Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2017

Open Access 01-12-2017 | Systematic review

Nutritional deficiencies in homeless persons with problematic drinking: a systematic review

Authors: Sharea Ijaz, Joni Jackson, Helen Thorley, Katie Porter, Clare Fleming, Alison Richards, Adrian Bonner, Jelena Savović

Published in: International Journal for Equity in Health | Issue 1/2017

Login to get access

Abstract

Background

A significant proportion of homeless people drink alcohol excessively and this can lead to malnutrition and consequent medical problems. The aim of this review was to assess the evidence on the range of nutritional deficiencies in the homeless problem-drinking populations.

Methods

We conducted a comprehensive search of nine scientific literature databases and 13 grey literature sources. We included studies of any design that included homeless population with problem-drinking and reported measures of nutritional deficiencies in urine or blood. Study selection and data extraction was done by one reviewer and checked by another. Data on malnutrition profile were summarized narratively.

Results

We found nine studies reporting nutritional deficiencies in homeless populations with problem-drinking. The oldest study was from the 1950s and the most recent from 2013. The following nutrients were reported across studies: vitamins B1, B2, B6, B9, B12, C, A, and E; haemoglobin; and albumin. The most common deficiencies reported were of vitamin B1 (prevalence of deficiency was 0, 2, 6, 45, and 51% in five studies) and vitamin C (29, 84, and 95% in three studies). None of the studies were assessed to be at a low risk of bias.

Conclusions

The limited, low quality and relatively old evidence suggests that homeless people who drink heavily may be deficient in vitamin C, thiamine, and other nutrients. New, well conducted studies are needed in order to optimally inform public health interventions aimed at improving deficiencies in this population.

Trial Registration

PROSPERO CRD42015024247
Appendix
Available only for authorised users
Literature
1.
Homeless Link. The unhealthy state of homelessness. In: Health Audit Results 2014. London: Homeless Link; 2014. p. 23.
2.
Salaspuro M. Nutrient intake and nutritional status in alcoholics. Alcohol Alcohol. 1993;28:85–8.PubMed
3.
4.
Thomson AD, Cook CCH, Touquet R, Henry JA. The Royal College of Physicians Report on Alcohol: Guidelines For Managing Wernicke’s Encephalopathy In The Accident And Emergency Department. Alcohol Alcohol. 2002;37:513–21.CrossRefPubMed
5.
6.
Thorley H, Porter K, Fleming C, Jones T, Kesten J, Marques E, Richards A, Savovic J. Interventions for preventing or treating malnutrition in problem drinkers who are homeless or vulnerably housed: protocol for a systematic review. Syst Rev. 2015;4:131.CrossRefPubMedPubMedCentral
7.
8.
Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, Baker P, Smith E, Buchbinder R. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012;65:934–9.CrossRefPubMed
9.
Loney PL, Chambers LW, Bennett KJ, Roberts JG, Stratford PW. Critical appraisal of the health research literature: prevalence or incidence of a health problem. Chronic Dis Can. 1998;19:170–6.PubMed
10.
Boyle MH. Guidelines for evaluating prevalence studies. Evid Based Ment Health. 1998;1:37–9.CrossRef
11.
Munn Z, Moola S, Riitano D, Lisy K. The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence. Int J Health Policy Manag. 2014;3:123–8.CrossRefPubMedPubMedCentral
12.
Darnton-Hill I, Ash S. Dietary and alcohol intake patterns of a sample of homeless men in Sydney, Australia. J Hum Nutr Diet. 1988;1:397–408.CrossRef
13.
Darnton-Hill I, Sriskandarajah N, Craig GK, Truswell AS. Vitamin status of homeless men, Proceedings of the Nutrition Society of Australia, vol. 11. 1986.
14.
Darnton-Hill I, Sriskandarajah N, Stewart PM, Craig G, Truswell AS. Vitamin supplementation and nutritional status in homeless men. Aust J Public Health. 1993;17:246–51.CrossRefPubMed
15.
Darnton-Hill I, Truswell AS. Thiamin status of a sample of homeless clinic attenders in Sydney. Med J Aust. 1990;152:5–9.PubMed
16.
Drijver E, Van Strik R. Influence of intramuscular vitamin-B supplementation on TK activity and TDP-effect in erythrocytes in alcoholics. [Dutch]. TGO - Tijdschrift voor Therapie Geneesmiddel en Onderzoek. 1993;18:132–7.
17.
Figueroa WG, Sargent F, Imperiale L, Morey GR, Paynter CR, Vorhaus LJ, Kark RM. Lack of avitaminosis among alcoholics: its relation to fortification of cereal products and the general nutritional status of the population. J Clin Nutr. 1953;1:179–99.PubMed
18.
Kubisova D, Dlouhy P, Rambouskova J, Andel M. Absence of protein-energy malnutrition in Prague homeless. Int J Public Health. 2008;53:57–63.CrossRefPubMed
19.
Lee HJ, Shin J, Hong K, Jung JH. Vitamin C Deficiency of Korean Homeless Patients Visiting to Emergency Department with Acute Alcohol Intoxication. J Korean Med Sci. 2015;30:1874–80.CrossRefPubMedPubMedCentral
20.
Lee HJ, Shin JH, Kang E, Jung J, Kim DK. Vitamin B and C levels of homeless patients who visit the emergency department with alcohol ingestion. Crit Care. 2014;18:S155.CrossRef
21.
Malmauret L, Leblanc J, Cuvelier I, Verger P. Dietary intakes and vitamin status of a sample of homeless people in Paris. Eur J Clin Nutr. 2002;56:313–20.CrossRefPubMed
22.
van der Westhuyzen J, Davis RE, Icke GC, Metz J. Thiamine deficiency in black male hostel-dwellers. The need for thiamine supplementation of sorghum beer. S Afr Med J. 1987;71:231–4.PubMed
23.
Fung AT, Rimmer J. Hypophosphataemia secondary to oral refeeding syndrome in a patient with long-term alcohol misuse. Med J Aust. 2005;183:324–6.PubMed
24.
25.
Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, Fuleihan GE, Josse RG, Lips P, Morales-Torres J, Advisors IOFCS. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int. 2009;20:1807–20.CrossRefPubMed
26.
SACN. Vitamin D and Health. UK: Scientific Advisory Committee on Nutrition; 2016.
27.
Kettaneh A, Stirnemann J, Fain O, Letellier E, Thomas M. [Micronutrients status of Ile-de-France inhabitants. A literature review]. Rev Med Interne. 2004;25:507–13.CrossRefPubMed
28.
Leevy CM, Moroianu SA. Nutritional aspects of alcoholic liver disease. Clin Liver Dis. 2005;9:67–81.CrossRefPubMed
29.
30.
Auerhahn C. Recognition and management of alcohol-related nutritional deficiencies. Nurse Pract. 1992;17:40. 43–44, 49.PubMed
31.
Klein S, Iber FL. Alcoholism and associated malnutrition in the elderly. Nutrition. 1991;7:75–9.PubMed
32.
33.
Wiecha JL, Dwyer JT, Dunn-Strohecker M. Nutrition and health services needs among the homeless. Public Health Rep. 1991;106:364–74.PubMedPubMedCentral
34.
Foster R, Lunn J. 40th Anniversary Briefing Paper: Food availability and our changing diet. Nutr Bull. 2007;32:187–249.CrossRef
35.
Steyn NP, Bradshaw D, Norman R, Joubert JD, Schneider M, Steyn K. Dietary changes and the health transition in South Africa: implications for health policy. In: Division NaCP, editor. The double burden of malnutrition Case studies from six developing countries. Rome: Food and Agriculture Organization of the United Nations; 2006. p. 259–304.
36.
Imamura F, Micha R, Khatibzadeh S, Fahimi S, Shi P, Powles J, Mozaffarian D, on behalf of the Global Burden of Diseases N, Chronic Diseases Expert G. Dietary quality among men and women in 187 countries in 1990 and 2010: a systematic assessment. Lancet Glob Health. 2015;3:e132–42.CrossRefPubMedPubMedCentral
37.
Micha R, Khatibzadeh S, Shi P, Fahimi S, Lim S, Andrews KG, Engell RE, Powles J, Ezzati M, Mozaffarian D, et al. Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys. BMJ. 2014;348:g2272.CrossRefPubMedPubMedCentral
38.
Darnton-Hill I. Overview: Rationale and Elements of a Successful Food-Fortification Programme. Food Nutr Bull. 1998;19:92–100.CrossRef
39.
Fletcher RJ, Bell IP, Lambert JP. Public health aspects of food fortification: a question of balance. Proc Nutr Soc. 2007;63:605–14.CrossRef
40.
Reeve K, Batty E. The hidden truth about homelessness. London: Crisis; 2011.
41.
Reijnierse GLA, Van Der Horst AR, De Kloet K, Voorhorst CD. A radiochemical method for the determination of transketolase activity in erythrocyte hemolysates. Clin Chim Acta. 1978;90:259–68.CrossRefPubMed
42.
Ihara HHA, Wang L, Okada M, Hashizume N. Reference values for whole blood thiamine and thiamine phosphate esters in Japanese adults. J Anal Bio-Sci. 2005;28:241–6.
43.
Itokawa Y, Hashizume N, Asano M, Igarashi O, Mino M, Ihara H, Ishiwata Y, Kadowaki H, Kubota N, Okazaki M, et al. Proposed standard for human blood vitamin B1 value using HPLC. The Committee for Vitamin Laboratory Standards, Japan. Biofactors. 1999;10:295–9.CrossRefPubMed
44.
McLean E, de Benoist B, Allen LH. Review of the magnitude of folate and vitamin B-12 deficiencies worldwide. Food Nutr Bull. 2008;29:S38–51.CrossRefPubMed
45.
Williamson P, Altman D, Blazeby J, Clarke M, Gargon E. Driving up the Quality and Relevance of Research Through the Use of Agreed Core Outcomes. J Health Serv Res Policy. 2012;17:1–2.CrossRefPubMed
46.
Kirkham JJ, Boers M, Tugwell P, Clarke M, Williamson PR. Outcome measures in rheumatoid arthritis randomised trials over the last 50 years. Trials. 2013;14:324.CrossRefPubMedPubMedCentral
47.
Darmon N. A fortified street food to prevent nutritional deficiencies in homeless men in France. J Am Coll Nutr. 2009;28:196–202.CrossRefPubMed
48.
Manzardo AM. Clinical outcomes associated with benfotiamine treatment in chronic, severe alcohol dependence. Alcohol Clin Exp Res. 2014;38:310A.CrossRef
49.
50.
Centerwall BS, Criqui MH. Prevention of the Wernicke-Korsakoff syndrome: a cost-benefit analysis. N Engl J Med. 1978;299:285–9.CrossRefPubMed
51.
Fischer AJ, Yellowlees PM. Prevention of the Wernicke-Korsakoff syndrome in Australia: a cost-benefit analysis. Med J Aust. 1989;150:311–3. 317.PubMed
52.
Kamien M. The repeating history of objections to the fortification of bread and alcohol: from iron filings to folic acid. Med J Aust. 2006;184:638–40.PubMed
53.
Wodak A, Cooney A. Do Needle Syringe Programs Reduce HIV Infection Among Injecting Drug Users: A Comprehensive Review of the International Evidence. Subst Use Misuse. 2006;41:777–813.CrossRefPubMed
54.
Kleinig J. Thinking Ethically About Needle and Syringe Programs. Subst Use Misuse. 2006;41:815–25.CrossRefPubMed
55.
Gelberg L, Linn LS. Social and physical health of homeless adults previously treated for mental health problems. Hosp Community Psychiatry. 1988;39:510–6.PubMed
Metadata
Title
Nutritional deficiencies in homeless persons with problematic drinking: a systematic review
Authors
Sharea Ijaz
Joni Jackson
Helen Thorley
Katie Porter
Clare Fleming
Alison Richards
Adrian Bonner
Jelena Savović
Publication date
01-12-2017
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2017
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-017-0564-4

Other articles of this Issue 1/2017

International Journal for Equity in Health 1/2017 Go to the issue

Research

Prevalence of malnutrition and associated factors in children aged 6–59 months among rural dwellers of damot gale district, south Ethiopia: community based cross sectional study

Research

Factors associated with gender equality among church-going young men in Kinshasa, Democratic Republic of Congo: a cross-sectional study

Research

The equity of China’s emergency medical services from 2010–2014

Research

Gender difference in utilization willingness of institutional care among the single seniors: evidence from rural Shandong, China

Research

Progressive disability in elderly population among tribals of Telangana: a cross sectional study

Research

Allocating health care resources: a questionnaire experiment on the predictive success of rules