Prescriptions for fruits and vegetables as part of a healthcare plan have been related to enhanced heart health and food security. This method, known as “food as medicine,” is gaining popularity as an efficient strategy to prevent and manage chronic diseases such as heart disease.
Adults at high risk of heart disease who participated in produce prescription programs for an average of six months increased their consumption of fruits and vegetables while also lowering their blood pressure, BMI, and blood sugar levels.
Participants in produce prescription programs with an elevated risk of cardiovascular disease increased their consumption of fruits and vegetables, which was associated with improved BMI, blood sugar, and blood pressure levels, as well as a decrease in food insecurity. This new study was published today in Circulation: Cardiovascular Quality and Outcomes, a peer-reviewed publication of the American Heart Association.
Doctors can now prescribe fruits and vegetables in addition to drugs through produce prescription programs. According to research lead author Kurt Hager, Ph.D., M.S., an instructor at UMass Chan Medical School in Worcester, Massachusetts, patients receive electronic cards or vouchers to access free or discounted produce of their choosing at retail supermarkets or farmers’ markets.
We know that food insecurity impacts health through several important pathways, including overall dietary quality, but also through stress and anxiety, mental health, and tradeoffs between paying for food and other basic needs such as housing costs, utilities and medications.
Kurt Hager
Although previous research has examined the effects of small, individual-produced prescription programs, this analysis is believed to be the largest produce prescription study by pooling data from nine programs across the U.S. to assess health outcomes after about six months.
“We know that food insecurity impacts health through several important pathways, including overall dietary quality, but also through stress and anxiety, mental health and tradeoffs between paying for food and other basic needs such as housing costs, utilities and medications,” said Hager, who completed these analyses while a doctoral student at the Friedman School of Nutrition Science and Policy at Tufts University in Boston. “These results indicate produce prescriptions may lay an important foundation for improved health and well-being.”
Participants in the study received a monthly stipend of $63 to spend on produce at local supermarkets and farmers markets. Participants also attended nutrition classes. Participants answered questionnaires about fruit and vegetable consumption, food insecurity, and health status at the start and end of the program, which lasted 4 to 10 months. Routine blood pressure, weight, and height measurements, as well as hemoglobin A1c (HbA1c) – a measure of blood sugar – were all conducted at the start and end of the program. There was no control group in the study, which assessed results among individuals before and after program participation.
The analysis of all participants found:
- Adults reported that their intake of fruits and vegetables increased by nearly one cup per day (0.85 cups per day). Among children, intake of fruits and vegetables increased by about a quarter of a cup per day (0.26 cups per day).
- Systolic blood pressure — blood pressure during heartbeats — decreased more than 8 millimeters of mercury (mm Hg); while diastolic blood pressure — blood pressure between heartbeats — decreased nearly 5 mm Hg among adults who had high blood pressure at enrollment in the study.
- Blood sugar, as measured by HbA1C levels, decreased by 0.29 to 0.58 percentage points among adults with diabetes.
- BMI significantly improved, with a reduction of 0.52 kilograms per square meter (kg/m2) among adults with obesity. Among children, however, BMI did not change.
- Adults were 62% more likely and children were more than twice as likely to report better health status by program completion.
- Overall, participants were one-third less likely to report food insecurity after completing the programs compared to before the programs.
“Poor nutrition and nutrition insecurity are major drivers of chronic disease globally, including cardiometabolic conditions like Type 2 diabetes and their cardiovascular consequences, including heart failure, heart attack and stroke,” according to Mitchell Elkind, M.D., M.S., FAHA, chief clinical science officer of the American Heart Association and a tenured professor of neurology and epidemiology at Columbia University.
“This analysis of produce prescription programs shows how subsidized produce prescriptions have the potential to increase consumption of nutritious fruits and vegetables, reduce food insecurity, and, hopefully, improve subjective and objective health measures.” Future study will need to incorporate randomized controlled trials to counteract any potential bias and prove the benefits of produce prescription programs more rigorously. The American Heart Association’s new Food Is Medicine Initiative will assist such studies.”
The Food is Medicine Initiative, announced in September 2022 at a White House Conference on Hunger, Nutrition, and Health by the American Heart Association and The Rockefeller Foundation, seeks to ensure patients receive medical prescriptions for healthy food to help prevent and manage chronic disease.
According to a 2022 American Heart Association Policy Statement: Strengthening U.S. Food Policies and Programs to Promote Equity in Nutrition Security, poor nutrition plays a significant impact in serious long-term illness, such as cardiovascular disease and Type 2 diabetes.
According to the Association’s figures, inadequate nutrition contributed to approximately 8 million deaths in 2019. Food insecurity is defined as a lack of equal and consistent availability, access, and affordability of foods and beverages that support health and disease prevention and treatment.
Study details:
- The analysis included 1,817 children and 2,064 adults enrolled in one of nine produce prescription programs operated by the non-profit organization, Wholesome Wave, from 2014-2020. The programs were administered at 22 sites in low-income communities in 12 U.S. states.
- All program participants had or were at risk for developing heart disease or Type 2 diabetes and either had food-insecurity or were enrolled at a clinic serving a predominantly low-income neighborhood.
- The average age of adult participants was 54 years old; 71% were women, 30% were white adults, 45% were Black adults, 21 percent were Hispanic adults and 4% of adults’ race / ethnicity was classified as “other.”
- The children in the study were an average of 9 years old; almost half were girls, 9% were white children, 13% were black children, 76% were Hispanic children, and 2% were classed as “other.” The government Supplemental Nutrition Assistance Program (SNAP) was used by nearly two-thirds of the kid enrollees.
- More than half of the households in the survey reported food insecurity at the start of the study.
The study had significant limitations, including a lack of a control group for comparison; high rates of missing survey data for food insecurity and fruit and vegetable consumption data at the end of some programs; and the impact of the COVID-19 pandemic on programs that began during that time period.
