Food as Medicine Programs Could Address Food Insecurity, Improve Cardiovascular Health

Lisa Goldman Rosas, PhD, MPH
Credit: Stanford Health

A new study adds to the growing evidence base supporting healthy food interventions to reduce cardiovascular risk.

Presented at the American Heart Association’s Epidemiology and Prevention│Lifestyle and Cardiometabolic Scientific Sessions 2024, the study, which assessed the effects of a free, weekly program delivering fruits and vegetables, suggests leveraging a "Food as Medicine" approach was associated with improved dietary habits, increase physical activity, and decreased food insecurity, with further analysis providing evidence of additional benefit on cardiovascular risk factors, such as cholesterol levels and HbA1c.^1,2

“I was really excited to see that providing patients with a modest amount of locally grown produce resulted in improvements in food insecurity, diet and indicators of cardiovascular health. This study took place during the COVID-19 pandemic, when many of these outcomes were worsening, especially among patients receiving care at Federally Qualified Health Centers that were disproportionately impacted,” said senior investigator Lisa Goldman Rosas, PhD, MPH, an assistant professor in the department of epidemiology and population health and the department of medicine at Stanford School of Medicine.²

Even with the onslaught of pharmacologic advances in recent decades, achieving and maintaining healthy lifestyle habits remains a cornerstone of management for almost every chronic disease. However, as a result of suboptimal infrastructure and equity, patients in many areas, including food deserts and dense urban environments, are at a disadvantage and can face additional hurdles in their efforts to achieve optimal lifestyle management.³

With this in mind, Rosas and a team of colleagues sought to assess how the implementation of a Food as Medicine program might influence food insecurity and risk factors for chronic disease. Called Recipe4Health, the program of interest was conducted at 4 Federally Qualified Health Centers and included a “Food Farmacy” that provided 16 weekly deliveries of produce with or without a “Behavioral Pharmacy”, which was 16 weekly group medical visits.^1,2

The primary outcomes of interest for the analyses were pre- and post-program changes in outcomes, which were assessed via survey data. Secondary outcomes of interest for the study included changes in cardiovascular risk factors, including lipids, BMI, blood pressure, and HbA1c, which were assessed via EHR data. Of note, secondary outcomes were measured at the end of 12 months and compared against propensity score-matched controls identified from similar clinics not participating in Recipe4Health.¹

Overall, 5286 middle-aged individuals were identified for inclusion in the study. This cohort had a mean age of 51.2 (Standard Deviation, 13.9) years, 68% were women, 51% were Latinx, 21% were Black, and 8% were Asian American/Pacific Islander.¹

Analysis of pre- and post-program survey data indicated Recipe4Health participants experienced a significant improvement in (0.41 servings [0.11, 0.72], p=007), physical activity (41.98 minutes per week [22.33, 61.63], p<.001), and prevalence of food insecurity (59% vs 48%; P <.001). Analysis of EHR data highlighted participants experienced statistically significant reductions in non-HDL cholesterol (-17.1 [-26.9, -7.2], p<.001) and HbA1c (-0.37%, 95% CI [-0.65, -0.08]; p=0.01) compared to propensity score-matched controls at 12 months. According to investigators, no differences were observed between controls and participants for BMI or blood pressure.¹

Investigators noted multiple limitations within their study to consider when interpreting results. These included small sample sizes, lack of a control group for primary outcomes, and reliance on EHR data.²

“This research demonstrates the potential for a food prescription, accessible through a health care visit, to improve health outcomes for significant portions of the U.S. population,” said Kevin Volpp, MD, PhD, the Mark V. Pauly Professor at the Perelman School of Medicine and the Wharton School, director of the Penn Center for Health Incentives and Behavioral Economics and research lead for the Association’s Health Care by Food^TM initiative.² “A coordinated research approach is needed to more systematically and rigorously define how well food is medicine interventions prevent and treat disease compared to standard medical care.”

References:

1. _{^{Rosas GL, Chen S, Xiao L, et al. Examining the Impact of Food as Medicine on Heart Health. Paper presented at: American Heart Association EPI|Lifestyle Scientific Sessions 2024. March 18 – 21, 2024. Chicago, IL.}}
2. _{^{American Heart Association Newsroom. Free, weekly fresh produce improved diet, physical activity and reduced CVD risk factors. American Heart Association. March 20, 2024. Accessed March 23, 2024. https://newsroom.heart.org/news/free-weekly-fresh-produce-improved-diet-physical-activity-and-reduced-cvd-risk-factors.}}
3. _{^{Campbell P. Study finds prescribing fruits and vegetables could reduce future healthcare spending by $40 billion. HCP Live. July 14, 2023. Accessed March 23, 2024. https://www.hcplive.com/view/study-finds-prescribing-fruits-and-vegetables-could-reduce-future-healthcare-spending-by-40-billion.}}