Customized medical meals may help improve outcomes in type 2 diabetes

Type 2 diabetes and high blood pressure are among the world’s most pressing public health problems. Together, they affect millions of people and raise the risk of cardiovascular disease, stroke, kidney disease, and early death.

About 830 million adults globally are living with diabetes, and more than 95% of those cases are type 2 diabetes. At the same time, roughly 1.4 billion adults have hypertension.

Diet quality is a major factor in both preventing and managing these conditions, and poor eating habits are a significant risk factor.

Eating a balanced, healthy diet can help regulate blood sugar, support a healthy body weight, and lower blood pressure, which may reduce the risk of these diseases and their complications.

A study presented at the American Heart Association’s Scientific Sessions found that people who received meals designed around their medical needs saw improvements in blood sugar control, blood pressure, and access to healthy food.

The findings also indicate that gradually reducing the number of meals over time may still preserve these benefits when paired with nutrition counseling and education on heart health.

The results add to growing interest in “food is medicine,” an approach that uses nutrition-based interventions as part of healthcare to help prevent and manage chronic disease.

Because the research is available only as a conference abstract and has not yet completed full peer review, the results should be considered preliminary.

Medically tailored meals may support heart health

Medically tailored meals are nutritious meals customized to fit a person’s dietary needs in the context of their medical conditions.

“This makes it easier for the patient to eat healthy, since they do not have to worry about shopping for ingredients or meal preparation,” lead study author Nour Makarem, PhD, FAHA, an assistant professor of epidemiology and co-director of the Chronic Disease Unit at Columbia University’s Mailman School of Public Health, explained to Medical News Today.

In the past, food is medicine programs have often focused on people with more advanced or severe illness. The researchers suggest that starting these interventions earlier may help people better manage chronic disease and perhaps slow its progression.

To explore this idea, they studied 110 adults in New York City who had both type 2 diabetes and hypertension. The average age was 63, 68% of participants were women, about 47% identified as Hispanic, and 43% identified as Black.

Participants were recruited from neighborhoods with high rates of chronic disease and premature death. They were assigned to two groups and followed for an 8-month intervention.

One group received 10 medically tailored meals per week throughout the full program. The other group also received 10 meals per week at first, but after 3 months the number was reduced by one meal each week over the next 5 months. By the last month, this group was receiving five medically tailored meals weekly.

Both groups also met with a dietitian for nutrition counseling and took part in an interactive heart health education program. They additionally received culturally responsive cooking demonstrations, fresh produce, healthy seasonings, recipes, and other ingredients to support healthy meal preparation at home.

Researchers measured blood sugar, blood pressure, diet quality, food security, and overall health status at the start and end of the study.

What were the main findings?

After 8 months, both groups showed better diet quality and improvements in several cardiometabolic measures.

Improved diet quality

In both groups, adherence to a heart-healthy Mediterranean-style eating pattern improved by three points.

The results suggest that nutritious meals combined with dietary education may help people make healthier food choices.

Better blood sugar control

HbA1c levels also dropped by about 0.5 percentage points, pointing to better blood sugar management in adults with type 2 diabetes.

Keeping blood glucose in a healthy range is important for lowering the risk of diabetes-related complications.

Lower blood pressure

Systolic and diastolic blood pressure each fell by around 4 millimeters of mercury (mm Hg).

Even relatively small reductions in blood pressure can matter for people with hypertension, although the long-term clinical meaning of the changes in this study is still uncertain.

Improved food security

Participants were also more likely to report improved food security after the program ended.

Using a six-item U.S. Department of Agriculture food security scale, researchers found that participants in either group were more than twice as likely to reach a higher food security status at 8 months than they were at the start of the study.

Better access to nutritious food may help people manage chronic conditions while making it easier to maintain a healthy diet.

“The important takeaway is that a medically tailored meals program, as a Food Is Medicine intervention that provides a healthy diet in a manner that is integrated with the healthcare system, is an effective approach to lower blood pressure and blood glucose in patients living with type 2 diabetes and high blood pressure, especially when coupled with a co-intervention that includes education and counseling on healthy diet and lifestyle, cooking demonstrations , healthy recipes, and gift bags with healthy ingredients and fresh produce.”

– Nour Makarem, PhD, FAHA

“The intervention lowered blood pressure by [more than] 4mmHg and blood glucose by [more than] 0.5%. These are clinically meaningful changes that reduce the risk of developing cardiovascular disease and further morbidity,” Makarem emphasized to MNT.

Reducing meal provision did not appear to weaken the benefits

One notable result was that gradually cutting back on the number of delivered meals did not seem to reduce the gains seen in either group.

Those who received fewer meals toward the end of the program had similar overall improvements in diet quality, blood sugar, and blood pressure to participants who continued receiving 10 meals per week.

“In our study, the medically tailored meals program was coupled with a heart health curriculum that included engaging educational content about healthy diet and lifestyle based on the AHA’s Life’s Essential 8 guidelines, cooking demonstrations, healthy recipes, and gift bags with healthy ingredients and fresh produce.” Makarem told us.

The researchers suggest that combining fewer delivered meals with counseling, cooking demonstrations, and access to healthy ingredients may help people continue healthier habits on their own.

This may help fill an important gap in understanding how the number of meals supplied in food is medicine programs affects health outcomes.

“I think these co-interventions (nutritional counseling, education on heart health, cooking demonstrations, healthy recipes, and gift bags with healthy ingredients and fresh produce) are critical, because they provide the patient with tangible tools to eat healthy outside of the medically tailored meals program and when the program ends,” Makarem explained.

The findings suggest that such programs could improve health among people at higher risk of cardiovascular disease, including those with limited income or limited access to nutritious food. Still, the study does not show whether meal reductions would work as well without the added education and nutritional support.

Even so, the results support further study of whether medically tailored meals could become a broader part of healthcare. These programs may improve access to nutritious food, help people manage more than one chronic illness, and possibly lower the risk of disease progression.

Because medically tailored meals can be costly, expenses may be a barrier to expanding these programs. If fewer meals can deliver similar benefits when paired with the right education and support, healthcare systems may be able to reach more people.

What are the limitations of the research?

Although the findings are encouraging, several limitations should be kept in mind.

First, the study included only 110 participants and took place at a single site in New York City. The results may not apply to other populations or to people with different health conditions.

Second, researchers measured outcomes only at the beginning and end of the 8-month intervention. More research is needed to see whether the improvements last after the program ends and whether they lead to fewer heart attacks, strokes, diabetes complications, or other long-term outcomes.

The study also compared two meal-provision schedules that both included extra nutritional and educational support.

As a result, it cannot show how much of the improvement came from the meals themselves, the education program, or the combination of both.

Finally, the work was presented as a conference abstract, so it has not yet been peer-reviewed and should be viewed as preliminary until published in a full manuscript in a peer-reviewed journal.

Larger, multi-site clinical trials are needed to confirm the findings and determine the most effective and cost-efficient way to provide medically tailored meals.

What does this mean for people with type 2 diabetes and hypertension?

The findings suggest that better access to nutritious meals, along with practical nutrition education, may help people manage type 2 diabetes and hypertension.

For people living with these conditions, a balanced diet is an important part of managing blood sugar, blood pressure, and cardiovascular risk. But healthy eating can be difficult when nutritious foods are expensive, hard to find, or time-consuming to prepare.

Programs that pair meal delivery with nutrition counseling and cooking support may help overcome some of those barriers.

For now, medically tailored meals appear to be a promising way to support people with multiple chronic health conditions, especially those facing food insecurity.

View the original article on Medical News Today