Background: Nutrition-related conditions, including malnutrition and food insecurity, disproportionately affect rural and medically underserved populations. Louisiana and Alabama exhibit regional disparities in food insecurity and socioeconomic factors that contribute to nutritional risk. Evaluating documentation of nutrition-specific ICD-10 codes at a medical school’s Rural and Medically Underserved Population (RMUP) clinical rotation sites may identify gaps in recognition of nutritional needs and inform targeted clinical and educational interventions. Methods: We conducted a retrospective observational study of adult patient encounters documented in the Clinical Rotation Evaluation and Document Organizer (CREDO) database at Edward Via College of Osteopathic Medicine (VCOM)-affiliated Rural and Medically Underserved Population (RMUP) clinical sites in Alabama and Louisiana between March 2022 and December 2023, classifying ICD-10 codes into nutrition-status categories using Academy of Nutrition and Dietetics criteria. Results: A total of 34,967 ICD-10 codes were analyzed. Direct nutrition-status codes were infrequently documented across both states, including low utilization of codes for dietary counseling and food insecurity. In contrast, chronic disease diagnoses such as hypertension and type 2 diabetes mellitus were frequently recorded but did not reflect nutritional status. The Endocrine, Nutrition, and Metabolic category showed a modest but statistically significant difference between states (p < 0.05). Conclusion: Nutrition-specific ICD-10 codes capturing malnutrition, nutritional deficiencies, and food insecurity were underutilized at RMUP clinical sites in both Alabama and Louisiana. These findings highlight opportunities to improve nutrition-focused assessment, documentation, and education in rural and underserved clinical settings.
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