A culturally and medically tailored Indigenous Food is Medicine meal (CMTM) program reduced hospitalization and emergency department (ED) visits compared with dietary advice alone among patients with heart failure (HF) in Native communities, according to results of the MUTTON-HF trial, published July 27 in JAMA Internal Medicine.

The pragmatic, open-label MUTTON-HF trial, conducted at two Indian Health Service sites in the Navajo Nation, enrolled 206 participants (mean age, 66 years; 42% women; 99% American Indian) with HF and either a hospitalization or an ED visit within the past year. Participants had high rates of obesity (46%), type 2 diabetes (66%), prediabetes (21%), hypertension (72%), dyslipidemia (65%) and food insecurity (54%), with a mean baseline KCCQ summary score of 58.

Enrollees were randomized to 60 days of either dietary advice (a booklet with nutritional recommendations) or two daily meals from a tailored meal program. The meals consisted of traditional and culturally relevant recipes sourced from Native farmers and ranchers. Food distribution infrastructure was put in place to cover for lack of mail delivery, and participants were given the household devices needed to adopt the intervention, including microwaves, freezers, stoves and propane-powered appliances.

At 90 days, hospitalizations and ED visits were significantly lower with CMTM than dietary guidance alone (43/106 vs. 57/100), driven mainly by fewer hospitalizations (12% vs. 26%) and HF hospitalizations (4% vs. 13%). Within eight weeks, CMTM participants also had improved KCCQ health-status measures and food security, with less financial strain, weight and blood pressure.

Investigators Lauren A. Eberly, MD, MPH, et al,. note that the distribution program may have also decreased social isolation among the predominantly rural participants.

"Indigenous Food is Medicine programs are one way to rectify the profound disruptions of cultural practices and traditional relationships with the natural world that have resulted from settler colonialism," write Eberly and colleagues, noting this is one of the first Food is Medicine cardiovascular health programs that shifts the focus from urban food deserts to rural communities facing their own unique infrastructure and access issues. "Leveraging the protective assets of Native communities is paramount to advancing Indigenous health and well-being."