Healthy Food Prescription Programs and their Impact on Dietary Behavior and Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis

Abstract

The enormous burden of diet-related chronic diseases has prompted interest in healthy food prescription programs. Yet, the impact of such programs remains unclear. The aim of this study was to conduct a systematic review of healthy food prescription programs and evaluate their impact on dietary behavior and cardiometabolic parameters by meta-analysis. A systematic search was carried out in Medline, Embase, Scopus, and Cochrane Central Register of Controlled Trials databases since their inception to 3 January, 2020 without language restriction. A systematic search of interventional studies investigating the effect of healthy food prescription on diet quality and/or cardiometabolic risk factors including BMI, systolic (SBP) and diastolic blood pressure (DBP), glycated hemoglobin (HbA1c), or blood lipids was carried out. Thirteen studies were identified for inclusion, most of which were quasi-experimental (pre/post) interventions without a control group (n = 9). Pooled estimates revealed a 22% (95% CI: 12, 32; n = 5 studies, n = 1039 participants; I2 = 97%) increase in fruit and vegetable consumption, corresponding to 0.8 higher daily servings (95% CI: 0.2, 1.4; I2 = 96%). BMI decreased by 0.6 kg/m2 (95% CI: 0.2, 1.1; I2 = 6.4%) and HbA1c by 0.8% (95% CI: 0.1, 1.6; I2 = 92%). No significant change was observed in other cardiometabolic parameters. These findings should be interpreted with caution in light of considerable heterogeneity, methodological limitations of the included studies, and moderate to very low certainty of evidence. Our results support the need for well-designed, large, randomized controlled trials in various settings to further establish the efficacy of healthy food prescription programs on diet quality and cardiometabolic health.

Impact of a Virtual Culinary Medicine Curriculum on Biometric Outcomes, Dietary Habits, and Related Psychosocial Factors among Patients with Diabetes Participating in a Food Prescription Program

“…Food prescription programs that operate collaboratively between healthcare and social services are fast gaining popularity in the U.S., with a recent meta-analysis demonstrating significant positive impacts on obesity and diabetes outcomes [25]. However, a major limitation identified in the meta-analysis was the lack of rigor in study designs used and small sample sizes [25]. There was also significant heterogeneity in the nutrition educational components of these food prescription programs.…”

Healthy food prescription incentive programme for adults with type 2 diabetes who are experiencing food insecurity: protocol for a randomised controlled trial, modelling and implementation studies

“…[43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] Moreover, a recent metaanalysis of 13 studies found that healthy food prescription programmes may increase fruit and vegetable intake by 0.8 servings/day, reduce BMI by 0.6 kg/m 2 and reduce A1C by 0.8%, although the certainty of the evidence was rated as very low to moderate. 60 Qualitative data similarly suggest patients and care providers perceive financial, dietary and health benefits from these programmes, and support their ongoing delivery. 43 50 61-63 Food prescription programmes also appear to be cost-effective, with one recent modelling study indicating that a national healthy food prescription incentive programme in the USA could eliminate US$100.2 billion in healthcare costs if implemented over the lifetime of beneficiaries.…”

“…Despite some promising initial findings, major knowledge gaps remain pertaining to the impact and optimal implementation of healthy food prescription programmes. 60 Most prior studies have been small and uncontrolled, and have examined a small number of self-reported outcomes using brief dietary 44 45 48 63 65 and/or food insecurity screeners, 47 50–53 and/or short descriptive surveys, 44 61 63 rather than objective clinical outcomes. The majority of prior programmes have also subsidised the purchase of fruits and vegetables alone, without considering the relevance of entire dietary patterns to blood glucose levels and health outcomes.…”

“…Preliminary evidence from several studies suggests that these programmes may improve diet quality and self-reported health, while reducing food insecurity, A1C, hypertension and body mass index (BMI), including within Indigenous communities 43–59. Moreover, a recent meta-analysis of 13 studies found that healthy food prescription programmes may increase fruit and vegetable intake by 0.8 servings/day, reduce BMI by 0.6 kg/m 2 and reduce A1C by 0.8%, although the certainty of the evidence was rated as very low to moderate 60. Qualitative data similarly suggest patients and care providers perceive financial, dietary and health benefits from these programmes, and support their ongoing delivery 43 50 61–63.…”

Accelerating Evaluation of Financial Incentives for Fruits and Vegetables: A Case for Shared Measures

“…A 2019 systematic review on food-insecurity interventions in healthcare settings, including PPR, found no effect on FVI when individual studies were pooled, while overall impact on health or healthcare utilization could not be determined due to variability in measures [17]. Finally, a recent meta-analysis on PPR found a 22% increase in FVI among participants when estimates were pooled; however, the authors cautioned that considerable heterogeneity and other methodological limitations preclude causal inference [27].…”