Free access to fruit and vegetables linked to better heart health, research reveals

21 Mar 2024 --- Providing free, weekly home delivery of fresh fruits and vegetables from local farms helped to improve people’s nutrition, physical activity levels and cardiovascular disease risk factors, says a new study presented this week at a conference of the American Heart Association (AHA).

Researchers examined participants in Recipe4Health, a program providing free, weekly deliveries of locally grown produce to adults receiving health care at a local Federally Qualified Health Center for 16 weeks. Participants completed surveys on their diet, physical activity level and food insecurity before and after the program.

Participants increased their fruit and vegetable intake by almost half a serving daily after the program and added nearly 42 minutes of additional physical activity. Food insecurity decreased from 59% before the study to 48% after the 16-week program. 

“We all know that eating healthier foods, like fruits and vegetables, is good for you. However, sometimes we focus too much on finding a simple solution rather than taking small, preventative measures to improve health,” says lead study author Dr. Lisa Goldman Rosas, an assistant professor in the department of epidemiology and population health and the department of medicine at Stanford School of Medicine in Palo Alto, California, US. 

“‘Food as Medicine’ programs, such as the Recipe4Health program we studied, aim to shift the focus to ensuring a healthy diet including fresh fruits and vegetables is consistently accessible and affordable to all people to help improve health outcomes.”

The research was presented at this week’s AHA’s Lifestyle and Cardiometabolic Scientific Sessions 2024, offering the latest science on population-based health and wellness and implications for lifestyle.

Heart-healthy diet 
The AHA recommends individuals consume four to five servings of fruits and vegetables daily and engage in at least 150 minutes of moderate-intensity physical activity each week. 

The study included 5,286 adults, about 50% participating in the Recipe4Health program. Coronary artery disease had already been diagnosed in 45% of participants at enrollment, with about half of the total participants having high cholesterol.

“I was excited to see that providing patients with a modest amount of locally grown produce resulted in improvements in food insecurity, diet and indicators of cardiovascular health,” highlights Rosas.

The AHA recommends four to five servings of fruits and vegetables daily and 150 minutes of physical activity weekly.“This study occurred during the COVID-19 pandemic, when many of these outcomes were worsening, especially among patients receiving care at Federally Qualified Health Centers that were disproportionately impacted.” 

At the same time, the researchers note several limitations, such as small sample sizes for follow-up blood tests and not having a control group reporting on diet and activity levels. 

Lowering risk factors 
One year after the start of the program, researchers analyzed changes in cardiovascular disease risk factors by comparing Recipe4Health participants with people who did not receive free produce deliveries. 

They found that program participants had significantly higher reductions of non-high-density lipoprotein (HDL) cholesterol at an average of 17.1 mg/dL. This is calculated as total cholesterol minus HDL cholesterol, or “good” cholesterol. 

Moreover, the researchers found a reduction in blood glucose levels in program participants, with an average decrease in HbA1c of 0.37%. They note that such a reduction is lower than that of type 2 diabetes medication in a similar time frame. 

In this second analysis, researchers found no changes in blood pressure or body mass index (BMI). 

Rosas comments: “Additional strategies may be needed to change BMI and blood pressure. Additional strategies may include behavioral interventions and pharmacotherapy in conjunction with a Food as Medicine program.” 

Produce prescription programs enable doctors to prescribe fruits and vegetables in addition to medications.Follow-up research  
As a next step, the researchers aim to explore different strategies for delivering food and to evaluate the effects of food approved by a registered dietitian or nutritionist, so-called medically supportive groceries. They also want to engage diverse patient groups, such as people with type 2 diabetes or cancer, people in rural areas and children. 

The AHA is also working to improve access to healthy food for people who receive treatment for chronic health conditions and those at a high risk of developing those conditions. Its Health Care by Food initiative invests in research, advocacy and education to demonstrate the benefits of Food is Medicine interventions. 

“This research demonstrates the potential for a food prescription, accessible through a health care visit, to improve health outcomes for significant portions of the US population,” says Dr. Kevin Volpp, the research lead for the Health Care by Food initiative. 

“A coordinated research approach is needed to more systematically and rigorously define how well ‘Food is Medicine’ interventions prevent and treat disease compared to standard medical care.”

Research highlights that produce prescription programs help to reduce heart health risk, increase fruit and vegetable intake and improve BMI. 

Earlier this year, Nutrition Insight spoke to the US Food is Medicine Institute about its calls to integrate food-based nutritional interventions into healthcare to increase population-wide nutrition security, health equity and wellness. 

By Jolanda van Hal