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 decreased food insecurity. 

This research was published 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.

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 US 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,” says study lead author Kurt Hager, PhD, MS, an instructor at UMass Chan Medical School, in a release. “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 four 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 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 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,” says Mitchell Elkind, MD, MS, FAHA, chief clinical science officer of the American Heart Association and a tenured professor of neurology and epidemiology at Columbia University, in a release. “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.”

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 patients receive medical prescriptions for healthy food to help prevent and manage chronic disease.

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

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