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

Abstract

BackgroundExcessive drinking leads to poor absorption of nutrients and homeless problem-drinkers often have nutritionally inadequate diets. Depletion of nutrients such as vitamin B1 can lead to cognitive impairment, which can hinder efforts to reduce drinking or engage with services. This review aimed to assess effectiveness of interventions designed to prevent or treat malnutrition in homeless problem-drinkers.MethodsWe systematically searched nine electronic databases and 13 grey literature sources for studies evaluating interventions to improve nutrition in homeless populations, without regional or language restrictions. Screening for inclusion was done in duplicate. One reviewer extracted data and assessed risk of bias, and another checked the extractions. Primary outcomes were nutrition status/deficiency, liver damage, and cognitive function. Secondary outcomes included abstinence, comorbidities, resource use, acceptability and engagement with intervention. Results were synthesised narratively.ResultsWe included 25 studies (2 Randomised Controlled Trials; 15 uncontrolled before and after; 7 surveys; 1 case-control). Nine studies evaluated educational and support interventions, five food provision, and three supplement provision. Eight studies evaluated a combination of these interventions. No two interventions were the same, and all studies were at high risk of bias. Nutritional status (intake/ deficiency) were reported in 11 studies and liver function in one.Fruit and vegetable intake improved with some education and support interventions (n = 4 studies) but not others (n = 2). Vitamin supplements appeared to improve vitamin deficiency levels in the blood (n = 2). Free or subsidised meals (n = 4) and food packs (n = 1) did not always fulfil dietary needs, but were usually considered acceptable by users. Some multicomponent interventions improved nutrition (n = 3) but acceptability varied (n = 3). No study reported cost effectiveness.ConclusionsThe evidence for any one intervention for improving malnutrition in homeless problem-drinkers was based on single studies at high risk of bias. Various food and supplement provision interventions appear effective in changing nutritional status in single studies. Educational and multicomponent interventions show improved nutritional behaviour in some studies but not others. Further better quality evidence is required before these interventions can be recommended for implementation. Any future studies should seek the end user input in their design and conduct.Trial registrationRegistered with PROSPERO: CRD42015024247.

Systematic review of nutritional interventions for people admitted to hospital for alcohol withdrawal

“…Interventions included education, supplementation (ie, intramuscular, oral tablet or fortified food product based), and provision of food products (ie, hot meals or food rations). Although multicomponent interventions lead to improved nutritional behaviour in some studies, results were not consistent across others . Therefore, holistic and individualised nutritional interventions post admission to hospital should be formulated by a trained nutritional professional, considering psychosocial aspects of care and long term follow up and evaluation.…”

“…There were no identified studies included in this review that focussed on addressing malnutrition despite the known nutritional risk of this patient population. A recent systematic literature review undertook a review of interventions for the prevention or treatment of malnutrition in homeless problem drinkers . Although participants were not recruited from a hospital inpatient admission for alcohol withdrawal, the outcomes reported in this review are relevant when considering nutritional intervention on discharge from acute hospital based care.…”

Characteristics of Patients in Treatment for Alcohol and Drug Addiction Who Succeed in Changing Smoking, Weight, and Physical Activity: A Secondary Analysis of an RCT on Combined Lifestyle Interventions

“…In contrast, recent studies on only 1 lifestyle factor, especially smoking, have shown effects among patients with alcohol and drug addiction, but here, the interventions seem to be longer, reaching up to 12 months for smoking [3]. Another important element could be handling out healthy food products [13]. The VIP study did not include similar interventions.…”

“…This information is an integrated part of the VIP. Few studies have been conducted on food interventions, but a review including a broad variety of study designs and qualities indicates that handing out food products to homeless problem drinkers seems to be effective [13]. Overall, an effect of mono-factor interventions and not the comprehensive VIP may add to some existing general experiences of taking 1 step at a time.…”

Role of Thiamin in Health and Disease

“…One is the decrease in thiamin absorption in the small intestine, which is already mentioned above. Another reason is that alcohol intake causes decreased caloric intake from sources other than alcohol and thus reduces the supply of thiamin from the diet . In addition, liver cirrhosis, a complication of chronic alcoholism, also leads to a decreased supply of thiamin to the liver .…”