Add ground beef and onions to a large pot. Cook the beef until it is no longer pink. Drain any excess fat, then stir in the garlic.
Pour in the beef broth, tomatoes, tomato paste, Worcestershire, oregano, basil, and bay leaf. Stir to combine. Bring the mixture to a boil and simmer for 5 minutes.
Add the elbow macaroni and vegetables, stir, and simmer for 8-10 minutes or until the macaroni is tender.
Season with salt and pepper (to taste) and top with shredded parmesan cheese if desired.