Impact of Produce Prescriptions on Diet, Food Security, and Cardiometabolic Health Outcomes: A Multisite Evaluation of 9 Produce Prescription Programs in the United States

• Published in: Circulation Cardiovascular quality and outcomes Vol. 16; no. 9; p. e009520
• Main Authors: Hager, Kurt, Du, Mengxi, Li, Zhongyu, Mozaffarian, Dariush, Chui, Kenneth, Shi, Peilin, Ling, Brent, Cash, Sean B, Folta, Sara C, Zhang, Fang Fang
• Format: Journal Article
• Language: English
• Published: United States 01-09-2023
• Subjects: Adult; Child; Diet; Food Security; Glycated Hemoglobin; Humans; Hypertension; Obesity; United States - epidemiology; United States; obesity management; glycemic control; food assistance; hypertension; nutrition policy
• ISSN: 1941-7713; 1941-7705; 1941-7705
• DOI: 10.1161/CIRCOUTCOMES.122.009520

Produce prescriptions may improve cardiometabolic health by increasing fruit and vegetable (F&V) consumption and food insecurity yet impacts on clinical outcomes and health status have not been evaluated in large, multisite evaluations.
This multisite, pre- and post-evaluation used individual-level data from 22 produce prescription locations in 12 US states from 2014 to 2020. No programs were previously evaluated. The study included 3881 individuals (2064 adults aged 18+ years and 1817 children aged 2-17 years) with, or at risk for, poor cardiometabolic health recruited from clinics serving low-income neighborhoods. Programs provided financial incentives to purchase F&V at grocery stores or farmers markets (median, $63/months; duration, 4-10 months). Surveys assessed F&V intake, food security, and self-reported health; glycated hemoglobin, blood pressure, body mass index (BMI), and BMI
-score were measured at clinics. Adjusted, multilevel mixed models accounted for clustering by program.
After a median participation of 6.0 months, F&V intake increased by 0.85 (95% CI, 0.68-1.02) and 0.26 (95% CI, 0.06-0.45) cups per day among adults and children, respectively. The odds of being food insecure dropped by one-third (odds ratio, 0.63 [0.52-0.76]) and odds of improving 1 level in self-reported health status increased for adults (odds ratio, 1.62 [1.30-2.02]) and children (odds ratio, 2.37 [1.70-3.31]). Among adults with glycated hemoglobin ≥6.5%, glycated hemoglobin declined by -0.29% age points (-0.42 to -0.16); among adults with hypertension, systolic and diastolic blood pressures declined by -8.38 mm Hg (-10.13 to -6.62) and -4.94 mm Hg (-5.96 to -3.92); and among adults with overweight or obesity, BMI decreased by -0.36 kg/m
(-0.64 to -0.09). Child BMI
-score did not change -0.01 (-0.06 to 0.04).
In this large, multisite evaluation, produce prescriptions were associated with significant improvements in F&V intake, food security, and health status for adults and children, and clinically relevant improvements in glycated hemoglobin, blood pressure, and BMI for adults with poor cardiometabolic health.