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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
    Footnotes
    1 Co-first authors.
    Affiliations
    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
    Footnotes
    1 Co-first authors.
    Affiliations
    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
    Affiliations
    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
    Correspondence
    Address correspondence to: Enza Gucciardi, PhD, School of Nutrition, Faculty of Community Services, Toronto Metropolitan University, 288 Church Street, Toronto, Ontario M5B 1Z5, Canada.
    Affiliations
    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:https://doi.org/10.1016/j.jcjd.2022.11.001

      Abstract

      Objective

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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.

      Résumé

      Objectif

      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.

      Méthodes

      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.

      Résultats

      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.

      Conclusions

      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.

      Keywords

      Mots clés

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      References

      1. Diabetes Canada. Diabetes in Canada: Backgrounder.
      2. PROOF. Household food insecurity in Canada---PROOF.
        https://proof.utoronto.ca/food-insecurity
        Date accessed: November 29, 2020
        • Gucciardi E.
        • Vogt J.A.
        • DeMelo M.
        • Stewart D.E.
        Exploration of the relationship between household food insecurity and diabetes in Canada.
        Diabetes Care. 2009; 32: 2218-2224
        • Najibi N.
        • Firoozi R.
        • Shahrezaee S.
        • Eshraghian M.
        • Daneshi-Maskooni M.
        • Dorosty-Motlagh A.
        Food insecurity is an important risk factor for type 2 diabetes: A case-control study of new referrals to the university clinics, Shiraz, Southern Iran.
        BMC Public Health. 2019; 19: 885
        • Montgomery J.
        • Lu J.
        • Ratliff S.
        • Mezuk B.
        Food insecurity and depression among adults with diabetes: Results from the National Health and Nutrition Examination Survey (NHANES).
        Diabetes Educ. 2017; 43: 260-271
        • Seligman H.K.
        • Jacobs E.A.
        • López A.
        • Tschann J.
        • Fernandez A.
        Food insecurity and glycemic control among low-income patients with type 2 diabetes.
        Diabetes Care. 2012; 35: 233-238
        • Berkowitz S.A.
        • Gao X.
        • Tucker K.L.
        Food-insecure dietary patterns are associated with poor longitudinal glycemic control in diabetes: Results from the Boston Puerto Rican Health Study.
        Diabetes Care. 2014; 37: 2587-2592
        • Lyles C.R.
        • Wolf M.S.
        • Schillinger D.
        • et al.
        Food insecurity in relation to changes in hemoglobin A1c, self-efficacy, and fruit/vegetable intake during a diabetes educational intervention.
        Diabetes Care. 2013; 36: 1448-1453
        • Rabaut L.J.
        Medically tailored meals as a prescription for treatment of food-insecure type 2 diabetics.
        J Patient Cent Res Rev. 2019; 6: 179-183
        • Sattler E.L.P.
        • Lee J.S.
        • Bhargava V.
        Food insecurity and medication adherence in low-income older Medicare beneficiaries with type 2 diabetes.
        J Nutr Gerontol Geriatr. 2014; 33 (401–17)
        • Tarasuk V.
        • Cheng J.
        • de Oliveira C.
        • Dachner N.
        • Gundersen C.
        • Kurdyak P.
        Association between household food insecurity and annual health care costs.
        CMAJ. 2015; 187: E429-E436
        • Downer S.
        • Berkowitz S.A.
        • Harlan T.S.
        • Olstad D.L.
        • Mozaffarian D.
        Food is medicine: Actions to integrate food and nutrition into healthcare.
        BMJ. 2020; 369: m2482
        • Berkowitz S.A.
        • Terranova J.
        • Hill C.
        • et al.
        Meal delivery programs reduce the use of costly health care in dually eligible Medicare and Medicaid beneficiaries.
        Health Aff (Millwood). 2018; 37: 535-542
        • Berkowitz S.A.
        • Terranova J.
        • Randall L.
        • Cranston K.
        • Waters D.B.
        • Hsu J.
        Association between receipt of a medically tailored meal program and health care use.
        JAMA Intern Med. 2019; 179: 786-793
        • Swartz H.
        Produce Rx programs for diet-based chronic disease prevention.
        AMA J Ethics. 2018; 20: 960-973
        • Veldheer S.
        • Scartozzi C.
        • Knehans A.
        • et al.
        A systematic scoping review of how healthcare organizations are facilitating access to fruits and vegetables in their patient populations.
        J Nutr. 2020; 150: 2859-2873
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration.
        PLoS Med. 2009; 6e1000100
      3. DistillerSR. Version 2.35. DistillerSR Inc.; 2020. https://www.evidencepartners.com. Accessed November 30, 2022.

        • The Cochrane Collaboration
        Data extraction forms.
        • The Cochrane Collaboration
        RoB 2: A revised Cochrane risk-of-bias tool for randomized trials.
        • Viswanathan M.
        • Berkman N.
        • Dryden D.
        • Hartling L.
        Assessing risk of bias and confounding in observational studies of interventions or exposures: Further development of the RTI item bank. Methods Research report. July 31, 2013.
      4. RevMan.
        • Elbourne D.R.
        • Altman D.G.
        • Higgins J.P.
        • Curtin F.
        • Worthington H.V.
        • Vail A.
        Meta-analyses involving cross-over trials: Methodological issues.
        Int J Epidemiol. 2002; 31: 140-149
        • Palar K.
        • Napoles T.
        • Hufstedler L.L.
        • et al.
        Comprehensive and medically appropriate food support is associated with improved HIV and diabetes health.
        J Urban Health. 2017; 94: 87-99
        • Berkowitz S.A.
        • Delahanty L.M.
        • Terranova J.
        • et al.
        Medically tailored meal delivery for diabetes patients with food insecurity: A randomized cross-over trial.
        J Gen Intern Med. 2019; 34: 396-404
        • Seligman H.K.
        • Lyles C.
        • Marshall M.B.
        • et al.
        A pilot food bank intervention featuring diabetes-appropriate food improved glycemic control among clients in three states.
        Health Aff (Millwood). 2015; 34: 1956-1963
        • Tester J.M.
        • Leak T.M.
        Fiber-rich foods delivered to low-income households: A feasibility study of children with prediabetes and spillover effect on their caregivers.
        Prev Med Rep. 2021; 24101511
        • Seligman H.K.
        • Smith M.
        • Rosenmoss S.
        • Marshall M.B.
        • Waxman E.
        Comprehensive diabetes self-management support from food banks: A randomized controlled trial.
        Am J Public Health. 2018; 108: 1227-1234
        • Ferrer R.L.
        • Neira L.-M.
        • De Leon Garcia G.L.
        • Cuellar K.
        • Rodriguez J.
        Primary care and food bank collaboration to address food insecurity: A pilot randomized trial.
        Nutr Metab Insights. 2019; 12117863881986643
        • Cheyne K.
        • Smith M.
        • Felter E.M.
        • et al.
        Food bank–based diabetes prevention intervention to address food security, dietary intake, and physical activity in a food-insecure cohort at high risk for diabetes.
        Prev Chronic Dis. 2020; 17190210
        • Freedman D.A.
        • Choi S.K.
        • Hurley T.
        • Anadu E.
        • Hébert J.R.
        A farmers’ market at a federally qualified health center improves fruit and vegetable intake among low-income diabetics.
        Prev Med. 2013; 56: 288-292
        • Bryce R.
        • Guajardo C.
        • Ilarraza D.
        • et al.
        Participation in a farmers’ market fruit and vegetable prescription program at a federally qualified health center improves hemoglobin A1C in low income uncontrolled diabetics.
        Prev Med Rep. 2017; 7: 176-179
        • Xie J.
        • Price A.
        • Curran N.
        • Østbye T.
        The impact of a produce prescription programme on healthy food purchasing and diabetes-related health outcomes.
        Public Health Nutr. 2021; 24: 3945-3955
        • Bryce R.
        • Wolfson J.
        • Cohen A.
        • et al.
        A pilot randomized controlled trial of a fruit and vegetable prescription program at a federally qualified health center in low income uncontrolled diabetics.
        Prev Med Rep. 2021; 23101410
        • Harris J.P.
        • Bett C.
        • McCleary-Jones V.
        Farmers’ market voucher initiative to improve diabetes control in older adults.
        J Nurse Pract. 2022; 18: 236-238
        • Weinstein E.
        • Galindo R.J.
        • Fried M.
        • Rucker L.
        • Davis N.J.
        Impact of a focused nutrition educational intervention coupled with improved access to fresh produce on purchasing behavior and consumption of fruits and vegetables in overweight patients with diabetes mellitus.
        Diabetes Educ. 2014; 40: 100-106
        • Snailer B.
        • Painter I.
        • Duncan G.
        Lowering HbA1c in food insecure type 2 diabetics through a fruit and vegetable prescription program.
        (2019.)
        https://www.ssrn.com/abstract=3397202
        Date: 2019
        Date accessed: January 24, 2021
        • Blitstein J.L.
        • Lazar D.
        • Gregory K.
        • et al.
        Foods for health: An integrated social medical approach to food insecurity among patients with diabetes.
        Am J Health Promot. 2021; 35: 369-376
        • Veldheer S.
        • Scartozzi C.
        • Bordner C.R.
        • et al.
        Impact of a prescription produce program on diabetes and cardiovascular risk outcomes.
        J Nutr Educ Behav. 2021; 53: 1008-1017
      5. European Medicines Agency. Guideline on clinical investigation of medicinal products in the treatment or prevention of diabetes mellitus.
        (2012.)
        • Pomerleau J.
        • Lock K.
        • Knai C.
        • McKee M.
        Interventions designed to increase adult fruit and vegetable intake can be effective: A systematic review of the literature.
        J Nutr. 2005; 135: 2486-2495
        • Berkowitz S.A.
        • Shahid N.N.
        • Terranova J.
        • et al.
        “I was able to eat what I am supposed to eat”---patient reflections on a medically-tailored meal intervention: A qualitative analysis.
        BMC Endocr Disord. 2020; 20: 10
        • Worswick J.
        • Wayne S.C.
        • Bennett R.
        • et al.
        Improving quality of care for persons with diabetes: An overview of systematic reviews—what does the evidence tell us?.
        Syst Rev. 2013; 2