Sato Imuro Sandra Emi, Sabharwal Ashutosh, Conneely Casey, Glantz Namino, Bevier Wendy, Barua Souptik, Pai Amruta, Larez Arianna, Kerr David
Electrical and Computer Engineering, Rice University, Houston, TX, USA.
Sansum Diabetes Research Institute, Santa Barbara, CA, USA.
Heliyon. 2023 Jul 20;9(8):e18440. doi: 10.1016/j.heliyon.2023.e18440. eCollection 2023 Aug.
In the United States (U.S.), consumption of fresh vegetables and fruits is below recommended levels. Enhancing access to nutritious food through food prescriptions has been recognized as a promising approach to combat diet-related illnesses. However, the effectiveness of this strategy at a large scale remains untested, particularly in marginalized communities where food insecurity rates and the prevalence of health conditions such as type 2 diabetes (T2D) are higher compared to the background population. This study evaluated the impact of a produce prescription program for predominantly Hispanic/Latino adults living with or at risk of T2D. A total of 303 participants enrolled in a 3-month observational cohort received 21 medically prescribed portions/week of fresh produce. A subgroup of 189 participants used continuous glucose monitoring (CGM) to assess the relationship between CGM profile changes and HbA level changes. For 247 participants completing the study (76% female, 84% Hispanic/Latino, 32% with T2D, age 56·6 ± 11·9 years), there was a reduction in weight (-1·1 [-1·6 to -0·6] lbs., p < 0.001), waist circumference (-0·4 [-1·0 to 0·6] cm, p = 0·007) and systolic blood pressure (SBP) for participants with baseline SBP >120 mmHg (-4·2 [-6·8 to -1·8] mmHg, p = 0·001). For participants with an HbA ≥ 7·0% at baseline, HbA fell significantly (-0·5 [-0·9 to -0·1] %, p = 0·01). There were also improvements in food security (p < 0·0001), self-reported ratings of sleep, mood, pain (all p < 0·001), and measures of depression (p < 0·0001), anxiety (p = 0·045), and stress (p = 0·002) (DASS-21). There was significant correlation (r = 0·8, p = 0·001) between HbA change and the change in average glucose for participants with worsening HbA, but not for participants with an improvement in HbA. In conclusion, medical prescription of fresh produce is associated with significant improvements in cardio-metabolic and psycho-social risk factors for Hispanic/Latino adults with or at risk of T2D.
在美国，新鲜蔬菜和水果的消费量低于推荐水平。通过食物处方增加获得营养食品的机会已被认为是对抗与饮食相关疾病的一种有前景的方法。然而，这一策略在大规模应用中的有效性仍未得到检验，尤其是在边缘化社区，那里的粮食不安全率以及2型糖尿病（T2D）等健康状况的患病率高于总体人群。本研究评估了一项针对主要为患有T2D或有T2D风险的西班牙裔/拉丁裔成年人的农产品处方计划的影响。共有303名参与者参加了一个为期3个月的观察性队列研究，他们每周收到21份医学规定的新鲜农产品份额。189名参与者的一个亚组使用连续血糖监测（CGM）来评估CGM曲线变化与糖化血红蛋白（HbA）水平变化之间的关系。对于247名完成研究的参与者（76%为女性，84%为西班牙裔/拉丁裔，32%患有T2D，年龄56.6±11.9岁），体重有所减轻（-1.1[-1.6至-0.6]磅，p<0.001），腰围有所减小（-0.4[-1.0至0.6]厘米，p=0.007），基线收缩压（SBP）>12mmHg的参与者的收缩压也有所降低（-4.2[-6.8至-1.8]mmHg，p=0.001）。对于基线时HbA≥7.0%的参与者，HbA显著下降（-0.5[-0.9至-0.1]%，p=0.01）。粮食安全状况（p<0.0001）、自我报告的睡眠、情绪、疼痛评分（均p<0.001）以及抑郁（p<0.0001）、焦虑（p=0.045）和压力（p=0.002）（抑郁、焦虑和压力量表-21）也有所改善。HbA恶化的参与者中，HbA变化与平均血糖变化之间存在显著相关性（r=0.8，p=0.001），而HbA改善的参与者则不存在这种相关性。总之，为患有T2D或有T2D风险的西班牙裔/拉丁裔成年人开具新鲜农产品的医学处方与心血管代谢和心理社会风险因素的显著改善相关。
