It’s well known that individuals suffering from food insecurity often have higher risks for chronic diseases, including heart disease. Decreased fruit and vegetable intake can certainly impact blood pressure, weight, and lipids (1).

A recent study published in Circulation Cardiovascular Quality and Outcomes, a peer-reviewed American Heart Association journal, found that individuals at higher risk for heart disease who joined produce prescription programs and increased their intake of fruits and vegetables had improved BMI, blood sugar, blood pressure levels, and reduced food insecurity (2).

Fruits and vegetables in produce prescription programs are allowed to be prescribed by doctors as they would medicine. Vouchers or electronic cards are provided to patients which allows access to their choice of free or reduced-priced produce. Produce may be purchased at grocery stores or farmer’s markets, according to lead author Kurt Hager, Ph.D., M.S., an instructor at UMass Chan Medical School in Worcester, Massachusetts.

Their study pooled data from nine programs across the US to evaluate health outcomes after half a year. Prior research has evaluated the impact of small, individual, produce prescription programs.

"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 roughly $63 each month to buy produce at farmer’s markets and local groceries. Participants also attended nutrition classes. At the start and after finishing the program that was offered between 4 and 10 months, subjects answered questionnaires about produce intake, food insecurity, and health status.

Regular checks of blood pressure, BMI, and HbA1C, a 3-month measure of blood sugar were performed at the start and conclusion of the program. The study did not have a control group and evaluated outcomes among subjects before and after they completed the program.

The evaluation of all participants discovered:

• Intake of fruits and vegetables by adults was increased by .85 cups per day and .26 cups per day in children.

• Systolic blood pressure (pressure during heartbeats) dropped over 8 millimeters of mercury (mm Hg). Diastolic blood pressure (pressure between heartbeats) was reduced by almost 5 mm Hg in adults who had high blood pressure at the start of the study.

• In adults with diabetes, HbA1C levels were reduced by .29 to .58 percentage points.

• BMI was significantly lower with a drop of .52 kilograms per square meter (kg/m2) in adults with obesity. BMI in children was unchanged.

• By the end of the program, adults were 62% more likely to report improved health status Children were more than twice as likely to report better health status.

• Participants, overall, were one-third less likely to record issues with food insecurity after finishing the programs than before the programs.

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. "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."

"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 was announced in September 2022 by the American Heart Association and The Rockefeller Foundation at a White House Conference on Hunger, Nutrition, and Health. It seeks to ensure patients obtain medical prescriptions for nutritious food to help prevent and manage chronic disease.

According to the American Heart Association, poor nutrition was attributed to almost 8 million deaths in 2019. Food insecurity impacts the access, availability, and affordability of nutritious foods and drinks that promote health and prevent or treat disease.

Study Details:

• This study included 2,064 adults and 1,817 children in one of nine produce prescription programs operated by the American Heart Association, Wholesome Wave, from 2014 to 2020. The programs were offered at 22 sites in low-income communities in 12 U.S. states.

• All program subjects had or were at risk for developing heart disease or Type 2 diabetes. They also either suffered food insecurity or were enrolled at a clinic serving a primarily low-income neighborhood.

• The average age of adult subjects 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 average age of children in the study was 9 years old. Half were girls, 9% were white children, 13% were Black children, 76% were Hispanic children and 2% of children's race/ ethnicity was classified as "other." Almost two-thirds of child participants were enrolled in the federal Supplemental Nutrition Assistance Program (SNAP).

• At the start of the study, over half of the households reported experiencing food insecurity.

Limitations of the study included the lack of a control group for comparison; large rates of missing survey data for food insecurity and fruit and vegetable intake data at the end of some programs; and the impact of the COVID-19 pandemic on programs that began during that period.

Below are tips to help your clients with food insecurity:

• Become familiar with SNAP benefits and how your clients can enroll.

• Partner with primary care offices that offer Prescription produce programs.

• Provide a list of community resources such as food pantries and farmer’s markets for those dealing with food insecurity.

• Encourage the use of bruised or “not so perfect” produce that may be discounted at the grocery store.

• Offer classes to teach clients how to cook various fruits and vegetables.

• Provide simple recipes using canned, fresh, or frozen produce.

• Offer incentives such as grocery gift cards for class attendees.

Lisa Andrews, MEd, RD, LD

References:

1. Te Vazquez J, Feng SN, Orr CJ, Berkowitz SA. Food Insecurity and Cardiometabolic Conditions: a Review of Recent Research. Curr Nutr Rep. 2021 Dec;10(4):243-254. doi: 10.1007/s13668-021-00364-2. Epub 2021 Jun 21. PMID: 34152581; PMCID: PMC8216092.

2. Kurt Hager, Mengxi Du, Zhongyu Li, Dariush Mozaffarian, Kenneth Chui, Peilin Shi, Brent Ling, Sean B. Cash, Sara C. Folta, Fang Fang Zhang. Impact of Produce Prescriptions on Diet, Food Security, and Cardiometabolic Health Outcomes: A Multisite Evaluation of 9 Produce Prescription Programs in the United States. Circulation: Cardiovascular Quality and Outcomes, 2023; DOI: 10.1161/CIRCOUTCOMES.122.009520