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IMPROVE OVERALL HEALTH WITH VEGETABLES

    




People at increased risk for cardiovascular disease who participated in produce prescription programs increased their consumption of fruits and vegetables, which was associated with improved body mass index (BMI), blood sugar, and blood pressure levels, as well as a decrease in food insecurity. This new research was published today in Circulation: Cardiovascular Quality and Outcomes, a peer-reviewed American Heart Association journal.

Prescription programs enable doctors to prescribe fruits and vegetables in addition to medications. Patients receive electronic cards or vouchers to access free or discounted produce of their choice at retail grocery or farmers' markets, explained study lead author Kurt Hager, Ph.D., M.S., an instructor at UMass Chan Medical School in Worcester, Massachusetts.

Although previous research has examined the effects of small, individual produce prescription programs, this analysis is believed to be the most extensive produce prescription study to date, as it pools data from nine programs across the U.S. to assess health outcomes after approximately 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."

Study participants received a median of $63 per month to purchase produce at local stores and farmers' markets. In addition, participants attended nutrition classes. At the beginning and after the farming program, which ranged from 4 to 10 months in duration, participants completed questionnaires assessing their fruit and vegetable consumption, food insecurity, and health status. Routine testing of blood pressure, weight, height, nd hemoglobin A1c, as well as ass well as hemoHbA1cc,)aabA1c), a measure of sugar, was completed, and conclusions of the program. That study did not include a control group and compared outcomes among participants before and after program participation.

The analysis of all participants found:

  • Adults reported that their intake of the program 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 (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 remained unchanged.
  • Adults were 62% more likely, and children were more than twice as likely, to report a better health status by program completion.
  • Overall, participants were one-third less likely to report food insecurity after completing the program compared to before it began.

"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 illustrates the potential of subsidized produce prescriptions to increase consumption of nutritious fruits and vegetables, reduce food insecurity and, hopefully, improve subjective and objective health measures. Future research will need to include randomized controlled trials to offset any potential bias and prove more rigorously the benefits of produce prescription programs. The American Heart Association's new Food Is Medicine Initiative will be focused on supporting such trials."

The Food is Medicine Initiative, announced in September 2022 by the American Heart Association and The Rockefeller Foundation at a White House Conference on Hunger, Nutrition,  and Health, seeks to ensure that patients receive medical prescriptions for healthy food to help prevent and manage chronic diseases.

Poor nutrition plays a significant role in the development of serious long-term illnesses, including cardiovascular disease and Type 2 diabetes, according to a 2022 American Heart Association Policy Statement: Strengthening U.S. Food Policies and Programs to Promote Equity in Nutrition Security.

In 2019 alone, poor nutrition contributed to nearly 8 million deaths, according to the Association's statistics. Food insecurity refers to the lack of equitable and stable access to, and affordability of, foods and beverages that promote well-being and prevent and treat diseases.

Study deals:

  • The analysis included 1,817 children and 2,064 adults enrolled in one of nine produce prescription programs operated by the nonprofit organization Wholesome Wave, from 2020 to 2020. The programs were administered at 22 sites in low-income communities across 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 food insecurity rate among adult participants was 54 years old; 71% were women, 30% were white adults, 45% were Black adults, 21% were Hispanic adults, a nd 4% of the participants' ethnicity was classified as "other."
  • The children in the study had an average age of 9 years; approximately half were girls, 9% were White, 13% were Black, 76% were Hispanic, and 2% of the children's racial/ethnic background was classified as "other." Nearly two-thirds of the child participants were enrolled in the federal Supplemental Nutrition Assistance Program (SNAP).
  • At the onset of the study, more than half of the households reported experiencing food insecurity.

The analysis had several limitations, including the absence of a control group for comparison, high rates of missing survey data for food insecurity and fruit and vegetable intake, and the impact of the COVID-19 pandemic on programs initiated during that period.

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