Produce prescriptions key to improving cardiometabolic health?

A large multisite evaluation found that produce prescriptions were associated with statistically significant and clinically meaningful health improvements, including clinical biomarkers of cardiometabolic health, in adults and children.

“Our investigation provides the largest evaluation and strongest evidence to date that produce prescriptions are associated with improved nutrition, food security, and self-perceived health among adults and children, as well as key health outcomes among adults with suboptimal cardiometabolic health,” said the researchers.

Using individual-level data from 22 produce prescription locations in 12 US states, the investigators evaluated 2,064 adults (mean age 54.4 years, 70.7 percent female) and 1,817 children (mean age 9.2 years, 51.4 percent female) with, or at risk for, poor cardiometabolic health recruited from clinics serving low-income neighbourhoods. More than half (56 percent) of all households experienced food insecurity. [Circ Cardiovasc Qual Outcomes 2023;16:e009520]

 

Outcomes in adults

After a median participation of 6 months, food and vegetable (F&V) intake increased by 0.85 cups/day. “[This was] a meaningful improvement, given that <10 percent of American adults meet national F&V recommendations to consume 5–6 cups/day,” the researchers noted.

The odds of food insecurity dropped by a third (odds ratio [OR], 0.63), while that of improving self-reported health status by one level increased (OR, 1.62).

HbA_1c levels dropped by −0.29 and −0.58 percentage points in the respective subgroups of participants with HbA_1c ≥6.5 and ≥8.0 percent. BMI also dropped in overweight/obese adults (−0.36 kg/m²) and those with obesity (−0.52 kg/m²).

Blood pressure also dropped among those with stage I hypertension (−8.38 [systolic] and −4.94 mm Hg [diastolic]), more so among those with stage II hypertension (−11.10 and −9.43 mm Hg, respectively).

All primary outcomes were statistically significant at the 0.01 significance level after adjusting for covariates and after Bonferroni correction, the researchers noted.

 

Outcomes in children

After adjusting for covariates, F&V intake increased by 0.26 cups/day post-intervention (p=0.009), while the odds of having an improvement in self-reported health status increased (OR, 2.37; p<0.0001). However, no significant change was observed in BMI z-score among those with overweight/obesity (−0.01; p=0.71) and obesity (−0.03; p=0.37).

“Produce prescriptions may need to be of longer duration or combined with additional components to impact child BMI z-score. Nonetheless, the significant increase in F&V intake, reduction in household food insecurity, and improved self-reported health among children all support potential for meaningful impact on child well-being and longer-term health outcomes,” said the researchers.

 

Implications for practice, policymakers

“By pooling individual-level data … our study provides more robust evidence that produce prescriptions could be a promising component of clinical care for food insecure and low-income patients with poor cardiometabolic health,” they said.

The observed improvements across all outcomes also support biologic plausibility despite the study’s lack of control arm, they added.

The researchers noted that the results were timely and relevant for both clinical practice and policy. “These findings provide important new evidence from a diverse set of programmes for meaningful benefits of produce prescriptions, highlighting the need for clinical, policy, and healthcare payer and provider efforts to implement larger pilots and randomized designs of produce prescriptions.”

Furthermore, the findings hold implications for policymakers in charge of carrying out action plans, noted Dr Candice Myers from Pennington Biomedical Research Center, Baton Rouge, Louisiana, US, in an editorial. [Circ Cardiovasc Qual Outcomes 2023;16:e009520]

“More specifically, investment in food-based nutrition programmes and interventions such as produce prescription programmes that provide for the purchase and intake of healthy foods such as F&V holds potential to address food insecurity and improve downstream health outcomes, especially in health disparate populations at the greatest risk of poor nutrition,” Myers continued.