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Table 2 Primary outcomes in included studies

From: Interventions for preventing or treating malnutrition in homeless problem-drinkers: a systematic review

Study

Design/ duration

N

Outcome

Findings

Direction of effect / interpretation

Education, information or support

 Rusness 1993

UBA/ 1 month

7

Number with Anaemia (%)

3 (43%)

Unclear if this is due to nutrition education classes: no pre-test values; 1 month study

Number with Hypalbuminaemia (%)

1 (14%)

Eating right skill score- food frequency data (Mean change)

“One third higher than pre test scores”

Educating shelter living women in healthy eating improved nutritional intake

Numbers of women maintaining family targeted diet behaviour (%)

6 (86%)

 Derrickson 2003 (RCT)

RCT/ 1 month

210

Mean (SD) intake of fruit servings per day in compared groups post intervention

Intervention = 6.6 (7.5) Control = 4.5 (4.8)

Nutrition workshop increased average fruit and vegetable intake

Mean (SD) intake of vegetable servings per day in compared groups post intervention

Intervention = 8.3 (7.8) Control = 6.3 (6.2)

 Johnson 2009

UBA/ 10 months

50

Proportion who ate more fruit and vegetables compared to baseline

19%

Nutrition education classes made more people eat fruit and vegetable and yogurt, and =avoid carbohydrate

Proportion who ate more yogurt compared to baseline

3%

Proportion who tried to limit carb intake compared to baseline

22%

Mean (SD) of fruit servings eaten daily

Pre-test = 0.83 (0.71) Post-test = 0.7 (0.65)

Nutrition education classes decreased mean fruit intake and increased carbohydrate intake

Mean (SD) servings of bread, cereal, pasta, and rice (eaten) daily

Pre-test = 1.44 (1.16) Post-test = 1.83 (1.29)

 Bonevski 2012

UBA/ 1.5 months

6

Proportion who tried to eat more fruit N (%)

4(66%)

Intervention increased attempts to eat fruit and vegetable

Proportion who tried to eat more vegetable N (%)

6 (100%)

 Rustad 2013

UBA/ 1.5 months

118

Mean (SD) of fruit serving intake

Pre-test = 1.3 (1.3) Post-test = 1.6 (1.4)

Nutrition and health education sessions increased fruit and vegetable intake

Mean (SD) of vegetable serving intake

Pre-test = 1.5 (1.3) Post-test = 1.9 (1.5)

 Barbour 2016

UBA/ 6 months

5

Mean (range) fruit servings eaten/ day (compared to reference Daily recommended values)

Pre-test = 0.8 (0, 2.2) Post-test = 0.4 (0.0, 1.0)

Food literacy programme decreased mean fruit intake and mean diet quality score.

Mean (range) vegetable servings eaten/ day (compared to reference Daily recommended values)

Pre-test = 2.7 (0.0, 11.9) Post-test = 3.6 (0.0, 12.0)

Intervention increased mean vegetable, iron, vitamin C, folate, calcium, and total energy intake

Mean (range) intake of Folate (B9) mg/day

Pre-test = 256 (211, 272) Post-test = 309 (108, 551)

Mean (range) intake of Calcium mg/day

Pre-test = 655 (365, 998) Post-test = 771 (423, 1367)

Mean (range) intake of Iron mg/day

Pre-test = 9.9 (6.6, 14.4) Post-test = 10.4 (5.3, 15.9)

Mean (range) vitamin C intake mg/24 h

Pre-test = 67 (10, 159) Post-test = 72 (0, 143)

Mean (range) diet quality score (max 100)

Pre-test = 45 (38, 61) Post-test = 41 (27, 60)

Mean (range) daily energy intake kJ

Pre-test = 7981 (2574, 11,384) Post-test = 10,244 (6321, 15,152)

Supplement provision

 Darnton-Hill 1986

Comparative survey/ 24 months

106

% deficient in vitamin B1

NV gp = 45 V gp = 25

Oral vitamin supplements reduced the number of people with vitamin deficiency

% deficient in vitamin B6

NV gp = 63 V gp = 21

% deficient in vitamin C

NV gp = 29 V gp = 10

% deficient in vitamin B12

NV gp = 0 V gp = 0

% deficient in folate (B9)

NV gp = 80 V gp = 49

% deficient in iron

NV gp = 12 V gp = 15

% deficient in zinc

NV gp = 25 Vgp = 25

Mean (SD) levels of TPP%

NV gp = 15.3 (10.5) V gp = 10.5 (9.9)

Oral vitamin supplements don’t always improve group mean levels of vitamins

Mean (SD) levels of vitamin B6 P5P%

NV gp = 57 (26.6) V gp = 36.2(31.4)

Mean (SD) levels of vitamin C μmol/L

NV gp = 34.9 (16.2) V gp = 72.6 (35.2)

Mean (SD) levels of serum Folate ng/ml

NV gp = 3.6 (4.0) V gp = 5.2 (4.0)

Mean (SD) levels of vitamin B 12 pmol/L

NV gp = 341 (203) V gp = 433 (223)

 Drijver 1993

UBA/ NR

9

Mean Tk activity increase (units)

Single injection: Before = 9.6; day 14 = 11.8

Multivitamin injection keeps vitamin levels up for 14 days.

Weekly injection: Before = 10.2; day7 = 12; day21 = 11.2; day35 = 12

Mean TDP effect (%)

Single injection: Before = 18; day 14 = 9

Weekly injection: Before = 17; day7 = 3; day21 = 5; day 35 = 5

Food provision

 Murakami 2013

UBA/ NR

315

% of Clients eating below recommended energy intake

79.0

The hot meals do not fulfil energy needs for most participants, and even though provide a high fibre diet, still contribute to higher than recommended fat and saturate intake in many participants.

Mean (SD) 24 h Energy intake kcal

948.55 (108.75)

Proportion with above average fibre intake

62.9%

Proportion with saturated fat above the recommended levels

22%

Proportion with cholesterol intake above the recommended levels

41%

 Allen 2014

UBA/ 12 months

78

Proportion eating more frequently and gaining weight

Numbers not reported: “many clients eat more frequently, and experience positive weight gain”

A subsidy to have one meal per day n may increase food intake

Multicomponent interventions

 Kendzor 2016

RCT/ 1 month

32

Mean (cups) vegetable and fruit intake

Intervention = 3.56; controls =2; MD = 1.5 cups more in intervention at 4 week follow up

Newsletters, fruit/vegetables & pedometers with walking goals are able to increase fruit and vegetable intake

 Wiecha 1993

Comparative survey/ 9 months

77

Mothers’ Mean (mg) Vitamin B6 intake per 1000 kcal

Kitchen facilities with or without food support (shelter group) = 0.68; no facilities or food(hotels group) = 0.55

Provision of full kitchen facilities with or without added food support can increase intake of important micronutrients but not total protein or energy intake for families

Mothers’ Mean (mg) Vitamin C intake per 1000 kcal

Kitchen facilities with or without food support (shelter group) = 61; no facilities or food(hotels) group =41

Mothers’ Mean (g) protein intake per 1000 kcal

Kitchen facilities with or without food support (shelter group) = 35; no facilities or food(hotels) group =33

Mothers’ Mean Energy (kcal) intake per 1000 kcal

Kitchen facilities with or without food support (shelter group) = 1980; no facilities or food(hotels) group =2016

 Kadoura 2014

UBA/ 1 month

25

Mean change in frequency of fruit and vegetable intake (Cohen’s D)

0.56

Family physical activity, education/training, and a ‘healthy dinner ‘increased both amount and frequency of fruit and vegetable intake

Mean change in amount of fruit and vegetable intake (Cohen’s D)

0.87

 Grazioli 2015

UBA/ 3 months

6

AST levels median (IQR) units

Baseline = 64.5 (34.5, 95.5), follow up = 60 (29.25, 90.5), Wilcoxon signed rank test = −0.77

Detoxification with naltrexone and harm-reduction counselling with a focus on better diet habits led to no change in liver function tests post intervention

ALT levels median (IQR) units

Baseline = 40.5 (30.25, 51.5), follow up = 32 (21.5, 56.75), Wilcoxon signed rank test = − 0.7

  1. ASTaspartate transaminase, ALT alanine transaminase, B1 thiamine, B2 riboflavin, B3 niacin, B5 pantothenic acid,B6 pyridoxine, B7 biotin, B9 folic acid, B12 cobalamins, C ascorbic acid, g gram, gp group, kcal kilocalories, kJ kilojoules, L litre, MD mean difference, mg milligram, mmol millimoles, nmol nanomoles, μmol micromoles, N number of participants, NR not reported, NV no vitamin, pmol picomoles, P5P pyridoxal 5 phosphate, RCT randomised controlled trial, SD standard deviation, Tk transketolase, TDP thiamine diphosphate, TPP thiamine pyrophosphate, UBA uncontrolled before and after study, V vitamin