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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