Fruit and Vegetable Prescription Program in the US

Free produce recipes were associated with reduced blood pressure, blood sugar, and body mass index, according to a new study published in Circulation: Cardiovascular Quality and Outcomes .

People at increased risk of 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 levels, and blood pressure, as well as a decrease in food insecurity. This new research was published in Circulation: Cardiovascular Quality and Outcomes , a peer-reviewed journal of the American Heart Association .

Producing prescription programs allows doctors to prescribe fruits and vegetables in addition to medications. Patients receive electronic cards or vouchers to access products of their choice for free or at a discount at retail supermarkets or farmers markets, explained the study’s lead author, Kurt Hager, Ph.D., MS, an instructor at the College of UMass Chan Medicine in Worcester, Massachusetts.

Although previous research has examined the effects of small, individual product prescribing programs, this analysis is believed to be the largest product prescribing study by combining data from nine programs in the US to evaluate health outcomes after approximately six months.

"We know that food insecurity affects health through several important pathways, including overall diet quality, but also through stress and anxiety, mental health, and trade-offs between paying for food and other basic needs. such as housing, utility and drug costs," said Hager, who completed these analyzes while a doctoral student at the Friedman School of Nutrition Science and Policy at Tufts University in Boston. "These results indicate that produce recipes can lay an important foundation for improving health and well-being."

Study participants received an average of $63 per month to purchase products at local stores and farmers markets. Additionally, participants attended nutrition classes. At the beginning and after completing the program, which lasted 4 to 10 months, participants completed questionnaires about fruit and vegetable consumption, food insecurity, and health status. Routine blood pressure testing; weight and height; and hemoglobin A1c (HbA1c), a measure of blood sugar, was completed at enrollment and at program completion. The study did not include a control group and compared outcomes between participants before and after participation in the program.

Analysis of all participants found:

• Adults reported that their fruit and vegetable consumption increased by almost one cup per day (0.85 cups per day). Among children, fruit and vegetable intake increased by about a quarter cup per day (0.26 cups per day).
   
• Systolic blood pressure decreased more than 8 millimeters of mercury (mm Hg); while diastolic blood pressure decreased nearly 5 mm Hg among adults who had high blood pressure at the time of study enrollment.
   
• Blood glucose, as measured by HbA1C levels, decreased by 0.29 to 0.58 percentage points among adults with diabetes.
   
• BMI improved significantly, with a reduction of 0.52 kilograms per square meter (kg/m2) among adults with obesity. However, BMI did not change among children.
   
• Adults were 62% more likely and children were more than twice as likely to report better health status at the end of the program.
   
• Overall, participants were one-third less likely to report food insecurity after completing the programs compared to before the programs.

"Poor nutrition and nutritional insecurity are leading drivers of chronic diseases globally, including cardiometabolic conditions such as type 2 diabetes and their cardiovascular consequences such as heart failure, heart attacks, and strokes," according to Mitchell Elkind, MD, MS , FAHA, chief of clinical science, American Heart Association official, and senior 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 measures of health. Future research should include randomized controlled trials to offset any potential bias and more rigorously demonstrate the benefits of produce prescription programs. The American Heart Association’s new Food Is Medicine initiative will focus 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 prescriptions for healthy foods to help prevent and control chronic diseases.

Poor nutrition plays a major role in serious long-term diseases, 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 nutritional security.

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

Study details:

The analysis included 1,817 children and 2,064 adults enrolled in one of nine produce prescription programs operated by the nonprofit Wholesome Wave, between 2014 and 2020. The programs were administered at 22 sites in low-income communities in 12 US states

All program participants had or were at risk for developing heart disease or type 2 diabetes and were either food insecure or enrolled in a clinic serving a predominantly low-income neighborhood.

The average age of adult participants was 54 years; 71% were women, 30% were white adults, 45% were black adults, 21 percent were Hispanic adults, and 4% of the adults’ race/ethnicity was classified as “other.”

The children in the study had an average age of 9 years; approximately half were girls, 9% were white children, 13% were black children, 76% were Hispanic children, and 2% of the children’s race/ethnicity was classified as “other.” Nearly two-thirds of participating children were enrolled in the federal Supplemental Nutrition Assistance Program (SNAP).

At the start of the study, more than half of participating households reported experiencing food insecurity.

The analysis had several limitations , including the lack of a control group for comparison; high rates of missing food insecurity survey data and fruit and vegetable intake data at the end of some programs; and the effect of the COVID-19 pandemic on programs that began during that period.