","journal-title":"Genes Dev."},{"key":"ref_176","first-page":"09727531241275347","article-title":"Sleep and Immune System Crosstalk: Implications for Inflammatory Homeostasis and Disease Pathogenesis","volume":"32","author":"Singh","year":"2024","journal-title":"Ann. Neurosci."},{"key":"ref_177","doi-asserted-by":"crossref","unstructured":"Xu, N., Zhang, J.-X., Zhang, J.-J., Huang, Z., Mao, L.-C., Zhang, Z.-Y., and Jin, W.-D. (2025). The Prognostic Value of the Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) in Colorectal Cancer and Colorectal Anastomotic Leakage Patients: A Retrospective Study. BMC Surg., 25.","DOI":"10.1186\/s12893-024-02708-5"},{"key":"ref_178","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1038\/s41392-024-01953-7","article-title":"Signaling Pathways Involved in Colorectal Cancer: Pathogenesis and Targeted Therapy","volume":"9","author":"Li","year":"2024","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_179","doi-asserted-by":"crossref","first-page":"200","DOI":"10.5603\/ocp.99934","article-title":"Evaluating the Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as Prognostic and Treatment Response Biomarkers in Stage IV Colorectal Cancer Patients","volume":"21","author":"Allahyari","year":"2024","journal-title":"Oncol. Clin. Pract."},{"key":"ref_180","doi-asserted-by":"crossref","unstructured":"Bausys, A., Kryzauskas, M., Abeciunas, V., Degutyte, A.E., Bausys, R., Strupas, K., and Poskus, T. (2022). Prehabilitation in Modern Colorectal Cancer Surgery: A Comprehensive Review. Cancers, 14.","DOI":"10.3390\/cancers14205017"},{"key":"ref_181","doi-asserted-by":"crossref","unstructured":"Xu, S., Yin, R., Zhu, H., Gong, Y., Zhu, J., Li, C., and Xu, Q. (2025). The Role of Exercise-Based Prehabilitation in Enhancing Surgical Outcomes for Patients with Digestive System Cancers: A Meta-Analysis. BMC Gastroenterol., 25.","DOI":"10.1186\/s12876-025-03626-3"},{"key":"ref_182","doi-asserted-by":"crossref","first-page":"e081164","DOI":"10.1136\/bmj-2024-081164","article-title":"Relative Efficacy of Prehabilitation Interventions and Their Components: Systematic Review with Network and Component Network Meta-Analyses of Randomised Controlled Trials","volume":"388","author":"Mcisaac","year":"2025","journal-title":"BMJ"},{"key":"ref_183","doi-asserted-by":"crossref","unstructured":"Delle Cave, D. (2025). Advances in Molecular Mechanisms and Therapeutic Strategies in Colorectal Cancer: A New Era of Precision Medicine. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26010346"},{"key":"ref_184","doi-asserted-by":"crossref","unstructured":"He, S., Zhang, S., Yao, Y., Xu, B., Niu, Z., Liao, F., Wu, J., Song, Q., Li, M., and Liu, Z. (2022). Turbulence of Glutamine Metabolism in Pan-Cancer Prognosis and Immune Microenvironment. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.1064127"},{"key":"ref_185","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1186\/s12935-021-02121-5","article-title":"Role of Glutamine and Its Metabolite Ammonia in Crosstalk of Cancer-Associated Fibroblasts and Cancer Cells","volume":"21","author":"Li","year":"2021","journal-title":"Cancer Cell Int."},{"key":"ref_186","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1186\/s13046-025-03430-7","article-title":"Targeting Glutamine Metabolism as a Potential Target for Cancer Treatment","volume":"44","author":"Zou","year":"2025","journal-title":"J. Exp. Clin. Cancer Res."},{"key":"ref_187","doi-asserted-by":"crossref","unstructured":"Qian, L., Zhang, F., Yin, M., and Lei, Q. (2022). Cancer Metabolism and Dietary Interventions. Cancer Biol. Med., 19.","DOI":"10.20892\/j.issn.2095-3941.2021.0461"},{"key":"ref_188","doi-asserted-by":"crossref","unstructured":"Ruban, M., Pozhidaeva, E., Bolotina, L., and Kaprin, A. (2025). The Role of Diet and Nutrition in Cancer Development and Management: From Molecular Mechanisms to Personalized Interventions. Foods, 14.","DOI":"10.3390\/foods14101788"}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/15\/7242\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:16:36Z","timestamp":1760033796000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/15\/7242"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,26]]},"references-count":188,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["ijms26157242"],"URL":"https:\/\/doi.org\/10.3390\/ijms26157242","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,26]]}}}