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Huang C, Foster H, Paudyal V, Ward M, Lowrie R. A systematic review of the nutritional status of adults experiencing homelessness. Public Health 2022; 208:59-67. [PMID: 35716429 DOI: 10.1016/j.puhe.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/05/2022] [Accepted: 04/29/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To identify, appraise, and describe studies focussing on the nutritional characteristics of people experiencing homelessness (PEH). STUDY DESIGN Systematic (narrative) review. METHODS We identified full-text studies of any design and in the English language of adults (≥18 years) fulfilling the European Typology criteria for homelessness, based in community or hospital settings, and which report nutritional measures. Five electronic databases, 13 grey literature sources, reference lists, and forward citations were searched. Data on study characteristics and nutrition measures were collected and synthesised narratively. Risk of bias was assessed using relevant checklists for each study type. RESULTS A total of 1130 studies were identified and retrieved. After screening, six studies were included for review: three cross-sectional studies; two case-control studies; and one randomised control trial, involving a total of 1561 participants from various settings including shelters, drop-in centres, hospitals, and hostels. All included studies were from high-income countries. Studies reported a range of nutrition measures including anthropometry (e.g., body mass index (BMI)), serum micronutrients and biomarkers, and dietary intake. Between 33.3% and 68.3% of participants were overweight or obese; 3.5%-17% were underweight; and low blood levels of iron, folate, vitamins C, D, and B12, and haemoglobin were prevalent. PEH consumed high amounts of dietary fats and alcohol, and low amounts of fruits and vegetables compared with national guidelines and housed individuals. There was moderate to high risk of selection and measurement bias and confounding in included studies. CONCLUSIONS A majority of PEH are within unhealthy BMI ranges and are deficient in serum micronutrients and nutritional biomarkers. Studies using large data sets that examine multiple aspects of nutrition are needed to describe the nutritional characteristics of PEH. REGISTRATION This systematic review is based on a prespecified protocol registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42021218900).
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Affiliation(s)
- C Huang
- School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, UK.
| | - H Foster
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, UK.
| | - V Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, UK.
| | - M Ward
- Marianne Ward, Homelessness Dietitian, Dietetics, Glasgow City HSCP, Shettleston Health Centre, 420 Old Shettleston Road, Glasgow G32 7JZ, UK.
| | - R Lowrie
- PHOENIx Team, Pharmacy Services, NHS Greater Glasgow and Clyde, UK.
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Clergue-Duval V, Azuar J, Fonsart J, Delage C, Rollet D, Amami J, Frapsauce A, Gautron MA, Hispard E, Bellivier F, Bloch V, Laplanche JL, Questel F, Vorspan F. Ascorbic Acid Deficiency Prevalence and Associated Cognitive Impairment in Alcohol Detoxification Inpatients: A Pilot Study. Antioxidants (Basel) 2021; 10:antiox10121892. [PMID: 34942994 PMCID: PMC8750659 DOI: 10.3390/antiox10121892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 12/29/2022] Open
Abstract
Malnutrition has been reported in alcohol use disorder patients as having a possible influence on cognitive function. The aim of this study was to analyse the prevalence of ascorbic acid (AA) deficiency in inpatients admitted for alcohol detoxification and the associated factors, including cognitive impairment in the early period of abstinence. A retrospective chart review was conducted. The AA level was categorised into three groups: deficiency (AAD) (<2 mg/L), insufficiency (AAI) (2–5 mg/L) and normal level. The cognitive impairment was screened using the Montreal Cognitive Assessment (MoCA). Ninety-six patients were included (74 men; mean age 49.1 years (±11.5)). Twenty-seven AAD (28.1%) and twenty-two AAI (22.9%) were observed. In multivariate analysis, risk factors for AAD versus normal AA level were men (OR 17.8, 95%CI (1.63–194)), compensated cirrhosis (OR 9.35, 95%CI (1.60–54.6)) and street homelessness (OR 5.76, 95%CI (1.24–26.8) versus personal housing). The MoCA score was available for 53 patients (mean MoCA score: 25.7 (±3.3)). In multivariate analysis, the natural logarithm of AA (β = 1.18, p = 0.037) and sedative use disorder (β = −2.77, p = 0.046) were associated with the MoCA score. AAD and AAI are frequent in inpatients admitted for alcohol detoxification. A low level of AA was associated with cognitive impairment in the early period of abstinence.
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Affiliation(s)
- Virgile Clergue-Duval
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, 75010 Paris, France; (J.A.); (D.R.); (J.A.); (E.H.); (F.B.); (F.Q.); (F.V.)
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, 75006 Paris, France; (C.D.); (V.B.); (J.-L.L.)
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
- UFR de Médecine, Université de Paris, 75006 Paris, France
- Resalcog (Réseau Pour la Prise en Charge des Troubles Cognitifs Liés à L’alcool), 75017 Paris, France
- Correspondence:
| | - Julien Azuar
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, 75010 Paris, France; (J.A.); (D.R.); (J.A.); (E.H.); (F.B.); (F.Q.); (F.V.)
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, 75006 Paris, France; (C.D.); (V.B.); (J.-L.L.)
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
- Resalcog (Réseau Pour la Prise en Charge des Troubles Cognitifs Liés à L’alcool), 75017 Paris, France
| | - Julien Fonsart
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Biochimie et Biologie Moléculaire, 75010 Paris, France;
| | - Clément Delage
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, 75006 Paris, France; (C.D.); (V.B.); (J.-L.L.)
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Service de Pharmacie, 75010 Paris, France;
| | - Dorian Rollet
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, 75010 Paris, France; (J.A.); (D.R.); (J.A.); (E.H.); (F.B.); (F.Q.); (F.V.)
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
| | - Jihed Amami
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, 75010 Paris, France; (J.A.); (D.R.); (J.A.); (E.H.); (F.B.); (F.Q.); (F.V.)
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
| | - Alexia Frapsauce
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Service de Pharmacie, 75010 Paris, France;
| | - Marie-Astrid Gautron
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
- APHP GHU Nord, Site Beaujon, Unité de Traitement Ambulatoire des Maladies Addictives, 92110 Clichy, France
| | - Eric Hispard
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, 75010 Paris, France; (J.A.); (D.R.); (J.A.); (E.H.); (F.B.); (F.Q.); (F.V.)
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
| | - Frank Bellivier
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, 75010 Paris, France; (J.A.); (D.R.); (J.A.); (E.H.); (F.B.); (F.Q.); (F.V.)
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, 75006 Paris, France; (C.D.); (V.B.); (J.-L.L.)
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
- UFR de Médecine, Université de Paris, 75006 Paris, France
| | - Vanessa Bloch
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, 75006 Paris, France; (C.D.); (V.B.); (J.-L.L.)
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Service de Pharmacie, 75010 Paris, France;
- UFR de Pharmacie, Université de Paris, 75006 Paris, France
| | - Jean-Louis Laplanche
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, 75006 Paris, France; (C.D.); (V.B.); (J.-L.L.)
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Biochimie et Biologie Moléculaire, 75010 Paris, France;
- UFR de Pharmacie, Université de Paris, 75006 Paris, France
| | - Frank Questel
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, 75010 Paris, France; (J.A.); (D.R.); (J.A.); (E.H.); (F.B.); (F.Q.); (F.V.)
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, 75006 Paris, France; (C.D.); (V.B.); (J.-L.L.)
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
- Resalcog (Réseau Pour la Prise en Charge des Troubles Cognitifs Liés à L’alcool), 75017 Paris, France
| | - Florence Vorspan
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, 75010 Paris, France; (J.A.); (D.R.); (J.A.); (E.H.); (F.B.); (F.Q.); (F.V.)
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, 75006 Paris, France; (C.D.); (V.B.); (J.-L.L.)
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
- UFR de Médecine, Université de Paris, 75006 Paris, France
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Kępka A, Zwierz P, Chojnowska S, Ochocińska A, Skorupa E, Szczepański M, Szajda SD, Waszkiewicz N. Relation of plasma carnitine and aminotransferases to alcohol dose and time of dependence. Alcohol 2019; 81:62-69. [PMID: 31029632 DOI: 10.1016/j.alcohol.2019.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Serum aspartate, alanine aminotransferases (AST, ALT), and plasma carnitine are all indirect biomarkers of alcohol abuse. Carnitine transfers long-chain fatty acids from cytoplasm to mitochondria for β-oxidation. The aim of the study was to determine the relationship between daily alcohol intake, time of alcohol dependence, plasma carnitine, and serum aminotransferases. PATIENTS We studied 26 men who were addicted for 2-30 years, consuming ethanol from 75 to 700 g/day (alcoholic group), as well as 17 healthy men (control group). RESULTS In alcoholics, compared to the controls, we found: a significant increase in serum: AST (p = 0.0014), ALT (p = 0.0071), AST/ALT ratio (p < 0.000); significantly lower plasma free carnitine (FC) (p = 0.0316) and total carnitine (TC) (p = 0.0349); and a significant negative correlation between FC (r = -0.6200; R2 = 0.3844; p = 0.0007), TC (r = -0.4365; R2 = 0.1905; p = 0.0258), and time of alcohol dependence, suggesting carnitine as an indirect marker of alcohol abuse. We did not find any significant correlation between FC, TC, and levels of alcohol or aminotransferase activity. CONCLUSION In the alcoholic group, there was an increase in serum activity of AST, ALT, and AST/ALT ratio that confirms liver injury. In addition, we found low plasma FC and TC, which may indicate damage to mitochondrial β-oxidation caused by alcohol metabolites. The significantly higher plasma FC and TC in patients consuming the most, compared to patients consuming smaller doses of alcohol, may be caused by a lower carnitine demand of injured liver cells, decreased urinary carnitine excretion by impaired renal tubules, and leakage of carnitine into the blood from damaged muscles by the higher quantities of alcohol. The negative correlation between carnitine concentration and time of alcohol dependence may suggest the potential use of carnitine for treatment of alcohol abuse.
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Micronutrient Deficiencies in Medical and Surgical Inpatients. J Clin Med 2019; 8:jcm8070931. [PMID: 31261695 PMCID: PMC6678268 DOI: 10.3390/jcm8070931] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/17/2019] [Accepted: 06/21/2019] [Indexed: 02/06/2023] Open
Abstract
Inpatients are threatened by global malnutrition, but also by specific micronutrient (i.e., trace element and vitamins) deficiencies that frequently are overseen in the differential diagnosis of major organ dysfunctions. Some of them are related to specific geographic risks (iodine, iron, selenium, zinc, vitamin A), while others are pathology related, and finally many are associated with specific feeding patterns, including low dose enteral feeding. Among the pathologies in which laboratory blood investigations should include a micronutrient outwork, anemia is in the front line, followed by obesity with bariatric surgery, chronic liver disease, kidney disease, inflammatory bowel disease, cardiomyopathies and heart failure. The micronutrients at the highest risk are iron, zinc, thiamine, vitamin B12 and vitamin C. Admission to hospital has been linked with an additional risk of malnutrition—feeding below 1500 kcal/day was frequent and has been associated with a structural additional risk of insufficient micronutrient intake to cover basal needs. Although not evidence based, systematic administration of liberal thiamine doses upon admission, and daily complementation of inpatients’ food and enteral feeding solutions with multi-micronutrient tablets might be considered.
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Lee HJ, Shin J, You KM. High-Prevalence Vitamin D Deficiency among Korean Emergency Department Homeless, with a Comparison to a Healthy Korean Population. Nutrients 2019; 11:nu11040763. [PMID: 30939796 PMCID: PMC6521275 DOI: 10.3390/nu11040763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 12/23/2022] Open
Abstract
Although nutritional problems are a major concern for the homeless, their vitamin D status has not yet been widely evaluated. This study was a retrospective chart review conducted at a single academic, urban public hospital’s emergency department (ED). Patients whose serum 25-hydroxyvitamin D [25(OH)D] levels had been checked in the ED from July 2014 to June 2015 were reviewed and enrolled. For a healthy settled civilian control, 2011 and 2012 data from the Fifth Korean National Health and Nutrition Examination Survey (KNHANES) were used. A total of 179 patients were enrolled. Vitamin D deficiency was observed in 133 patients (73.7%). The vitamin D deficiency group showed a lower hemoglobin level than that of non-vitamin D deficiency group (p = 0.02). Winter visits were more common among the deficiency group (p = 0.048). Rhabdomyolysis was observed only in the deficiency homeless group (p = 0.03). When using age and sex as covariates of propensity score matching 25(OH)D levels were lower in the homeless than in the healthy control (15.7 ± 7.4 ng/mL vs. 18.2 ± 5.5 ng/mL, p < 0.001). Moreover, when the controls were limited to residents of the same city, the serum 25(OH)D level also was lower in the homeless than in the control (15.7 ± 7.4 ng/mL vs. 17.1 ± 5.4 ng/mL, p = 0.03). In summary, vitamin D deficiency was common and more frequent among homeless patients.
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Affiliation(s)
- Hui Jai Lee
- Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea.
| | - Jonghwan Shin
- Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea.
- Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea.
| | - Kyoung Min You
- Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea.
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Ijaz S, Jackson J, Thorley H, Porter K, Fleming C, Richards A, Bonner A, Savović J. Nutritional deficiencies in homeless persons with problematic drinking: a systematic review. Int J Equity Health 2017; 16:71. [PMID: 28476156 PMCID: PMC5418701 DOI: 10.1186/s12939-017-0564-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/24/2017] [Indexed: 01/22/2023] Open
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 Electronic supplementary material The online version of this article (doi:10.1186/s12939-017-0564-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sharea Ijaz
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK. .,School of Social and Community Medicine, University of Bristol, Bristol, UK.
| | - Joni Jackson
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Helen Thorley
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Katie Porter
- Bristol City Council, St Annes House, Bristol, BS4 4AB, UK
| | - Clare Fleming
- Compass Health, The Compass Centre, 1 Jamaica Street, Bristol, BS2 8JP, UK
| | - Alison Richards
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Adrian Bonner
- Research and Development Unit, The Salvation Army, London, SE1 6BN, UK
| | - Jelena Savović
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
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