McPherson SW, van Kuijk FJ, Ramezani S
… +8 more, Vitale S, Amundson WH, Caraganis A, Mahan KS, Mundae R, Reilkoff RA, Chew EY, Wacker DA
Nutr Clin Pract
· 2026 Apr · PMID 41219174
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BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic caused significant morbidity and mortality. Further study of modifiable factors influencing COVID-19 severity and outcomes continues to be necessary. Serum zin...BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic caused significant morbidity and mortality. Further study of modifiable factors influencing COVID-19 severity and outcomes continues to be necessary. Serum zinc levels may play a role in modulating COVID-19 virus replication and consequently influence clinical outcomes. METHODS: This was a prospective observational study of adult patients hospitalized with COVID-19 assessing the relationship between serum zinc levels and clinical outcomes. Serum zinc levels were measured within 7 days of admission. The primary outcome was the need for intubation at any time during inpatient stay. Secondary outcomes included hospital disposition and incidence of shock and acute kidney injury. RESULTS: Serum zinc levels could be obtained for 99 patients with COVID-19. The 25 requiring intubation during hospitalization had a statistically significantly lower median (IQR) zinc concentration (51.6 µg/dl [46.3-62.3 µg/dl]) than those who did not (64.4 µg/dl [55.2-76.0 µg/dl]; P < 0.01). Patients requiring more respiratory support on hospital day 1, having acute kidney injury on hospital day 8, or requiring pressors on hospital days 1 or 8 also had significantly lower zinc levels. In multivariable analysis including other clinical factors known to influence outcomes in COVID-19 disease, serum zinc level remained an independent predictor of the need for intubation (odds ratio 0.941, 95% CI 0.885-0.999; P = 0.048). CONCLUSION: In multivariable analysis, lower serum zinc level was an independent predictor of inpatient intubation in COVID-19, but further investigation of zinc supplementation to prevent or reduce severity in COVID-19 infection is warranted before routine clinical use.
BACKGROUND: Short bowel syndrome (SBS) is a chronic condition requiring parenteral nutrition (PN) support and multidisciplinary management. However, disparities in access to care and standardized treatment pathways, in a...BACKGROUND: Short bowel syndrome (SBS) is a chronic condition requiring parenteral nutrition (PN) support and multidisciplinary management. However, disparities in access to care and standardized treatment pathways, in addition to economic burden, remain considerable for patients. Understanding healthcare resource utilization (HCRU) and treatment patterns, especially in relation to patient-reported outcomes (PROs), is critical for improving care. METHODS: A cross-sectional, multiphase study was conducted in 2023. This analysis focuses on phase 3, using a deidentified database that integrated claims and PROs from 68 patients in phase 2. Twenty-three patients were included in the analytic cohort after applying additional criteria. Descriptive statistics summarized patient demographics, HCRU, and treatment patterns for the overall cohort and stratified by median SBS-quality of life (QoL) score. RESULTS: The median age at SBS diagnosis was 35 years, and 91% of patients were female. Patients saw a median of 35 different healthcare providers and underwent approximately five procedures before diagnosis. In the 6 months after diagnosis, 39% had been hospitalized, and 26% had emergency room (ER) visits. Healthcare costs increased after diagnosis, with long-term PN use accounting for 34% of total costs. Patients with worse QoL had a higher number of ER visits than patients with better QoL. Patients who self-reported being treated by SBS specialists had lower healthcare costs than patients who did not receive specialized care. CONCLUSION: SBS is associated with high HCRU and costs, particularly for patients with poor QoL. Multidisciplinary care, especially from SBS specialists, may help reduce healthcare costs and improve patient outcomes.
Survivors of critical illness frequently do not achieve recommended nutrition targets because of multiple barriers. Consequently, malnutrition is prevalent during hospitalization, yet posthospital discharge nutrition int...Survivors of critical illness frequently do not achieve recommended nutrition targets because of multiple barriers. Consequently, malnutrition is prevalent during hospitalization, yet posthospital discharge nutrition interventions are often missing, leaving a gap during a crucial recovery phase. This scoping review aims to explore barriers to nutrition adequacy, consequences of inadequate nutrition, and interventions for adult survivors of critical illness following hospital discharge. Using Joanna Briggs Institute methodology in conjunction with the PRISMA-ScR checklist, searches were conducted in MEDLINE, Embase, CINAHL, Web of Science, and Cochrane databases (2010-2024) for studies on adult intensive care unit (ICU) survivors posthospital discharge, reporting nutrition barriers, consequences, and/or nutrition interventions. Factors identified from the data are analyzed and presented using a conceptual framework derived from the Biopsychosocial model and the Social Ecological Model. Forty-three studies (mostly observational) were included encompassing 32,165 participants. Commonly reported barriers included (% of studies) appetite loss (40%), dysphagia (26%), and psychological distress (40%), contributing to inadequate dietary intake (19%), malnutrition (42%), and weight loss (56%) persisting up to 12 months. Body composition changes, observed in 21% of studies, demonstrated increased fat mass, whereas lean mass was maintained or lost. Despite high nutrition risk, only 37% reported nutrition input. Nutrition interventions improved nutrition, physical, and psychological outcomes. This review emphasizes the complexity of nutrition recovery faced by ICU survivors, highlighting significant gaps in nutrition care following hospital discharge. Understanding nutrition challenges from survivors' perspective is essential before evaluating specific nutrition interventions addressing the diverse nutrition needs of individuals recovering from critical illness.
Obesity, clinically defined as an excess of adipose tissue, remains a growing public health concern because of its strong association with cardiometabolic comorbidities and the impact on the quality of life of those affe...Obesity, clinically defined as an excess of adipose tissue, remains a growing public health concern because of its strong association with cardiometabolic comorbidities and the impact on the quality of life of those affected by this disease. Although body mass index (BMI) is widely used for diagnosing and stratifying obesity, it has limitations, including its inability to capture body fat distribution or differentiate between visceral and subcutaneous fat, key determinants in metabolic disease. This article reviews the incorporation of anthropometric and body composition assessment tools, including waist circumference (WC), waist to hip ratio, waist to height ratio, body roundness index, conicity index, sagittal abdominal diameter, a body shape index, and skinfold measurements in obesity diagnosis and their potential to offer greater insight into obesity-related health risks than BMI alone. Additionally, we explore home-based assessment tools-including digital scales, at-home WC measurements, bioelectrical impedance analysis, body scanning apps, and commercial dual-energy x-ray absorptiometry (DEXA)-in supporting remote weight management in telehealth settings. Although these tools show promise, they vary in accuracy, accessibility, and usability. Integrating both clinic-based and home-based assessments into routine obesity care may improve risk stratification and support individualized interventions.
BACKGROUND: Patients receiving home parenteral nutrition (HPN) face complex challenges and increasingly seek support online, including generative artificial intelligence (AI) platforms like ChatGPT. This survey study com...BACKGROUND: Patients receiving home parenteral nutrition (HPN) face complex challenges and increasingly seek support online, including generative artificial intelligence (AI) platforms like ChatGPT. This survey study compared ChatGPT with clinician responses to common HPN-related questions. METHODS: Responses to 20 HPN-related questions spanning five content themes were generated by ChatGPT and provided by HPN expert clinicians. In a blinded online survey, practicing clinicians (study participants) rated each response on a five-point scale (1 = excellent; 5 = very poor) for accuracy, appropriateness, and empathy and selected their overall preferred response. RESULTS: Among 23 participants (73.9% registered dietitians; mean HPN experience: 14.0 years), ChatGPT's responses were rated more favorably for accuracy (median [IQR] = 1.80 [0.79] vs 2.15 [0.62], P = 0.003), appropriateness (1.80 [0.70] vs 2.15 [0.53], P = 0.013), and empathy (1.95 [0.66] vs 2.25 [0.65], P = 0.007). Participants preferred ChatGPT responses in 48.5% of cases, clinician responses in 33.9%, and had no clear preference in 17.6%. ChatGPT outperformed clinicians across content themes for "best practices, care, and safety of HPN use/infection risk" and scored more favorably for empathy in "symptoms" and for accuracy and appropriateness in "lifestyle stressors." Clinicians scored more favorably for appropriateness in "biochemical test concerns." CONCLUSION: ChatGPT may support HPN care and patient education, particularly for broad medical and lifestyle topics. However, complex clinical issues require medical expertise. Further research is needed to guide the safe integration of AI into clinical practice and patient care.
BACKGROUND: Clinical nutrition (CN) is becoming increasingly complex because of the rising prevalence of chronic illness, cancer, and malnutrition-related conditions such as short bowel syndrome and refeeding syndrome. D...BACKGROUND: Clinical nutrition (CN) is becoming increasingly complex because of the rising prevalence of chronic illness, cancer, and malnutrition-related conditions such as short bowel syndrome and refeeding syndrome. Despite its clinical significance, nutrition education among US physicians remains limited. Simultaneously, large language model (LLM)-based artificial intelligence assistants (AIAs) have emerged as tools to support complex clinical decision-making but remain largely untested in CN. METHODS: This retrospective study evaluated four LLM-based AIAs-ChatGPT (OpenAI), OpenEvidence (OpenEvidence Inc), Gemini (Google, Google DeepMind), and Copilot (Microsoft Corporation)-using five complex CN cases from our nutrition support service. Each AIA was queried with patient-specific CN questions. Responses were blinded and reviewed by five physician CN experts using an eight-item assessment tool evaluating clarity, relevance, evidence, and clinical utility. RESULTS: All AIAs produced clinically appropriate responses, with Gemini scoring highest in relevance (4.04) and clarity (4.16). Overall satisfaction scores ranged from 3.08 (Copilot) to 3.84 (Gemini). Citation quality and originality of insights varied and were generally limited, and no consistent differences in performance were observed across the five cases among the four AIAs. CONCLUSION: LLM-based AIAs can reliably replicate expert reasoning in CN. Although not yet a source of novel clinical insights, the true potential of this approach may lie in its application among physicians without specialized expertise in CN, helping to bridge existing knowledge gaps in nutrition care. Presenting full clinical cases, as shown in this study, could support AIA-enabled e-consultation in the future, thereby addressing gaps in CN education.
Morimoto N, Mandai S, Fujiki T
… +11 more, Ando F, Mori T, Susa K, Naito S, Sohara E, Anzai T, Takahashi K, Akita W, Ohta A, Uchida S, Iimori S
Nutr Clin Pract
· 2026 Jun · PMID 41188682
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BACKGROUND: Although previous experimental studies showed that metabolic acidosis promoted muscle catabolism and impaired protein synthesis, few epidemiological studies reported an independent association between serum b...BACKGROUND: Although previous experimental studies showed that metabolic acidosis promoted muscle catabolism and impaired protein synthesis, few epidemiological studies reported an independent association between serum bicarbonate levels and muscle atrophy in patients with chronic kidney disease (CKD). We examined the association between serum bicarbonate levels and low mid-upper arm circumference (MUAC), a surrogate marker of low muscle mass, in older adults with non-dialysis-dependent CKD. METHODS: A total of 174 patients aged ≥65 years with an estimated glomerular filtration rate <60 ml/min/1.73 m (33.9% women) were eligible. We cross-sectionally examined the association between serum bicarbonate levels and MUAC using multiple linear regression, adjusting for potential confounders selected by a directed acyclic graph of our causal model. The association between serum bicarbonate and low MUAC was examined by multiple Poisson regression with robust variance. We used two cutoffs to define low serum bicarbonate: serum bicarbonate levels <24 and <22 mmol/L. RESULTS: Serum bicarbonate levels were positively associated with MUAC (coefficient = 0.158, 95% CI = 0.026-0.289; P = 0.019). Serum bicarbonate levels <24 mmol/L were associated with a higher prevalence of low MUAC (prevalence ratio = 3.50, 95% CI = 1.61-7.61; P = 0.002), whereas the association was attenuated for serum bicarbonate levels <22 mmol/L. Restricted cubic spline analyses suggested a nonlinear association between serum bicarbonate levels and low MUAC. CONCLUSION: We found an independent association between serum bicarbonate levels <24 mmol/L and low MUAC, calling for further prospective studies to elucidate the target serum bicarbonate level that would help retard muscle atrophy.
Nutr Clin Pract
· 2026 Apr · PMID 41177667
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BACKGROUND: Persons living with amyotrophic lateral sclerosis (PALS) are at high risk for malnutrition because of disease-related factors such as dysphagia, self-feeding difficulty, and hypermetabolism. Nutrition interve...BACKGROUND: Persons living with amyotrophic lateral sclerosis (PALS) are at high risk for malnutrition because of disease-related factors such as dysphagia, self-feeding difficulty, and hypermetabolism. Nutrition interventions, including enteral nutrition (EN) initiation after gastrostomy tube (G-tube) placement, are integral to care but can introduce challenges, such as refeeding syndrome. This qualitative analysis explores how registered dietitians (RDs) at US-based outpatient amyotrophic lateral sclerosis (ALS) clinics assess malnutrition, facilitate discussions around G-tube placement, and mitigate refeeding syndrome risk. METHODS: Six focus groups were conducted with 22 RDs from US ALS clinics. Audio files were transcribed verbatim, and data analyzed by deductive thematic analysis. RESULTS: RDs reported widespread use of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition indicators for diagnosing malnutrition, with some using the Global Leadership Initiative on Malnutrition criteria. However, RDs described limitations in using these tools for PALS, particularly in differentiating disease-related from malnutrition-related muscle loss. When discussing G-tube placement, RDs described themselves as key informants in multidisciplinary teams, with timing of counseling typically based on symptoms and clinical progression. For refeeding syndrome, most clinics lacked formal protocols, although RDs used preventative practices, including slow initiation and advancement of EN and proactive communication with the care team. CONCLUSIONS: ALS RDs play a critical and multifaceted role in managing nutrition-related ALS care. There is a need for ALS-specific malnutrition criteria and standard protocols to manage refeeding syndrome in the outpatient setting. RDs' involvement in G-tube discussions underscores their role in supporting patients in medical decision-making.
Catheter-related thrombosis (CRT) is a consequential complication in patients receiving long-term home parenteral nutrition (HPN), compromising central venous access, nutrition support and, in some cases, survival. Yet w...Catheter-related thrombosis (CRT) is a consequential complication in patients receiving long-term home parenteral nutrition (HPN), compromising central venous access, nutrition support and, in some cases, survival. Yet whether routine prophylactic anticoagulation should be used to prevent CRT remains a clinical dilemma: although thrombosis prevention may preserve venous access, anticoagulation introduces bleeding risk, monitoring demands, added treatment burden, lifestyle restrictions, and cost. Proponents cite the relatively high incidence and clinical consequences of CRT, supported by observational data suggesting reduced thrombosis risk with prophylaxis. Opponents emphasize bleeding risks, lack of randomized controlled trial (RCT) evidence, and the improved safety of modern catheter care without anticoagulation. Consequently, practice varies widely, from routine anticoagulation to selective, risk-based approaches. This review critically evaluates the arguments on both sides, drawing on evidence from adult and pediatric cohorts. Beyond clinical outcomes, it considers the quality-of-life implications that daily anticoagulation imposes on an already complex HPN regimen. Routine anticoagulation in HPN sits at the intersection of prevention and harm: it may be appropriate for selected high-risk patients, but it is not a one-size-fits-all solution. An individualized, multidisciplinary approach, balancing thrombotic and bleeding risk alongside patient preference, is essential. Future research, including RCTs and predictive risk tools, is needed to refine patient selection and optimize strategies to preserve the venous lifelines sustaining HPN.
BACKGROUND: Multidisciplinary care under intestinal rehabilitation programs (IRPs) improves survival in pediatric intestinal failure (IF). Professional societies recommend the management of pediatric patients with IF by...BACKGROUND: Multidisciplinary care under intestinal rehabilitation programs (IRPs) improves survival in pediatric intestinal failure (IF). Professional societies recommend the management of pediatric patients with IF by an IRP. Whether these recommendations are followed in cases of neonatal IF is currently unclear. The objective of this study was to describe the current state of neonatal IF care across North America through the Children's Hospitals Neonatal Consortium. METHODS: A web-based survey was sent in July 2023. This survey consisted of adaptive questioning and contained 10-54 questions. The survey covered topics regarding IF care: diagnosis, rehabilitation program management, protocol use, and follow-up. To determine correlation of respondent role and answer given, Spearman correlation was used to analyze a portion of responses. RESULTS: There was a response rate of 93% (42/45). A total of 79% (33/42) of centers report having an IRP caring for neonatal patients. The composition and care provided by the program varied by center, with 60% (25/42) having protocols for neonatal IF management. A total of 76% (32/42) of centers report a multidisciplinary intestinal rehabilitation follow-up. CONCLUSIONS: Neonatal IF care varies across North America. Although the presence of a rehabilitation program is known to improve pediatric patient outcomes, a relevant minority of centers in this consortium do not have access to this care. Future studies comparing neonatal specific IF care strategies are critically important to optimize outcomes.
BACKGROUND: Vitamin C deficiency (VCD) is common in adult inpatients in high-income countries and is associated with moderate to severe frailty, cognitive impairment, and scurvy signs and symptoms. However, clinical prac...BACKGROUND: Vitamin C deficiency (VCD) is common in adult inpatients in high-income countries and is associated with moderate to severe frailty, cognitive impairment, and scurvy signs and symptoms. However, clinical practice associated with vitamin C status has not been explored in this setting. This study aims to describe current vitamin C clinical practices and explore barriers and enablers that influence nutrition care delivered to adult hospitalized patients within routine clinical practice. METHOD: This study was conducted across General Medicine units at a tertiary health service in Melbourne, Australia. Using an explanatory, sequential mixed methods design, data across each stage of the Nutrition Care Process (NCP) was triangulated from three phases involving analysis of clinical guidelines, file review data of patients with VCD (n = 100) according to plasma vitamin C levels, and focus groups informed by the Theoretical Domains Framework. RESULTS: Triangulated data revealed that barriers to vitamin C nutrition care include infrequent assessment, influenced by environmental factors, beliefs about consequences, clinical priority, and healthcare professionals' (HCPs') knowledge. Enablers include strong belief in nutrition care capability and belief that vitamin C nutrition care is within HCPs' roles. Low suspected VCD diagnosis and low intervention and discharge planning rates were also observed. The single vitamin C clinical guideline lacked detail across specific stages of the NCP. CONCLUSION: Limited vitamin C nutrition care potentially occurs in adult inpatients, hindered predominantly by assessment barriers. To achieve improvements in clinical practice, a theoretically driven implementation strategy targeted to healthcare systems, clinician behavior, and national quality standards is required.
Implementation science (IS) offers a structured approach to bridging the gap between research and practice by facilitating the adoption of evidence-based interventions (EBIs). One established framework within IS is the Q...Implementation science (IS) offers a structured approach to bridging the gap between research and practice by facilitating the adoption of evidence-based interventions (EBIs). One established framework within IS is the Quality Enhancement Research Initiative (QUERI), developed by the US Department of Veterans Affairs. QUERI promotes the active dissemination of EBIs through a phased roadmap: preimplementation (data to knowledge), implementation (knowledge to performance), and sustainment (performance to data). This review article explores the QUERI framework in depth and its application in clinical nutrition settings. Two case studies illustrate how QUERI can enhance implementation efforts: (1) improving inpatient malnutrition screening and (2) integrating outpatient surgical prehabilitation programs. In the first case, QUERI guides the identification of low screening and diagnosis rates, stakeholder engagement, toolkit development, and ongoing evaluation to ensure sustainability. In the second, QUERI aids in developing and adapting evidence-based prehabilitation protocols while balancing fidelity and customization to local workflows. Both examples demonstrate the importance of structured planning, stakeholder involvement, and iterative evaluation in achieving sustained change. QUERI's emphasis on choosing a high-volume or high-risk problem, defining best practices, and documenting outcomes makes it a valuable tool for nutrition professionals aiming to improve outcomes through consistent application of EBIs. As clinical nutrition continues to evolve, implementation frameworks like QUERI offer a practical pathway for translating research into impactful, sustainable improvements in patient care.
Reilly C, Foley J, Packer R
… +3 more, Thapar N, Keramat SA, Marshall J
Nutr Clin Pract
· 2026 Apr · PMID 41139280
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BACKGROUND: Although pediatric temporary (e.g., nasogastric) feeding tubes are widely used for short-term nutrition support, family impacts remain poorly defined. Research from long-term (e.g., gastrostomy) feeding tubes...BACKGROUND: Although pediatric temporary (e.g., nasogastric) feeding tubes are widely used for short-term nutrition support, family impacts remain poorly defined. Research from long-term (e.g., gastrostomy) feeding tubes does not generalize because management and burdens differ. This study aimed to explore the financial, time and family burdens of temporary feeding tubes, and their impact on children's quality of life. METHODS: A prospective mixed-methods longitudinal cohort study was conducted, following families over 4 months. Data were collected using diaries, interviews, Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales, and a caregiver burden questionnaire. Analyses included descriptive statistics for financial and time burdens, a multiple linear regression model fitted to identify factors associated with health-related quality of life, and qualitative content analysis. RESULTS: Thirty-six parents participated. Parents reported spending an average of 3.1 h daily on tube-related care. Indirect costs (e.g., lost income) averaged USD$1494.15/month (SD = $339.11), and out-of-pocket nonmedical costs (e.g., hiring help) represented 44% of monthly family income. Employment disruptions were reported by n = 18 (61%) of parents. Key predictors of lower quality of life for children were toddler age group, prior home tube feeding experience, and regional/rural residence. Preterm birth status and involvement of 4-6 medical teams were associated with higher quality of life. Parents reported challenges managing mealtimes, outings, and holidays. CONCLUSION: Temporary tube feeding imposes substantial financial burdens, time demands, and disruptions to family life, with impacts on children's quality of life. Supporting successful management for children requiring this intervention requires integrated family-centered care, including structured support, education, and psychosocial interventions.
Obesity is a growing global health concern and clinicians are frequently faced with developing a nutrition care plan for patients with obesity that includes assessment of energy requirements. Although indirect calorimetr...Obesity is a growing global health concern and clinicians are frequently faced with developing a nutrition care plan for patients with obesity that includes assessment of energy requirements. Although indirect calorimetry (IC) is the gold standard for determining resting energy expenditure, it is not readily available to all clinicians. This review provides an overview of estimating resting energy expenditure for patients with obesity in the inpatient and outpatient settings, including the use of IC and selecting an appropriate predictive equation when measuring energy expenditure is not possible with IC.
BACKGROUND: A broader project translated evidence for a Mediterranean-style dietary pattern (MDP) into clinicians' routine dietary care for type 2 diabetes and coronary heart disease in a public health service in Austral...BACKGROUND: A broader project translated evidence for a Mediterranean-style dietary pattern (MDP) into clinicians' routine dietary care for type 2 diabetes and coronary heart disease in a public health service in Australia. This study aimed to determine sustainment of practice and what predicts clinicians' routine use of an MDP approach 2 years after facilitated implementation. METHODS: May 2021-October 2022 implementation strategies targeted multidisciplinary clinicians involved with dietary care. In October 2024 clinicians were surveyed using an adapted 14-item Normalization Measure Development (NoMAD) questionnaire. Sustainment was defined as self-rating ≥7 on a scale from 0 (not at all) to 10 (always) that recommending MDP is a "normal part of your work." Exploratory analyses, including logistic regression, identified whether clinician characteristics, NoMAD items, and theoretical constructs predicted sustainment. RESULTS: Six dietitians and 61 other clinicians completed surveys, of which 100% and 52% self-reported MDP practice sustainment, respectively. Multivariable models in the total cohort found that the odds of sustainment increased with higher scores in NoMAD items related to the perception that using an MDP approach was legitimately within the clinicians' role (odds ratio [OR], 15.7; 95% CI, 3.23-224), shared understanding of supporting evidence (OR, 3.79; 95% CI, 1.35-15.8), and the constructs cognitive participation (OR, 6.12; 95% CI, 1.78-27.9) and collective action (OR, 5.7; 95% CI, 1.48-30.1). Twenty-seven clinicians commenced in the setting ≤2 years prior; within this group, MDP practice sustainment was significantly higher if MDP handover/orientation was received (71% vs 29%, P = 0.012). CONCLUSION: These data provide novel insights into impacts on sustainment of implemented evidence-based dietary practice in the context of a multidisciplinary workforce with high turnover.
BACKGROUND: Malnutrition worsens gastrointestinal (GI) cancer outcomes in older adults; long-term US mortality trends and disparities remain insufficiently understood. This study analyzed demographic/geographic mortality...BACKGROUND: Malnutrition worsens gastrointestinal (GI) cancer outcomes in older adults; long-term US mortality trends and disparities remain insufficiently understood. This study analyzed demographic/geographic mortality trends related to malnutrition and GI cancer among older adults in the United States. METHODS: Mortality data from 1999 to 2020 were obtained via CDC WONDER for adults aged ≥65 years, in which malnutrition and GI cancer were listed as underlying or contributing causes of death. Age-adjusted mortality rates (AAMRs) per 100,000 population and annual percentage changes (APCs) were calculated and stratified by year, sex, race/ethnicity, and region. RESULTS: A total of 31,806 deaths were recorded. AAMRs declined from 4.4 in 1999 to 2.6 in 2013 (APC: -7.7 to -1.4), then rose to 5.5 in 2020 (APC: 11.6, 95% CI: 10.7-12.8). Men had higher AAMRs (4.3) than women (2.7). Among men, AAMRs dropped from 5.4 in 1999 to 3.3 in 2006, then increased to 7.2 in 2020 (APC: 11.9, 95% CI: 10.5-14.1). Women's rates declined from 3.8 in 1999 to 2.0 in 2013, before rising to 4.2 in 2020 (APC: 11.8, 95% CI: 10.2-14.0). Black or African American individuals (5.3), Alaska (7.1), and the Western United States (7.0) had the highest mortality. Nonmetropolitan areas consistently had higher AAMRs (4.0) than metropolitan areas (3.3). CONCLUSIONS: After years of decline, mortality from malnutrition and GI cancers has sharply increased among older adults, with notable sex, racial, and regional disparities. These findings underscore the need for focused public health strategies to address these growing inequalities.