Food is medicine, home food for the health of vulnerable people
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'Food is medicine' is an area of health intervention based on the home delivery of food and ready meals, to improve the health of vulnerable people. Elderly population and/or affected by chronic pathologies and/or just discharged from hospital.
This practice has recently been implemented in some US states and in a few other countries (Australia, Canada and the United Kingdom). It has proven to be an effective and low-cost public health solution. But there are critical issues.
The role of nutrition in health and disease
Power drastically affects health. Globally, one in five deaths is attributable to an unbalanced diet. Food affects more than any other risk factor, including tobacco, according to a study published in 2019 on The Lancet. (1)
The first three risk factors related to diet are:
- salt, excessive consumption. Exceed the threshold indicated by WHO (5 grams per day) exposes you to serious risks of cardiovascular disease, diabetes and cancer. Moderate salt consumption, within 2,3 g per day, is conversely associated with the lowest blood pressure level in randomized controlled trials,
- whole grains, low consumption. At least 125 g (100-150 g) of whole grains (complete with bran, germ and endosperm. Not even 'false integrals') should be taken daily. As such (e.g. brown rice, cereal flakes in muesli) or through pasta and baked goods,
- fruit, scarcity. The average daily consumption of fruit should not fall below 250 g (200 to 300 g) of fruit. Excluding, of course, nectars and other sugary (or salty) fruit-based preparations. (1)
Possible source of disease, especially when exchanged for ultra-processed foods, (real) food is also a healing tool, as demonstrated by the practice called Food is medicine.
Food is medicine, food that cures
The experimentation of intervention models Food is medicine (or Food as medicine) as a tool to prevent, manage and cure diseases is attracting a lot of interest in the scientific community.
The analysis of the initiatives carried out in the United States (California (in primis)) highlights beneficial effects both for the health of the population involved and for the coffers of the health system. A budget win-win which could convince private health insurance companies to include alimony as a cure, in view of a reduction in health care costs to be reimbursed for medicines and hospitalizations.
How it works
The interventions they are articulated according to the needs and pathology of the recipients, always selected through general practitioners and other structures of the health system. They are usually designed to treat individuals with low income, food insecurity and/or limitations in activities of daily living that make preparing healthy meals difficult.
Access the service, subject to registration, is conditioned by the presence of a chronic disease (heart disease, kidney disease, diabetes, cancer etc.) influenced by food and by the recurring need for medical care and hospitalization.
Some programs they also include people with a disability that prevents them from preparing adequate meals, the elderly who are no longer self-sufficient, the HIV positive. Precisely AIDS patients were in the 90s the first recipients in the USA (at the federal level) of meals provided by health care, as a palliative measure when care was scarce (Ryan White Comprehensive AIDS Resources Emergency Act of the 1990).
Ready meals or voucher
Shapes of food-medicine delivery are of three types:
– home delivery of meals prepared according to the indications of nutritionists and according to the pathology to be treated (Medically Taylored Meals, MTM, or Medically Supportive Food, MSF). Programs usually include 2 or 3 meals a day for 12 weeks,
– the provision of an expense weekly food, designed according to the health needs of the recipient,
– the disbursement of vouchers to spend at the farmers' markets to buy fruit and vegetables.
In addition to food supplysome programs also include nutritional education interventions and group meals (particularly for the elderly, who thus benefit from adequate nutrition and the opportunity to socialize).
The effects of interventions Food is medicine
Benefits for the recipients of these innovative health services are evident, according to numerous studies that have been monitoring the phenomenon since 2018. (2)
This form of assistance in the low-income population improves diet, reduces the anxiety of having to choose whether to pay for food or medicines. Among HIV-positive patients, adherence to retroviral therapy increases. Among diabetics it improves the management of the pathology.
Consequently hospitalizations, visits to the emergency room and healthcare costs are also reduced.
Hospitalizations halved
The authors of a recent article published on JAMA Network Open they report that 'in observational studies and randomized pilot clinical trials, patients who received MTMs (Medically Taylored Meals, i.e. tailor-made meals, ed) experienced better disease management and had fewer hospitalizations, emergency department visits, nursing home visits care and lower healthcare costs compared to control patients (under similar conditions).'.
The reception of these customized meals has been associated with
- lower risk of hospitalization ranging from 37% to 52%,
- reduction between 16% and 31% of monthly healthcare costs,
- decreased net healthcare costs by approximately $2.500 per patient-year, after paying for the costs of tailored meals.
Based on these data, the researchers simulated the administration of Medically Taylored Meals to 6.309.998 US adults over the age of 18 with Medicare, Medicaid or private insurance and at least one food-sensitive disease and limitation in activities of daily living.
In 10 years, with 10 meals a week for 8 months a year, the measure 'could potentially be associated with approximately 1,6 million hospitalizations avoided and net cost savings of $13,6 billion annually'. (3)
Noteworthyfinally, the impact of tailor-made meals on the fate of individuals hospitalized. A study of 645 individuals admitted for chronic heart failure in 8 Swiss hospitals found that tailored nutrition reduced 56-day mortality by 30%, compared to patients fed ordinary hospital food. (4)
A potential to improve
The scientific evidence they are encouraging. However, an analysis published in the BMJ (5) shows that the large-scale application of the programmes Food is medicine requires filling some gaps, in particular
- Research. To consolidate the evidence from the pilot studies conducted so far, larger implementation studies are needed, including randomized studies with appropriate comparison groups,
- training. Improve training of clinicians to recognize a patient's nutritional needs and understand the potential impact of available services. In the US, less than 1% of medical school training hours are devoted to nutrition. Elsewhere, including Europe, the situation is similar, as evidenced by a study in the Lancet,(6)
- funding. The most sore point concerns money. In the United States, Food is Medicine programs are limited to a few pilot initiatives and philanthropy. Elsewhere, such as in Great Britain and Italy, the health system covers only particular foods (protein-free, gluten-free).
Marta Strinati
Note
(1) GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2019;393:1958-72. doi:10.1016/S0140-6736(19)30041-8 pmid:30954305 https://pubmed.ncbi.nlm.nih.gov/30954305/
(2) See overview of peer-reviewed research associated with Food is Medicine interventions by the Center for Health Law and Policy Innovation of Harvard Law School, Food is Medicine: Peer-Reviewed Research in the US Medically Tailored Meals, Medically Tailored Food Packages, and Nutritious Food Referrals. https://chlpi.org/wp-content/uploads/2013/12/Food-is-Medicine_Peer-Reviewed-Research-in-the-U.S.1.pdf
(3) Kurt Hager, Frederick P. Cudhea, John B. Wong et al. Association of National Expansion of Insurance Coverage of Medically Tailored Meals With Estimated Hospitalizations and Health Care Expenditures in the US. JAMA Net Open. 2022;5(10):e2236898. doi:10.1001/jamanetworkopen.2022.36898 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797397
(4) Lara Hersberger, Anna Dietz, Helene Bürgler, Annika Bargetzi, Laura Bargetzi, Nina Kägi-Braun, Pascal Tribolet, Filomena Gomes, Claus Hoess, Vojtech Pavlicek, Stefan Bilz, Sarah Sigrist, Michael Brändle, Christoph Henzen, Robert Thomann, Jonas Rutishauser, Drahomir Aujesky, Nicolas Rodondi, Jacques Donzé, Zeno Stanga, Beat Mueller, Philipp Schuetz. Individualized Nutritional Support for Hospitalized Patients With Chronic Heart Failure. Journal of the American College of Cardiology, Volume 77, Issue 18, 2021, Pages 2307-2319, ISSN 0735-1097, https://doi.org/10.1016/j.jacc.2021.03.232.
(5) Downer S, Berkowitz SA, Harlan TS, Olstad DL, Mozaffarian D. Food is medicine: actions to integrate food and nutrition into healthcare BMJ 2020; doi: https://doi.org/10.1136/bmj.m2482
6) Crowley J, Ball L, Hiddink GJ. Nutrition in medical education: a systematic review. Lancet Planet Health. 2019 Sep;3(9):e379-e389. doi: 10.1016/S2542-5196(19)30171-8. PMID: 31538623.
