{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:16:34Z","timestamp":1786115794159,"version":"build-2736575974"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Malnutrition is highly prevalent among patients with gastrointestinal (GI) malignancies and is further aggravated by comorbid chronic conditions, substantially increasing healthcare expenditures. However, few studies have dissected the cost composition of malnutrition management or identified its determinants in this comorbid population. This study aimed to characterize the composition of malnutrition management costs and explore their influencing factors among GI cancer patients with comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted at a tertiary hospital in Yinchuan, China. A total of 418 GI cancer inpatients with at least one chronic comorbidity, diagnosed with malnutrition between October 2024 and October 2025, were enrolled. Data on demographic characteristics, disease profiles, nutritional treatment modalities, and itemized hospitalization costs were extracted from the Hospital Information System (HIS). Malnutrition management costs were categorized into seven domains. Multivariable generalized linear models (Gamma distribution, log link) were fitted to identify independent cost determinants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median total malnutrition management cost was USD 833.61 (IQR: 386.21\u20131,391.72). Pharmaceutical cost constituted the largest share (57.35%), followed by laboratory cost (18.32%). Generalized linear model analysis showed that length of hospital stay was significantly positively associated with total cost: patients hospitalized for 10\u201319 days and \u226520 days incurred 2.06-fold (\u03b2 = 0.722,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001) and 3.35-fold (\u03b2 = 1.210,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001) higher costs, respectively. Surgery (\u03b2 = 0.263,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.005), combined parenteral and enteral nutrition (\u03b2 = 0.945,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), and total parenteral nutrition (\u03b2 = 0.929,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001) were also significantly positively associated with total costs. Comorbidity burden (\u22653 chronic diseases: \u03b2 = 0.247,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.003; endocrine and metabolic diseases: \u03b2 = 0.235,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.001) and moderate malnutrition (\u03b2 = 0.211,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.010) showed significant positive associations. Conversely, radiotherapy (\u03b2 = \u22120.593,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001) and respiratory comorbidities (\u03b2 = \u22120.295,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001) were significantly negatively associated with total costs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pharmaceutical cost dominates malnutrition management costs in GI cancer patients with comorbidities. Hospital stay duration, nutritional intervention intensity, and comorbidity burden were independently associated with cost variability. These findings may inform clinicians and health policymakers in efforts to optimize resource allocation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1868778","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T05:33:34Z","timestamp":1785994414000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Composition and influencing factors of malnutrition management costs among gastrointestinal cancer patients with chronic comorbidities"],"prefix":"10.3389","volume":"14","author":[{"given":"Ronghuan","family":"Zhang","sequence":"first","affiliation":[{"name":"School of Nursing, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danlu","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Nursing, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Nursing, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, People's Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lixue","family":"Cui","sequence":"additional","affiliation":[{"name":"School of Nursing, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Zhou","sequence":"additional","affiliation":[{"name":"School of Nursing, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1437","DOI":"10.1360\/SSV-2020-0297","article-title":"Investigation of nutritional status in Chinese patients with common cancer","volume":"50","author":"Li","year":"2020","journal-title":"Sci Sin Vitae."},{"key":"B3","doi-asserted-by":"publisher","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":"B4","doi-asserted-by":"publisher","first-page":"80","DOI":"10.3390\/cancers18010080","article-title":"Risk of malnutrition in digestive system cancers: a systematic review and meta-analysis","volume":"18","author":"Budai","year":"2025","journal-title":"Cancers."},{"key":"B5","doi-asserted-by":"publisher","first-page":"273","DOI":"10.16151\/j.1007-810x.2025.05.002","article-title":"Evaluating the factors influencing hospitalization costs of malnourished patients based on variations in DRG cost coefficients","volume":"32","author":"Jianmei","year":"2025","journal-title":"Parenter Enter Nutr."},{"key":"B6","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1186\/s12885-025-13517-1","article-title":"Effect of comorbidity classes on survival of patients with gastrointestinal tract cancer","volume":"25","author":"Gao","year":"2025","journal-title":"BMC Cancer."},{"key":"B7","doi-asserted-by":"publisher","first-page":"47","DOI":"10.19870\/j.cnki.11-3716\/ts.20251112.001","article-title":"Assessment of malnutrition status and analysis of influencing factors in hospitalized patients based on the GLIM criteria","volume":"31","author":"Qingyun","year":"2025","journal-title":"Food Nutr China."},{"key":"B8","year":"2024","journal-title":"CSCO Guidelines for Nutritional Therapy of Patients with Malignant Tumors."},{"key":"B9","volume-title":"Collaborating Center in China. 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