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

IF 6.9 2区 医学
Kurt Hager, Mengxi Du, Zhongyu Li, Dariush Mozaffarian, Kenneth Chui, Peilin Shi, Brent Ling, Sean B Cash, Sara C Folta, Fang Fang Zhang
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引用次数: 0

Abstract

Background: 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.

Methods: 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 z-score were measured at clinics. Adjusted, multilevel mixed models accounted for clustering by program.

Results: 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/m2 (-0.64 to -0.09). Child BMI z-score did not change -0.01 (-0.06 to 0.04).

Conclusions: 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.

农产品处方对饮食、食品安全和心脏代谢健康结果的影响:对美国9个农产品处方项目的多站点评估。
背景:生产处方可以通过增加水果和蔬菜(F&V)的消费和食物不安全来改善心脏代谢健康,但对临床结果和健康状况的影响尚未在大型多站点评估中进行评估。方法:这项多站点、前后评估使用了2014年至2020年美国12个州22个生产处方地点的个人水平数据。以前未评估任何程序。这项研究包括3881名来自低收入社区诊所的心脏代谢健康状况不佳或有风险的患者(2064名18岁以上的成年人和1817名2-17岁的儿童)。项目为在杂货店或农贸市场购买F&V提供了经济激励(中位数为63美元/月;持续时间为4-10个月)。调查评估了F&V摄入量、食品安全和自我报告的健康状况;在诊所测量糖化血红蛋白、血压、体重指数(BMI)和BMI z评分。调整后的多级混合模型按程序进行聚类。结果:在中位参与6.0个月后,成人和儿童的F&V摄入量分别增加了0.85杯(95%CI,0.68-1.02)和0.26杯(95%CI,0.06-0.45)/天。成人(比值比1.62[1.30-2.02])和儿童(比值比2.37[1.70-3.31])的食物不安全几率下降了三分之一(比值比0.63[0.52-0.76]),自我报告健康状况改善1级的几率增加。在糖化血红蛋白≥6.5%的成年人中,糖化血红蛋白下降了-0.29%的年龄点(-0.42--0.16);在患有高血压的成年人中,收缩压和舒张压下降了-8.38毫米 汞柱(-10.13至-6.62)和-4.94毫米 汞(-5.96至-3.92);在超重或肥胖的成年人中,BMI下降了-0.36 kg/m2(-0.64至-0.09)。儿童BMI z评分没有变化-0.01(-0.06至0.04)。结论:在这项大型多站点评估中,生产处方与成人和儿童的F&V摄入量、食品安全和健康状况的显著改善以及糖化血红蛋白的临床相关改善有关,心脏代谢健康状况不佳的成年人的血压和BMI。
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来源期刊
Circulation. Cardiovascular Quality and Outcomes
Circulation. Cardiovascular Quality and Outcomes Medicine-Cardiology and Cardiovascular Medicine
CiteScore
9.80
自引率
2.90%
发文量
357
期刊介绍: Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal, publishes articles related to improving cardiovascular health and health care. Content includes original research, reviews, and case studies relevant to clinical decision-making and healthcare policy. The online-only journal is dedicated to furthering the mission of promoting safe, effective, efficient, equitable, timely, and patient-centered care. Through its articles and contributions, the journal equips you with the knowledge you need to improve clinical care and population health, and allows you to engage in scholarly activities of consequence to the health of the public. Circulation: Cardiovascular Quality and Outcomes considers the following types of articles: Original Research Articles, Data Reports, Methods Papers, Cardiovascular Perspectives, Care Innovations, Novel Statistical Methods, Policy Briefs, Data Visualizations, and Caregiver or Patient Viewpoints.
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