A new study published in The Journal of the American Medical Association Internal Medicine shows that a culturally tailored food is medicine program featuring traditional Navajo foods significantly reduced all-cause hospitalizations or emergency room visits among patients with heart failure. The MUTTON-HF (Medically Utilized Tailored Traditional foods to Optimize Nutrition in Heart Failure) trial, funded by the American Heart Association's Health Care by Food initiative, included 206 adults receiving care at two Indian Health Service sites in rural Navajo Nation.
Participants were randomized to receive either usual care or eight weeks of medically tailored meals that incorporated traditional Navajo ingredients and recipes. Within 90 days, 40.6% of those in the meal intervention group experienced an emergency room visit or hospitalization, compared to 57.0% in the control group—a 28% relative reduction in risk. All-cause hospitalizations were cut by more than half (12.3% vs. 26.0%), and heart failure-specific hospitalizations were nearly 70% lower (3.8% vs. 13.0%). Participants in the intervention group also lost an average of 6.3 pounds more and had significant reductions in blood pressure.
“This trial provides strong evidence that a culturally grounded, medically tailored Indigenous food is medicine intervention can improve both health outcomes and social determinants of health,” said Kevin Volpp, M.D., Ph.D., American Heart Association’s Health Care by Food scientific lead. “This is a compelling proof point that food is medicine programs are most effective when they are not only medically appropriate, but also culturally relevant and well designed with relevant stakeholders.”
The program was developed through extensive community engagement, including listening sessions, focus groups, and surveys with Navajo Nation community members. Navajo dietitians, local farmers and ranchers, and Tocabe, a Native-owned kitchen, collaborated to create meals that honored traditional foods while meeting heart-healthy nutrition guidelines. To ensure access across the large reservation, the program established food distribution hubs, mini-hubs, and home delivery, and provided appliances like microwaves, freezers, and propane-powered refrigeration for households without reliable electricity.
“This study shows the power of leveraging the strengths and priorities of communities to advance health,” said lead author Lauren Eberly, M.D., MPH, an assistant professor at the University of Pennsylvania and a staff cardiologist for the Indian Health Service. “By combining traditional Indigenous foods with evidence-based nutrition support, we were able to improve health outcomes while honoring culture, identity and community knowledge.”
Participants in the meal group also reported significantly better overall health status, physical functioning, and social participation, as measured by the Kansas City Cardiomyopathy Questionnaire. At baseline, 53.4% of participants were food insecure. The Health Care by Food initiative, launched in 2023 with foundational support from The Rockefeller Foundation, has funded 23 early-stage clinical studies focused on food is medicine interventions. The findings underscore the potential of culturally tailored nutrition programs to improve cardiovascular health and reduce healthcare disparities.
