Homelessness is present in most societies and represents a situation in which the basic needs for survival including food are often limited. It is logical to surmise that the homeless person's diet is likely to be nutritionally deficient and yet there is a relative paucity in research regarding this issue with studies varying in both their methodology and homeless population. Despite these differences, diets of the homeless are frequently characterised as high in saturated fat and deficient in fibre and certain micronutrients, all of which can have negative implications for the homeless individual's health and/or mental state. The conclusion from intervention studies is that there is no consensus as to the most effective method for assessing dietary intake. In order to address this, the present review aims to provide a greater understanding of the existing literature surrounding nutrition and the homeless and to act as a foundation from which further research can be conducted. An evaluation of the main findings and challenges surrounding the assessment of the nutritional status of the homeless will be provided followed by a review of the physical and mental consequences of the homeless diet. Current and potential interventions aimed at increasing the nutritional quality of food consumed by the homeless will be addressed with a focus on the role of the nutritional science community in assisting in this endeavour.

Malnutrition has been reported in the homeless, yet the specific nutritional issues faced by each homeless community are unclear. This is in part due to nutrient intake often being compared with dietary reference values as opposed to a comparative housed population. In addition, the complex interplay between nutrient intake, reward mediated behaviour and mental illness is frequently overlooked. This study aimed to compare the dietary intake, nutritional status and mental wellbeing of homeless and housed adults. Homeless (n 75) and matched housed (n 75) adults were recruited from Reading (UK). Nutrient intake was determined using the European Prospective Investigation into Cancer and Nutrition Norfolk FFQ. The Patient Health Questionnaire: Somatic Anxiety Depressive Symptoms (PHQ-SADS) assessed for signs of mental illness. Demographic, behavioural and physiological information was collected using closed-ended questions and anthropometric measurements. Overall, dietary intake was poorer in homeless adults who reported higher intakes of salt (8·0 v. 6·4 g, P=0·017), SFA (14·6 v. 13·0 %, P=0·002) and alcohol (5·3 v. 1·9 %, P<0·001) and lower intakes of fibre (13·4 v. 16·3 g, P<0·001), vitamin C (79 v. 109 mg, P<0·001) and fruit (96 v. 260 g, P<0·001) than housed. Smoking, substance misuse and PHQ-SADS scores were also higher in the homeless (P<0·001). Within the homeless population, street homeless (n 24) had lower SFA (13·7 v.15·0 %, P=0·010), Ca (858 v. 1032 mg, P=0·027) and milk intakes (295 v. 449 g, P=0·001) than hostel residents (n 51), which may reflect the issues with food storage. This study highlights the disparity between nutritional status in homeless and housed populations and the need for dietary intervention in the homeless community.

Homelessness, which includes individuals sleeping rough (on the streets) or in hostels/temporary accommodation, increased 34% between 2011 and 2014 (1) . Homeless adults have greater physical and mental health needs and elevated levels of acute and chronic disease (2). Although malnutrition and wasting have been reported in the homeless (3) , the specific nutritional issues faced by each homeless community remain unclear. Food availability is a major problem for street homeless individuals and whilst some hostels provide meals, these may not adhere to national dietary recommendations.The aim of this study was to compare the dietary intake, nutritional status and wellbeing of street homeless and hostel residents in Reading (UK).Street homeless (n 24) and hostel residents (n 52) were recruited from the Reading region. Dietary intake was determined using the European Prospective Investigation into Cancer and Nutrition (EPIC) Norfolk Food Frequency Questionnaire (FFQ). The Patient Health Questionnaire: Somatic Anxiety Depressive Symptoms (PHQ-SADS) assessed for signs indicative of mental illness. Demographic, behavioural and physiological information was collected using closed-ended questions and anthropometric measurements. General linear models were adjusted for age, gender and ethnicity.Street homeless and hostel residents were aged 38 (SD 10·4) and 38 (SD 10·5) years with a body mass index of 23 kg/m 2 and 25 kg/m 2 respectively (P = 0·371) Reported intakes of saturated fat (SFA) (15·0 %TE vs. 13·6 %TE, P = 0·039), milk (449 g vs. 229 g, P = 0·005) and potato (107 g vs. 63 g, P = 0·021) were all significantly higher in hostel residents compared with street homeless, although street homeless individuals had a higher intake of soups and sauces (83 g vs. 48 g, P = 0·002). Additionally, daily intakes of SFA exceeded, and non-starch polysaccharide (NSP) (13·4 g, SD 7·9) and fruit and vegetables (F&V) (3·7 portions) failed to meet government recommendations and that reported in the general population (12·6 % SFA, 13·7 g NSP, 4·1 portions F&V). In total, 73 % of homeless adults reported having enough to eat, with the majority consuming 2 meals a day (n 35). Handgrip strength (P = 0·028) and PHQ9 scores (P = 0·011) were significantly higher in street homeless individuals than hostel residents, with depression (PHQ-9) reaching a 'moderate' classification.Homeless individuals demonstrated poorer dietary intakes than the general population, with street homeless at a significant disadvantage. Interventions to improve dietary intake are urgently needed, although may need to be targeted to the specific needs of the homeless groups.