# Nutrition Status of People Experiencing Homelessness Residing in Temporary Accommodation in London

## TL;DR

People experiencing homelessness in London face high malnutrition risk due to poor diet quality and food insecurity, highlighting the need for better nutrition support and guidelines.

## Contribution

This is the first study to assess malnutrition risk and dietary inequalities among homeless individuals in temporary accommodation in London.

## Key findings

- 60% of participants had a risk of malnutrition based on the MUST score.
- 44% experienced very low food security, and dietary quality was poor with low micronutrient intake.
- Mental health scores were low, with 55% showing moderate to severe depression or anxiety.

## Abstract

London has the highest proportion of people experiencing homelessness (PEH) living in temporary accommodation in the United Kingdom. PEH have poorer health outcomes, greater dietary inequalities, and die younger than the general population. Despite this, little is known about the nutrition status of PEH. This study aimed to examine the dietary health inequalities experienced by PEH in London, specifically assessing malnutrition among PEH living in temporary accommodation.

This was a prospective cross‐sectional study in 18 hostels in London. Participants were recruited from the temporary accommodation in which they resided through a combination of purposive, snowballing and convenience sampling. Demographic information was gathered, including age, gender, ethnicity and hostel of residence. The primary outcome was malnutrition risk assessed by the Malnutrition Universal Screening Tool (MUST), other outcomes included body composition, dietary intake and quality, mental health and food insecurity. Ethical approval was obtained from the University College London Ethics Committee (16191/006).

Two hundred participants were recruited between July and December 2023. The majority were male (84.5%), were of White ethnicity (61%), with a mean (SD) age of 45.7 years (11.6) and a BMI of 23.4 kg/m2 (4.7). The median MUST score was 2 (interquartile range [IQR]: 0.0, 3.0), and 60% had a risk of malnutrition. The median mental health score was 6 (3.0, 10.0), with 55% having moderate to severe depression/anxiety. Median food security score was low (4.5 [(0.0, 8.0]), with 44% experiencing very low food security. The median dietary quality score was low (8.0 [6.0, 9.0]) with low intakes of energy, fibre, and micronutrients, including vitamin D, iron, folate, and calcium, with a higher intake of free sugars compared with UK dietary recommendations and intakes.

This is the first study to show that PEH living in temporary residences had a high risk of malnutrition and experienced dietary inequalities related to poor diet quality and severe food insecurity. There is an urgent need for improved food environments, dietary quality of donated foods and improved nutrition screening and nutrition support provision for PEH in temporary accommodation. Findings could help inform policymakers, health services and food aid charities to set nutrition standards for temporary accommodation to promote the dietary health of PEH.

Malnutrition is prevalent among people experiencing homelessness alongside poorer diet quality, mental health, and high levels of food insecurity.Current nutritional screening practices appear insensitive to population‐specific nutrition risks and should be improved to promote prompt referrals for nutrition support.There is an urgent need for the development of nutrition guidelines and standards for people experiencing homelessness living in temporary accommodation.

Malnutrition is prevalent among people experiencing homelessness alongside poorer diet quality, mental health, and high levels of food insecurity.

Current nutritional screening practices appear insensitive to population‐specific nutrition risks and should be improved to promote prompt referrals for nutrition support.

There is an urgent need for the development of nutrition guidelines and standards for people experiencing homelessness living in temporary accommodation.