Nutritional assessment of charitable meal programmes serving homeless people in Toronto.
ABSTRACT To assess the potential nutritional contribution of meals provided in a sample of community programmes for homeless individuals, to determine the effect of food donations on meal quality and to develop food-based guidance for meals that would meet adults' total nutrient needs.
An analysis of weighed meal records from eighteen programmes. The energy and nutrient contents of meals were compared to requirement estimates to assess contribution to total needs, given that homeless people have limited access to nutritious foods. Mixed linear modelling was applied to determine the relationship between the use of food donations and meal quality. The composition of meals that would meet adults' nutrient requirements was determined by constructing simulated meals, drawing on the selection of foods available to programmes.
In all, seventy meals, sampled from eighteen programmes serving homeless individuals.
On average, the meals contained 2.6 servings of grain products, 1.7 servings of meat and alternatives, 4.1 servings of vegetables and fruits and 0.4 servings of milk products. The energy and nutrient contents of most meals were below adults' average daily requirements. Most meals included both purchased and donated foods; the vitamin C content of meals was positively associated with the percentage of energy from donations. Increasing portion sizes improved the nutrient contribution of meals, but the provision of more milk products and fruits and vegetables was required to meet adults' nutrient requirements.
The meals assessed were inadequate to meet adults' nutrient requirements. Improving the nutritional quality of meals requires additional resources.
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ABSTRACT: The purpose of this paper is to highlight the relationships between housing, food security, and health. We begin by reviewing the current literature on the intersections of housing and food security, emphasizing the current gaps in knowledge in the areas of building infrastructure, in-house food programs, and building context for social housing. Derived from the literature review, we present a model designed to highlight the relationships between food, housing, and health. Following this, we provide a case study of housing and food security for residents of the Downtown Eastside. By examining the experiences of residents struggling to find both food and shelter within a very low-income context, we underscore the ways in which food, health, and housing intersect. We conclude by outlining future research directions that will enhance understanding of these intersections.Housing Studies 08/2014; 29(6). · 0.66 Impact Factor
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ABSTRACT: A national online survey of 137 US food banks was conducted along with in-depth interviews with staff at 6 California food banks to assess the characteristics of their organizational culture, including the extent to which they focused on nutritional quality of emergency food. The majority of US food banks reported a substantial level of commitment to nutrition. Only a minority has written formal nutrition policies, but several California food bankers were in the process of developing policies. US food banks most often reported seeking to increase fresh produce; fewer reported deliberate efforts to increase low-fat dairy, lean meats, or whole grains or to reduce unhealthful foods. California food banks revealed that they have significantly expanded their capacity to respond to increased produce donations, yet there are still substantial limitations to be addressed in procuring, handling, and monitoring the quantity of more nutritious foods. Organizational practices commensurate with a nutrition policy are not widely evident although there is variation. Study results highlight a number of issues for attention in assisting food banks to align their culture, capacity, and practices more closely with their stated commitment to nutrition quality.Journal of Hunger & Environmental Nutrition 09/2013; 8(3):261–280.
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ABSTRACT: The prevalence of homelessness in the UK is rising, and demand for food aid through charitable meal services has increased. Charitable services make a substantial contribution to the food and nutrient intake of vulnerable people, and thus offer a platform for dietary improvement. This study examined food provision by a large charitable organisation in a major UK city. It had several objectives: Firstly to quantify nutritional composition of breakfast and lunch meals, secondly to understand factors that influence the composition of menus and meals, and thirdly to determine whether, within the context of these influences, improvements to the menu would be possible and whether these would be acceptable to clients. Mixed methods of ethnography, semi-structured interviews, quantitative nutrient analysis, recipe adaptation and taste tests were employed. The research team worked as volunteers in the organisation for a 3-wk period and interviews were held with kitchen staff. Food choice was recorded for 189 clients at breakfast and 251 clients at lunch over a five-day period and nutrient content of these meals was estimated. Meals were weighted towards fat and sugar energy. Energy, potassium, calcium, vitamin C, vitamin A, zinc and magnesium content of meals were below Dietary Reference Value (DRV) targets for at least 20% of breakfast and lunch meals. Such inadequacies may be addressed by addition of simple foods to the breakfast menu and adaptation of lunchtime recipes. 12 lunchtime dishes were proposed, and 8 of these were seemingly acceptable to clients in taste testing. Barriers to provision of healthier meals include budget, food donations and acceptability of meals.Appetite 07/2014; · 2.52 Impact Factor
Public Health Nutrition: 11(12), 1296–1305
Nutritional assessment of charitable meal programmes serving
homeless people in Toronto
Carmen Tse and Valerie Tarasuk*
Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada M5S 3E2
Submitted 17 August 2007: Accepted 16 April 2008: First published online 12 June 2008
Objectives: To assess the potential nutritional contribution of meals provided in a
sample of community programmes for homeless individuals, to determine the
effect of food donations on meal quality and to develop food-based guidance for
meals that would meet adults’ total nutrient needs.
Setting: Toronto, Canada.
Design: An analysis of weighed meal records from eighteen programmes. The
energy and nutrient contents of meals were compared to requirement estimates to
assess contribution to total needs, given that homeless people have limited access to
nutritious foods. Mixed linear modelling was applied to determine the relationship
between the use of food donations and meal quality. The composition of meals that
would meet adults’ nutrient requirements was determined by constructing simulated
meals, drawing on the selection of foods available to programmes.
Sample: In all, seventy meals, sampled from eighteen programmes serving
Results: On average, the meals contained 2?6 servings of grain products, 1?7
servings of meat and alternatives, 4?1 servings of vegetables and fruits and 0?4
servings of milk products. The energy and nutrient contents of most meals were
below adults’ average daily requirements. Most meals included both purchased
and donated foods; the vitamin C content of meals was positively associated with
the percentage of energy from donations. Increasing portion sizes improved the
nutrient contribution of meals, but the provision of more milk products and fruits
and vegetables was required to meet adults’ nutrient requirements.
Conclusions: The meals assessed were inadequate to meet adults’ nutrient
requirements. Improving the nutritional quality of meals requires additional
Charitable food programmes
As the number of people who are homeless (i.e. living in
public spaces or temporary accommodation because they
lack safe, secure housing) swells(1–3), communities across
Canada are struggling to establish and sustain effective
responses. Vulnerability to poorer physical(4–6)
mental health(7–10), poorer self-rated health(11)and higher
rates of mortality(8,12–14)are well-documented among
homeless individuals in Canada. Furthermore, a growing
body of research suggests that the food and nutrition
needs of many homeless people are poorly met(15–20).
Given the inadequacy of income assistance programmes,
lack of affordable housing and increasingly restrictive
eligibility criteria for existing supports and services, much
of the assistance available to homeless people comes
from community-based initiatives to help them meet basic
subsistence needs for shelter, food, personal hygiene and
primary health care. Local food provisioning efforts
typically include soup kitchens, street outreach pro-
grammes and meal provisions in shelters, but meals and
snacks are also now being offered on a smaller scale by
an increasing number of social service agencies, drop-in
centres and health centres(11). The programmes are
largely ad hoc, voluntary initiatives, with the scope of
operations varying from two to three meals per day
most days of the week to a single meal per week. Many
programmes rely on donated foodstuffs from food
banks(21)and other charitable food redistribution net-
works, though both the quantity and nutritional quality
of foods garnered through this route are limited(22–28).
Concerns about the appropriateness and effectiveness of
these efforts stem from the high levels of food depriva-
tion documented among samples of homeless indivi-
duals(15,17–20), and also a recent study in Toronto that
found homeless youth who used charitable meal pro-
grammes to be as nutritionally vulnerable as those who
Concerns about the adequacy of nutrition supports for
homeless groups are not unique to Canada. Studies in
*Corresponding author: Email email@example.com
r The Authors 2008
Europe(29–31), Australia(32,33)and the United States(34–39)
have also raised questions about the capacity of com-
munity food programmes to meet the food needs of
homeless people. Assessments of the meals provided in
soup kitchens in the USA have shown them to be of poor
nutritional quality and particularly limited in fruits and
vegetables(36,37,40). An assessment of the dietary intakes of
men using a shelter in Paris has also documented nutri-
tional deficits linked to the suboptimal quality of shelter
meals(30). As an initial step towards understanding the
meal provisioning efforts of community programmes
in Canada, the present study examines the nutritional
contribution of a sample of meals offered in eighteen
programmes serving homeless individuals in Toronto,
investigates the effect of food donations on the nutrient
contents of meals provided and develops food-based
guidelines for the construction of meals to meet adults’
estimated average nutrient requirements.
Sample and methods
In August 2004, an inventory of programmes serving
meals to homeless adults in Toronto was conducted,
drawing on data from a web-based community resource
(‘211 Toronto’), as well as data on the meal/snack pro-
grammes receiving food from the three major charitable
food assistance distributors in this area and programmes
participating in a winter relief programme. A brief tele-
phone survey designed to obtain information on pro-
gramme characteristics was completed with workers in
148 of the 157 programmes identified (94%) (results to be
reported elsewhere). From the survey sample, eighteen
programmes were selected for in-depth study, applying
purposive sampling to capture programmes with different
histories (considering time since inception and reasons
for beginning meal service), styles of service delivery (e.g.
meals offered in isolation or in conjunction with other
services) and geographic locations within the city. We
conducted participant observations and an open-ended
interview with the coordinator in each programme
(results to be reported elsewhere). In addition, over a
6–8-week period from September 2004 to April 2005, a
single meal was weighed and measured on four separate
occasions in sixteen programmes. Because of scheduling
problems, meals were recorded on only three occasions
in two programmes. In nine programmes that regularly
served more than one meal, the meal of highest atten-
dance was recorded. The meals recorded represented
‘best-case scenarios’, assuming ample quantities of all
meal items were available for all, throughout the meal
period. The origin of each meal item was also recorded,
differentiating between foods that had been purchased by
programmes and those that had been obtained free of
charge. The latter category included foods supplied by
the local food bank and a ‘surplus’ food redistribution
network operating in Toronto, as well as food donations
solicited by programme staff from food retail or food
The weighed meal records were entered into the
Nutrition Survey System (NSS) software (a food compo-
sition database based on the 1997 Canadian Nutrient File)
to estimate the energy and nutrient content of each meal.
The US Department of Agriculture Food Composition
Tables were used to obtain vitamin A values for foods in
retinol activity equivalents (RAE) to facilitate comparison
with requirements(41). All analyses were conducted using
SAS/PC Version 9?1(42).
Evaluation of meals
For each meal recorded, the number of servings from
each food group defined in Canada’s Food Guide
(CFG)(43)(i.e. grain products, fruits and vegetables, meat
and alternatives, and milk and alternatives) was calcu-
lated. The energy and nutrient contents of meals were
compared to adults’ average daily requirements to assess
the meals’ contribution towards the total needs of clients.
While this might seem like an unrealistically high stan-
dard for single meals, studies of the dietary patterns and
food acquisition strategies of homeless individuals in
Canada suggest that it cannot be assumed that a sub-
stantial amount of nutrients come from other sour-
ces(15,17,20,44). To assess nutrient contribution, the mean
protein, vitamin A, vitamin C, folate, vitamin B6, ribo-
flavin, thiamin, niacin, iron, phosphorus, magnesium
and zinc contents of the three or four meals recorded
in each programme were compared to the estimated
average requirements (EAR) for these nutrients(45–49).
The EAR represent the median requirements of different
age–sex groups, and they can be understood as unbiased
estimates of nutritional needs for any randomly selected
person within the population(49). The requirement esti-
mates for males and females, 31–50 years old, were used
in the analysis because they comprise the single largest
age grouping of homeless adults in Toronto(3), and the
requirement estimates of 31–50-year-olds equal or exceed
those for younger or older adults for most nutrients(45–49).
To permit comparison of the protein content of meals
with protein requirements expressed as grams/kilograms
of body weight/day, the body weights of people con-
suming the meals were approximated as the weights of
the population ‘reference’ male and female(49,50). Total
fibre and calcium were assessed by comparing pro-
gramme means to the Adequate Intake levels (AI) for
these nutrients(49). To assess the energy contribution of
meals, the mean energy content of meals sampled in each
programme was compared to the estimated energy
requirements (EER) of the reference adult male and
female, 31 years of age(50). The smallest BMI in the
healthy range (18?5kg/m2) was chosen for comparison to
determine whether the lowest energy needs of a refer-
ence individual could be met by the average meals of
Charitable meal programmes in Toronto1297
programmes, but the calculations were repeated assum-
ing different levels of physical activity levels to generate
the range of requirements for a person this size.
In nine programmes where more than one option was
offered in a meal (e.g. a choice of two kinds of sand-
wiches), only the option with the greatest energy content
was included in comparisons with requirement estimates;
an analysis of other options indicated that they had lower
Development of food-based meal guidelines to
meet participants’ nutrient needs
Two modelling exercises were undertaken to determine
the changes required for programmes to provide meals that
met individuals’ total nutrient needs, and thus develop
food-based guidance for programme operators. Total need
was represented by the EAR and AI for 31–50-year-olds
because meals containing this level of nutrition could be
assumed to meet the average nutrient requirements of
programme participants. It was important that a single meal
satisfy an individual’s daily nutrient requirements because
of homeless people’s limited access to nutrients from other
sources(15,17,20,44). Individuals could consume more than
one meal per day in a programme and thus not require a
single meal to fulfil their nutrient needs, but this would
likely only pertain to shelter users. Half of the programmes
studied served only one meal per day (Table 1), and those
serving more meals reported much lower attendance at
other meals (in some cases because features of the meal
service functioned to restrict attendance), suggesting that
the nutritional benefit of the additional meals would be
experienced only by a small proportion of clients. Indivi-
duals could conceivably eat at more than one programme
each day, but distances between programmes and lack of
coordination in meal schedules would make it difficult to
accomplish this on a daily basis.
To determine whether simply increasing the amounts
of food provided would be sufficient for the meals to
meet the total needs, portion sizes of foods in the ori-
ginally recorded meals in all programmes except one
were increased proportionally to their energy content so
that the average energy content of the meals of each
programme was equal to the EER of a small, sedentary
reference female, 31 years of age (7574kJ/1809kcal)(50).
This EER can be considered the lower bound of energy
requirements for clients (assuming most individuals
would be larger and more physically active), and it also
can represent a viable (albeit high) energy content for
a single meal. In fact, the mean energy content of meals
in one programme exceeded this level, so it was pro-
portionately reduced to obtain a mean of 7574kJ/
1809kcal. The nutrient contents of adjusted meals were
calculated and compared to the EAR and AI.
The selection and amount of foods required for meals
to meet adults’ total nutrient requirements were determined
by an iterative process to construct meals de novo,
assuming no changes in the selection of foods available to
programmes but ample quantities of all foods. All foods
recorded in the observed meals were grouped into the
food groups defined in CFG(43), with fruits and vegetables
further subdivided into vitamin C-rich, vitamin A-rich,
folate-rich and ‘other’ fruits and vegetables in order to
specifically target these three nutrients. Beginning with a
meal that consisted of two servings from each of the
seven food categories, the minimum number of servings
required from each food category was determined
through a process of systematically adding or subtracting
single servings from various categories. With each
change, test meals were assembled from randomly
selected food items within each category, and the mean
nutrient contents of thirty randomly assembled test meals
were compared to the EAR of men, 31–50 years old, and
women’s EAR for iron (i.e. the only nutrient for which
women’s requirements exceed men’s).
Effect of food donations
Food donations were used by fourteen of the eighteen
programmes, although most meals in these programmes
included both purchased and donated foods. Given the
widespread concern about the quality of food available
for distribution through food banks in Canada(22–28), we
hypothesised that depending on food donations would
pose a constraint on meal quality in these programmes.
Representing the contribution of food donations by the
percentage of energy from donated foods in a meal,
mixed linear modelling was conducted to determine the
effect of food donations on the energy and nutrient
content of meals and the number of servings from each
food group. Because the use of maximum likelihood
estimation methods in mixed linear modelling assumes
that the dependent variable is normal, the distributions of
all variables were reviewed. Box–Cox transformations
were applied to energy and all nutrient variables to
ensure that they approximated normal distributions(51),
and mixed linear models were run using the Residual
Maximum Likelihood estimation method (REML). Although
the servings of vegetables and fruits in meals appeared
normal without transformation, the distributions of servings
from the other food groups were skewed and could not be
transformed to approximate normality. The mixed linear
models for all food groups were run using Minimum
Variance Quadratic Unbiased Estimation (MIVQUE0), a
method that, while less powerful than REML(42), can be
used with non-normal data. This method was applied for
servings of vegetables and fruits for consistency.
The eighteen meal programmes included in the present
study varied widely in terms of size and scope (Table 1).
Only the three shelter programmes served three meals
1298C Tse and V Tarasuk
daily on all seven days of the week. The proportion of
clients who ate regularly at the programmes ranged from
30% to 100%.
The mean energy content of meals ranged from 2721kJ
(650kcal) in a dinner programme operating 6 d/week to
8750kJ (2090kcal) in a dinner programme operating
once weekly (Table 2). The meals in most programmes
would provide less than two-thirds of the EER of a small,
sedentary reference male or female (9261kJ (2212kcal)
and 7574kJ (1809kcal), respectively) and less than half of
the EER if high levels of physical activity were assumed
(12971kJ (3098kcal) and 10718kJ (2560kcal) for males
and females, respectively).
The meals in most programmes included $1 servings
of grain products, meat and alternatives, and vegetables
and fruit, but #0?25 servings of milk products (Table 2).
Seven programmes provided meals that, on average,
contained the recommended number of daily meat and
meat alternatives servings for women in CFG, and one
programme provided sufficient fruits and vegetables to
meet the daily recommendation for women. For the most
part, however, the average number of servings for each of
the four food groups fell well below the daily recom-
mendations for both men and women.
Wide variability was found in the nutrient content of the
meals (Table 3). Both the mean and median levels fell
below EAR for vitamin A, folate, magnesium and zinc, but
the mean levels of other nutrients examined approximated
or exceeded the EAR (Table 3). When the meals were
examined by programme, the only nutrient provided in
levels at or above the average requirements in almost all
programmes was niacin. More than half the programmes
had mean riboflavin, folate, zinc and vitamins A, B6and C
contents below EAR for both men and women, and all
Table 1 Descriptions of programmes
Programme Description of serviceMeal recordedn % Regulars
AHealth centre provides a self-serve lunch in a meal room on
the weekdays during the wintertime
Winter meal programme serves two rounds of both breakfast
and lunch, a dinner and a snack on Sundays. This
programme is part of a larger organisation that provides
A purpose-built shelter programme caters to youth; every day
it serves three meals, a snack and a meal-to-go for users
who request it
A meal programme offers breakfast and lunch on the
weekdays. Other services are available within the larger
The free meal of a programme serves brunch on the
weekdays and dinner on weekdays plus Saturdays. The
food programme is part of a larger organisation that
provides a variety of services, including housing
A mobile meal service offers breakfast to those living outdoors
on Wednesday to Saturday
A meal programme that offers Wednesday dinners, Thursday
breakfasts and Sunday brunches
A meal programme caters to ex-psychiatric clients, serving
breakfast and lunch on the weekdays and only lunch on
A drop-in programme offers breakfasts on Monday and
Saturday (winter only) and dinners on Wednesday nights
Ad hoc shelter programme receives three catered meals and
a snack every day
A drop-in programme offers a small snack and lunch every
A multi-service programme offers shelter; every day it serves
a morning snack, two rounds of lunch, a take-away lunch
A health clinic provides a self-serve lunch every weekday for
A drop-in programme for women serves breakfast and lunch
every day of the week
Youth arts initiative serves a participant-prepared lunch on
Tuesdays and Thursdays
A meal programme started by educators serve dinners on
Fridays and breakfasts on Saturdays and Sundays
A purpose-built shelter programme caters to youth; every day
it serves three meals, a snack and a meal-to-go for users
who request it
A meal programme serves dinner on Tuesday nights
Lunch 80 50
G Breakfast85 75
I Lunch 140–185 80–100
K Dinner70 100
L Lunch45 90
O Lunch 50–9080
PLunch 30 80
S Dinner65 85
Charitable meal programmes in Toronto1299
programmes failed to meet the EAR for magnesium. Half
of the programmes had mean protein contents below the
EAR for men and half had mean iron contents below
the EAR of women. The average calcium and total fibre
contents of meals in all programmes were well below the
AIs for these nutrients (data not shown).
When portion sizes of all foods served in the meals were
increased to achieve an average energy content equivalent
to the EER for a small, sedentary woman, all or almost all
programmes met the EARs for iron, phosphorus, protein,
niacin, riboflavin, thiamin and vitamin B6. However, the
average levels of folate, zinc, magnesium and vitamins A,
B12and C in the meals in several programmes were still
below median requirements. Additionally, the calcium and
fibre content of meals in almost all programmes were below
the AIs for these nutrients (data not shown).
Table 2 Mean energy content and number of food servings in the meals of each programmes and the recommended number of servings
from Canada’s Food Guide*
Number of servings
Energy (kJ) Energy (kcal) Meat and alternativesGrain products Milk and alternativesVegetable and fruits
*Recommendations for men and women, 31–50 years old(43).
-There were no milk product servings in any of the meals.
Table 3 Mean and median nutrient contents of the 70 meals sampled in eighteen programmes and the average requirements of 31–50-
year-old males and females
Vitamin A, RAE (mg)
Vitamin C (mg)
Folate, DFE (mg)
Total fibre (g)
RAE, retinol activity equivalents; DFE, dietary folate equivalents.
*Minimum and maximum values among all programmes.
-The estimated average requirements (EAR) are presented for smokers because a high proportion of homeless individuals smoke(20). The EAR for non-
smokers would be 35mg/d less.
--The Adequate Intakes were used in comparison with total fibre and calcium contents.
1300C Tse and V Tarasuk
A guide for planning more nutritionally adequate meals
was developed, working with foods included in the meals
recorded at these programmes (Table 4). On average,
the meals constructed following this guide exceeded
the EARs for all nutrients, except for magnesium, and
approximated the AI for calcium (Table 5). The mean
fibre content of the meals was still below the AI, but it
was more than double the content of observed meals
(Table 3). The mean energy content of the meals was only
838kJ (200kcal) higher than that of the observed meals
The mean per cent contribution of donated foods to
the total energy content of meals ranged from 0% to 94%;
even within programmes using donations, there was wide
variation in the per cent contribution of food donations
from one meal to the next (Table 6). The percentage
of energy from donations in a meal was positively asso-
ciated with vitamin C content, and marginally significant
positive relationships were observed for folate and
thiamin (Table 7). The use of Box–Cox transformed
nutrient variables in these analyses prohibits direct
inferences about the magnitude of the effect, but some
indication comes from the back-transformation of predicted
values for vitamin C. As the percentage of energy from food
donations increased from 0% to 100% of the meal, vitamin
C content increased from 40 to 100mg/meal. No associa-
tions were observed between the percentage of energy
from donations and the total energy content, other nutrients
or food group servings in meals (Table 7).
Our results indicate that the meals served in most of the
eighteen food programmes studied were insufficient to
meet adults’ daily energy and nutrient requirements. The
low nutritional contribution of meals implies that home-
less individuals cannot rely on these programmes to meet
their needs, let alone replenish micronutrient stores
depleted from frequent experiences of food deprivation
Table 4 Meal planning guide developed for meals to meet adults’ nutrient requirements
Food categories* Serving size-
Number of servings
Pasta, rice, noodles
Bagel, pita, bun
Meat and alternatives
Beef, poultry, pork, fish
Beans, lentils, chickpeas
Vitamin A-rich vegetables/fruit
Mixed vegetables (frozen)
Vitamin B-rich (folate) vegetables/fruit
Beans, lentils, chickpeas
Dark greens, e.g. broccoli,
Spinach, Romaine lettuce
Vitamin C-rich vegetables/fruit
Orange juice (from concentrate)
Grapefruit juice (from concentrate)
Apple juice with vitamin C added
Tomatoes (fresh, canned)
Potatoes, including dried potato products
Processed cheese slices
*The examples of foods in each food category were drawn from the list of foods found in the meals recorded.
-Based on standard serving sizes found in Canada’s Food Guide(43).
Charitable meal programmes in Toronto 1301
and dietary compromise(20). While the generalisability
of our results is clearly limited by the use of a small,
non-random sample of programmes, our findings are
consistent with programme users’ reports of the low
quality, limited selection and insufficient amount of foods
served in meal programmes(11,17,20,44,52,53). The results
also help to explain how an analysis of the dietary intakes
of homeless youth in Toronto could find little impact of
programme use on youths’ total energy and nutrient
We have likely overestimated the true contribution of
the meal programmes studied to individuals’ total needs
because the meal records analysed represent ‘best-case
scenarios.’ Portion sizes are often reduced and meals are
altered during the course of meal service as supplies
are depleted and other foods are substituted. Data on the
dietary intakes of meal participants are needed to truly
assess the meals’ contributions to their total nutrient
Table 5 Energy and nutrient content of meals (n 30) randomly generated following the meal planning guide
Vitamin A, RAE (mg)
Vitamin C (mg)
Folate, DFE (mg)
Total fibre (g)
RAE, retinol activity equivalents; DFE, dietary folate equivalents; n/a, not applicable.
*Requirement estimates are estimated average requirements (EAR) for males, 31–50 years old, unless otherwise noted.
-The protein requirement is obtained from the reference adult male.
--The EAR of iron for females, 31–50 years old, is shown because it is the highest requirement within this age group.
yRequirements for total fibre and calcium are presented as Adequate Intakes.
Table 6 Percentage of energy from donations in the average
meals at the eighteen community food programmes
% of energy from donations
Programmen* Minimum MaximumMean
*Number of meals sampled per programme.
Table 7 Linear relationship between the energy, nutrient and food
group content of meals and the percentage of energy from donated
F1/52 P value
Vitamin A, RAE (mg)
Vitamin C (mg)
Folate, DFE (mg)
Total fibre (g)
Meat and alternative servings 20?002--
Grain product servings
Vegetable and fruit servings
Milk product servings
0?00003 0?0009 0?00
RAE, retinol activity equivalents; DFE, dietary folate equivalents.
*n 54 meals (excluding meals recorded in four programmes that did not use
-Parameter estimate from mixed linear model, based on transformed intake
--Food group servings were not transformed, but rather the mixed linear
model was conducted using a method of estimation that did not assume
normality in the dependent variable.
1302C Tse and V Tarasuk
needs. In addition, data on height, weight, age, sex and
usual physical activity levels of meal participants are
required to obtain more accurate energy and nutrient
The true nutrient needs of many homeless adults
are likely higher than the requirement estimates applied
here. Not only do the EAR represent medians of the
requirement distribution for any one age–sex grouping,
but these estimates are also designed to apply to healthy
people. Given the high levels of poor health(4–14)and
nutrient inadequacies(20)documented among samples of
homeless groups in Canada, it is likely that some of their
nutrient requirements exceed the estimates used. Further-
more, at any given time, some proportion of homeless
women are pregnant(54), elevating their nutrient require-
ments. If the true nutrient needs of individuals were
known, meals would likely appear even more inadequate.
For simplicity in comparing meals to requirement
estimates, we considered the meals’ contribution only in
relation to the days when they were provided. However,
most programmes studied did not provide meals 7d/
week; thus, their true contribution must be less than what
our analyses indicate because on some days, they con-
tributed nothing. Conversely, we have underestimated
the contributions of programmes that served more than
one meal/d by considering only one meal. This under-
estimation was greatest in the three shelter programmes
that served three meals and a snack daily. Whether
examining all foods served would indicate that the pro-
grammes were meeting adults’ daily nutrient require-
ments, however, is debatable. A recent study of shelter
users in Toronto raised concerns about the quality of
food provided(53); moreover, studies of shelter users
elsewhere have revealed serious problems of dietary
inadequacy(30,34). A more comprehensive examination of
shelter meals is required to assess their nutrient adequacy.
Setting appropriate nutrient standards for charitable
meal programmes hinges on understanding the role of
these meals in relation to the total food intakes of those
who use them. Studies of homeless individuals in Canada
and elsewhere routinely document their difficulties
obtaining enough to eat(17,37,44). In the Canadian context,
this struggle is revealed in the assortment of desperate
strategies homeless individuals employ to acquire food,
including panhandling, theft, retrieval of food discarded
by others or receipt of free food from people who exploit
them(11,15,17,18,20,55,56). The inadequacy and insecurity of
such food acquisition strategies imply that substantial
nutrient intakes are unlikely to be achieved on a daily
basis from foods consumed outside charitable meal
programmes. Homeless individuals may obtain food or
beverages that provide additional energy during the
course of a day, but they are unlikely to meet their
micronutrient needs through other routes(20). Thus we
would argue that meal programmes providing one meal/
day or less to this extraordinarily vulnerable group should
strive to supply meals that meet adults’ daily require-
ments, particularly for protein and micronutrients. Our
results indicate that these nutrient goals can be achieved
through the provision of more nutrient-dense foods, such
as milk products and micronutrient-rich vegetables and
fruits, with minimal change in the energy content of the
meals. However, changes in food selection are required.
Simply increasing portion sizes will have little impact on
the micronutrient levels of meals in most programmes
because they include very little milk products, fruits and
vegetables currently. Improving the nutritional quality of
meals offered thus requires additional resources.
Most programmes in the present study relied, in part,
on food donations collected through large, well-estab-
lished, food redistribution networks. Contrary to expec-
tations, given the extensive literature critiquing the quality
Canada(22–28), meal quality was positively related to the
use of donated foods in these programmes. This must to
some extent reflect the limited funding available for food
purchases in many programmes. Unfortunately, there is
probably little scope for programmes to increase their
supplies of donated foodstuffs. Despite the constant quest
for more donations, food banks continue to report that
demands for their services exceed supplies(21). In dis-
tributing the donations they collect, food banks must
weigh the needs of meal programmes for homeless adults
against the needs of their extensive network of emer-
gency food hamper programmes for domiciled families, as
well as children’s programmes, prenatal programmes and
other valued community programmes that they supply.
Thus, programmes for homeless individuals probably can-
not make significant improvements in their meals without
additional funds for food purchasing. Yet this also appears
unlikely. Since 1999, the federal government has made
some financial assistance available to communities to help
them deal with local problems of homelessness, but fund-
ing has declined in recent years, and none of this funding is
specifically dedicated to food programmes(57–60).
While the present study has highlighted the low
nutritional contribution of meals provided by community
programmes, other problems have also been identified.
Homeless individuals report difficulty obtaining meals
because of the infrequent, short meal service hours in
many programmes and the distances required to access
different programmes at various times of the day or
week(11,17). Moreover, programme users complain about
having to stand in long line-ups for food, eat in what are
often crowded, unpleasant settings and participate in
prayer services or other activities as a prerequisite to
obtaining food in some programmes(11,17,52). Thus even
if resources can be found to improve the nutritional
adequacy of meals provided, the appropriateness of such
fragmented, ad hoc food provisioning as a long-term
response to meeting the food needs of homeless people
should be challenged.
Charitable meal programmes in Toronto1303
The ad hoc, voluntary nature of charitable food provision-
ing efforts in Canada speaks of the high levels of concern
in communities for the plight of homeless individuals.
However, our examination of the nutritional contribution of
meals served in a sample of programmes in Toronto sug-
gests that these initiatives may have limited potential to meet
the food and nutrition needs of this group. While any meal
is obviously ‘better than nothing’, a reliance on programmes
providing meals of low nutritional quality will further
compromise the nutritional health of homeless individuals.
More resources are required to remedy this situation,
highlighting the need for more systemic, policy responses to
the needs of homeless individuals in Canada.
Conflicts of interest:
operating grants from the Canadian Institutes of Health
Research (HPI – 66921) and Wellesley Institute (formerly
the Wellesley Central Health Corporation).
V.T. conceived this study, C.T.
conducted all the analyses presented in this manuscript,
and both authors actively participated in the preparation
of the manuscript.
The authors are indebted to
Naomi Dachner, Amy MacDonald, Carol Greenwood and
Dan Sellen for their helpful comments on this research.
The authors have no conflicts of
This study was funded in part by
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