title: Interventions for preventing or treating malnutrition in problem drinkers who are homeless or vulnerably housed: protocol for a systematic review.
abstract: BACKGROUND
  Problem alcohol drinking in homeless and vulnerably housed people can lead to malnutrition, which is associated with complications such as alcohol-related brain damage. Homeless alcohol drinkers are likely to have worse health outcomes and different nutritional needs compared with housed alcohol-drinking persons. It is not clear whether interventions to improve nutritional status in this population have been effective. The purpose of this review is to assess the effectiveness and cost-effectiveness of interventions for preventing or correcting micronutrient deficiencies and other forms of malnutrition and related comorbidities in this population.
  
  
  METHODS
  A systematic search for studies of a nutrition-based intervention applied in the homeless or vulnerably housed population with problem drinking will be conducted. The following electronic databases will be systematically searched for relevant studies: MEDLINE, EMBASE, Web of Science, PsycINFO, CAB abstracts, CINAHL, Cochrane Public Health Group Register and Cochrane Drugs and Alcohol Group Register. Screening of identified abstracts for relevance and assessment of papers for inclusion will be done in duplicate. One reviewer will extract data from the studies and assess quality, and this will be checked by another reviewer. Discrepancies will be resolved by consensus. The primary outcomes are (mal)nutrition status or micronutrient deficiencies or change in (mal)nutrition status or micronutrient deficiencies, measures of liver damage and cognitive function. Secondary outcomes include comorbidities, quality of life and functional scales, resources used to deliver treatment, uptake/acceptability of the intervention and engagement with treatment services. Results will be analysed descriptively, and, if appropriate, meta-analyses will be performed.
  
  
  CONCLUSIONS
  The results of this review should help to inform the development of effective interventions that can be implemented in the community to improve the health of homeless people who are problem drinkers.
  
  
  BACKGROUND
  PROSPERO CRD42015024247.
authors.affiliation: The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK. helen.thorley@bristol.ac.uk.|School of Social and Community Medicine, University of Bristol, Bristol, UK. helen.thorley@bristol.ac.uk.
authors.forename: Helen
authors.initials: H
authors.lastname: Thorley
authors.affiliation: Bristol City Council, St Anne's House, St Anne's Road, Bristol, BS4 4AB, UK. Katie.Porter@bristol.gov.uk.
authors.forename: Katie
authors.initials: K
authors.lastname: Porter
authors.affiliation: Compass Health, The Compass Centre, 1 Jamaica Street, Bristol, BS2 8JP, UK. Clare.Fleming2@nhs.net.
authors.forename: Clare
authors.initials: C
authors.lastname: Fleming
authors.affiliation: The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK. Timothy.Jones@bristol.ac.uk.|School of Social and Community Medicine, University of Bristol, Bristol, UK. Timothy.Jones@bristol.ac.uk.
authors.forename: Tim
authors.initials: T
authors.lastname: Jones
authors.affiliation: The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK. Jo.Kesten@bristol.ac.uk.|School of Social and Community Medicine, University of Bristol, Bristol, UK. Jo.Kesten@bristol.ac.uk.
authors.forename: Joanna
authors.initials: J
authors.lastname: Kesten
authors.affiliation: The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK. E.Marques@bristol.ac.uk.|School of Social and Community Medicine, University of Bristol, Bristol, UK. E.Marques@bristol.ac.uk.
authors.forename: Elsa
authors.initials: E
authors.lastname: Marques
authors.affiliation: The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK. Alison.Richards@bristol.ac.uk.|School of Social and Community Medicine, University of Bristol, Bristol, UK. Alison.Richards@bristol.ac.uk.
authors.forename: Alison
authors.initials: A
authors.lastname: Richards
authors.affiliation: The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK. J.Savovic@bristol.ac.uk.|School of Social and Community Medicine, University of Bristol, Bristol, UK. J.Savovic@bristol.ac.uk.
authors.forename: Jelena
authors.initials: J
authors.lastname: Savović
mesh_terms: D000437:Alcoholism / Q000150:complications*; D003071:Cognition; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics; D006703:Ill-Housed Persons / Q000523:psychology; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000209:etiology; D044342:Malnutrition / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy*; D018977:Micronutrients / Q000172:deficiency; D009752:Nutritional Status; D010342:Patient Acceptance of Health Care; D011788:Quality of Life; D012107:Research Design; D000078202:Systematic Reviews as Topic
chemical_list: D018977:Micronutrients