Characterizing the Nutritional Health of Unaccompanied Homeless Youth

Background and Aim: There is a lack of information about the nutritional health of homeless youth, one of the most vulnerable populations within society. Nutritional health influences the risk for poorer health outcomes. Homeless youth experience various challenges that could be related to their nutritional health. The goal of this study is to characterize the nutritional and dietary status of a sample of homeless youth in a Midwestern city in the U.S., and identify factors associated with their dietary patterns. It was hypothesized that youth would exhibit poor nutritional outcomes based on established standards indicative of good nutritional status.
Methods: An observational study was conducted of homeless youth recruited from a drop-in center in Columbus, Ohio. Socio-demographic characteristics, homeless experiences, and dietary intake data were collected. Anthropometric assessments and a serum blood sample were also done. Dietary intake data was based on 24-hour dietary recalls collected on two nonconsecutive days and a food frequency questionnaire (FFQ). Nutrient intakes were adjusted to usual intake and compared to Estimated Average Requirements (EAR) for age and gender to determine adequacy of intakes. The FFQ was used to assess diet quality and determine a healthy eating index (HEI) score. Descriptive statistics were used in characterizing the sample, along with exploration into associations between participant characteristics and diet quality. 
Results: A final sample of 132 youth was attained. Over two thirds of the youth were male. Most of the youth had completed high school (66%), yet 61% are currently unemployed. More than half the males were of normal weight, while 41% were either overweight or obese. For females, over half were obese, with 23% being morbidly obese. About a third of males and over two-thirds of females had waist-to-hip ratios that were above the cut-point. Likewise, waist-to-height ratios revealed that 55% of males and 85% of females were at increased cardiometabolic risk. Over 90% of males had inadequate intakes of vitamin A and D3, along with calcium and magnesium. For females, 100% had inadequate intakes of vitamin A, C, and D3, with greater than 90% failing to achieve adequate vitamin E and calcium. Analysis of serum vitamin D blood samples revealed that 80% of participants were either deficient or insufficient. The mean HEI score for the total sample population was 51.85, with a little over half the participants falling into the “fair” diet category. There were no significant differences in diet quality by all participant characteristics except age at first homelessness. Those who were homeless at 15 years of age or younger had significantly lower HEI scores than those who became homeless at an older age.
Conclusion: Inadequate nutrient intake as well as overweight and obesity are prevalent among homeless youth. Our findings support consequences of difficulty with food access reported within this population and low HEI scores. In addition, age at first homelessness may impact diet quality. Overall, poor weight status and a poor diet may expose homeless youth to poorer health outcomes.

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