A new study published in The Journal of the American Medical Association Internal Medicine shows that a culturally tailored food is medicine program significantly improved outcomes for adults with heart failure living in the Navajo Nation. The research, funded by the American Heart Association's Health Care by Food initiative with anchor funding from The Rockefeller Foundation, found that participants who received eight weeks of medically tailored meals incorporating traditional Navajo ingredients were far less likely to be hospitalized or visit the emergency room than those receiving usual care.
Among 206 adults with heart failure receiving care at two Indian Health Service sites in rural Navajo Nation, spanning northern New Mexico and Arizona, those in the intervention group had a 28% relative reduction in the risk of all-cause emergency room visits or hospitalizations within 90 days. Specifically, 40.6% of the meal-receiving group experienced such events compared to 57.0% in the control group. Hospitalizations were cut by more than half (12.3% vs. 26.0%), and heart failure-specific hospitalizations dropped dramatically from 13.0% to 3.8%.
Beyond reduced hospital utilization, participants receiving the culturally tailored meals experienced significant physical health benefits. On average, they lost 6.3 pounds more than the control group and saw significant reductions in both systolic and diastolic blood pressure. They also reported healthier eating patterns, including increased daily consumption of fruits and vegetables, and improved overall quality of life, as measured by the Kansas City Cardiomyopathy Questionnaire, which captures heart failure symptoms and well-being.
The MUTTON-HF (Medically Utilized Tailored Traditional foods to Optimize Nutrition in Heart Failure) 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 American Heart Association heart-healthy nutrition guidance. To reach participants across the geographically large reservation, the program established food distribution hubs, mini-hubs, and home delivery, and even provided appliances like microwaves, freezers, and propane-powered refrigeration for households without reliable electricity.
“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 and the Mark V. Pauly Professor at the Perelman School of Medicine and the Wharton School and Director of the Penn Center for Health Incentives and Behavioral Economics, University of Pennsylvania. “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.”
Lead author Lauren Eberly, M.D., MPH, assistant professor of Cardiovascular Medicine at the Perelman School of Medicine at the University of Pennsylvania and a staff cardiologist for the Indian Health Service, emphasized the importance of community engagement. “This study shows the power of leveraging the strengths and priorities of communities to advance health,” she said. “By combining traditional Indigenous foods with evidence-based nutrition support, we were able to improve health outcomes while honoring culture, identity and community knowledge.”
The findings underscore the potential of food is medicine interventions to address health disparities, particularly among Indigenous populations where food insecurity is prevalent—53.4% of participants were food insecure at baseline. The Health Care by Food initiative, launched in 2023 with foundational support from The Rockefeller Foundation, has funded 23 early-stage clinical research studies focused on identifying effective food is medicine interventions. More information about the American Heart Association’s work can be found at heart.org, and details about The Rockefeller Foundation’s initiatives are available at rockefellerfoundation.org.
