The Effect of Food is Medicine Interventions on Diabetes-related Health Outcomes Among Low-income and Food-insecure Individuals: A Systematic Review and Meta-analysis

  • Author Footnotes
    1 Co-first authors.
    Yueying Gao
    1 Co-first authors.
    School of Nutrition, Faculty of Community Services, Toronto Metropolitan University, Toronto, Ontario, Canada
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  • Author Footnotes
    1 Co-first authors.
    Adalia Yang
    1 Co-first authors.
    Clinical Public Health Division–Nutrition and Dietetics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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  • Andreea Zurbau
    School of Nutrition, Faculty of Community Services, Toronto Metropolitan University, Toronto, Ontario, Canada

    Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
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  • Enza Gucciardi
    Address correspondence to: Enza Gucciardi, PhD, School of Nutrition, Faculty of Community Services, Toronto Metropolitan University, 288 Church Street, Toronto, Ontario M5B 1Z5, Canada.
    School of Nutrition, Faculty of Community Services, Toronto Metropolitan University, Toronto, Ontario, Canada
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  • Author Footnotes
    1 Co-first authors.
Published:November 05, 2022DOI:



      In this study we aim to review the current evidence of Food is Medicine interventions on diabetes outcomes among low-income or food-insecure individuals.


      Seven databases were searched from January 1, 2000 to October 26, 2021 for full-text articles written in English. The studies included experimental studies of any duration and design which addressed the effect of Food is Medicine interventions on fruit and vegetable (F&V) intake and glycated hemoglobin (A1C) levels among low-income or food-insecure populations with prediabetes or diabetes of any age group. Only direction of effect of interventions on F&V intake were ascertained due to high variability in outcome measurement. A1C results were pooled using generic inverse variance with a fixed-effects model. Heterogeneity was assessed using Cochran’s Q and quantified by I2.


      Sixteen studies were included. Five of the 8 studies reported a significant increase in F&V intake. Seven of the 14 studies reported a significant decrease in A1C levels. A meta-analysis of 5 randomized controlled trials (n=843) resulted in clinically meaningful reductions in A1C compared with control (mean difference, −0.47%; 95% confidence interval, −0.66 to −0.29, I2=88%, p<0.0001). Half (n=8) of the studies have a high risk of bias due to missing data, detection bias and confounding.


      Food is Medicine interventions are effective in increasing F&V intake and reducing A1C levels of the target population. More randomized controlled studies are needed to validate the results.



      Dans la présente étude, nous avons pour objectif de passer en revue les données scientifiques actuelles sur les effets des interventions Food is Medicine sur les résultats cliniques liés au diabète chez les individus à faible revenu ou en insécurité alimentaire.


      Sept bases de données ont été consultées du 1er janvier 2000 au 26 octobre 2021 pour trouver des articles complets écrits en anglais. Les études étaient des études expérimentales de toute durée et de toute conception qui portaient sur les effets des interventions Food is Medicine sur la consommation de fruits et de légumes (F&L) et les concentrations de l’hémoglobine glyquée (A1c) sur les populations prédiabétiques ou diabétiques à faible revenu ou en insécurité alimentaire de tous les groupes d’âge. Seules les directions des effets des interventions sur la consommation de F&L ont été déterminées en raison de la forte variabilité des mesures des résultats. La méthode de l’inverse de la variance générique à l’aide d’un modèle à effets fixes a permis de regrouper les résultats de l’A1c. L’hétérogénéité a été évaluée à l’aide du test Q de Cochran et quantifiée par I2.


      Seize études ont été incluses. Cinq études sur 8 indiquaient une augmentation significative de la consommation de F&L. Sept études sur 14 indiquaient une diminution significative des concentrations de l’A1c. Une méta-analyse constituée de 5 essais comparatifs à répartition aléatoire (n = 843) a permis de conclure à des réductions cliniquement significatives de l’A1c par rapport aux témoins (différence moyenne, −0,47 %; intervalle de confiance à 95 %, de −0,66 à −0,29, I2 = 88 %, p < 0,0001). La moitié (n = 8) des études comportent un risque élevé de biais en raison du manque de données, de biais de détection et de confusion.


      Les interventions Food is Medicine sont efficaces pour augmenter la consommation de F&L et réduire les concentrations de l’A1c de la population cible. Plus d’essais comparatifs à répartition aléatoire sont nécessaires pour valider les résultats.


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