Research Highlights:

• Adults at risk for heart disease who participated in produce prescription programs for an average of six months increased their consumption of fruits and vegetables and had reduced blood pressure, body mass index and blood sugar levels.
• Among adults and children, produce prescription programs also appeared to decrease food insecurity — the lack of equitable and stable availability, access, affordability and consumption of healthy foods and drinks — and improve self-reported health status.

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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.

Produce 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 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.”

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 completing the program — which ranged from 4 to 10 months— participants completed questionnaires about fruit and vegetable consumption, food insecurity and health status. Routine testing of blood pressure; weight and height; and hemoglobin A1c (HbA1c) -a measure of blood sugar – was completed at enrollment and at the conclusion of the program. The 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 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 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.”