Malnutrition deaths are soaring in the US – especially among seniors

Malnutrition deaths are soaring in the United States — particularly among seniors — and the reasons are unclear, according to a new report.

In roughly the last 10 years, deaths linked to malnutrition have skyrocketed by a factor of six, making it the fastest-growing killer in the country, The Washington Post reported, citing data from the Centers for Disease Control and Prevention.

Malnutrition, a condition where the body lacks sufficient nutrients, often leading to weight loss and muscle wasting, remains uncommon, accounting for less than one percent of overall deaths. But, its rapid rise matches increases in mental disorders and arterial disease.

Though it hits low-income individuals especially hard, cases span all U.S. states, races, genders and education backgrounds.

In fact, just one metric indicated sizable differences: age. Those aged 85 and older die from malnutrition at a rate about 60 times higher than the rest of the American population, with deaths in that group increasing about twice as fast.

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The Post sought to uncover why seniors face such elevated and growing malnutrition levels. One reason appears to be that older people struggle to consume healthy diets.

Uche Akobundu, a dietitian who directs nutrition strategy at Meals on Wheels, told the outlet that the program’s local providers “consistently report serving seniors who struggle to afford or access nutritious food while living on fixed incomes and facing rising costs for housing, utilities and health care.”

Supporting this is the fact that Americans 65 and older reporting food insecurity reached a record high in 2023.

But this may not explain the full picture given that food insecurity increased by 5 percent from 2011 to 2023 among older Americans — a small figure compared to the 746 percent jump in malnutrition deaths over the same period.

Other experts cited by the Post provided another hypothesis: that malnutrition has always been prevalent, but it's been diagnosed more in recent years.

Malnutrition “has always been there,” Peggi Guenter, who led clinical practice, quality and advocacy at the American Society for Parenteral and Enteral Nutrition (ASPEN), said. “We’re just identifying and documenting it better than we ever have in the past.”

In the past, physicians characterized malnutrition as one part of a patient’s broader decline. But, sometime around 2010, evidence emerged that lack of proper nutrition, in and of itself, is a risk, resulting in doctors diagnosing it separately.

In 2010, roughly 3 percent of hospital patients were diagnosed with malnutrition. This figure had risen to 9 percent by 2018.

“As with other conditions, such as celiac disease, increased prevalence rates do not necessarily reflect more cases, but rather improved detection, diagnosis and intervention,” Michelle Schneider, ASPEN’s manager of clinical practice, said.

Another driver of the increase seems to be hospitals' and providers' incentives to identify malnutrition among critically ill patients.

“When hospitals are measured on their mortality, the calculation includes a comparison of how many people actually die compared to how many people are expected to die,” Kristina Newport, the chief medical officer at the American Academy of Hospice and Palliative Medicine, told the Post. “And that expected number is determined by the complexity of documented illnesses as reflected in diagnosis codes. So when there was more weight given to malnutrition as a diagnosis code — when it was better defined, based on the understanding that nutrition often correlates with severity of illness — all of a sudden, it changed the calculation.”

As a result, hospitals have a strong incentive to identify malnutrition since it is recognized as a factor that increases the odds a patient will have a poor outcome, meaning they will not be punished as much if a poor outcome occurs.

“You’re only eligible for hospice enrollment if you’re expected to die within six months and if you’re not pursuing life-prolonging treatments,” she added. “The hospice clinicians have to regularly demonstrate that somebody is progressing towards death, which is crazy, right? And so one of the ways that they have to routinely demonstrate that there’s evidence that this person is dying is to routinely assess different aspects of nutrition.”

On top of this, the people filling out death certificates are often not pathologists, and most certificates that list malnutrition likely were not signed off on by medical examiners.

“There’s a large number of people … who fill out death certificates,” Reade Quinton, the president of the National Association of Medical Examiners, said. “So you may have forensic pathologists filling them out in certain cases, you may have hospitalists filling them out, residents on service who are still in training, coroners. It’s incredibly variable depending on whose jurisdiction the death occurred in.”

“Electronic records are so accessible now,” he added. “We have a lot more information at our fingertips than we had 10 or 20 years ago. So is it possible that now they’re getting a better list of underlying conditions and saying, ‘Oh, he’s got malnutrition,’ and so they put that on there as well.”

The Post noted that this is not a “smoking gun,” but that it likely helps explain the giant increase in malnutrition deaths.

“A better understanding of malnutrition means it has appeared on more medical charts,” the outlet concluded. “And from there, it occasionally makes its way onto a death certificate, perhaps helped by a harried physician.”