多成分食物即药物干预对有无食物不安全患者行为和心理健康结局的影响
Impact of a multicomponent food-as-medicine intervention on behavioral and mental health outcomes for patients with and without food insecurity.
作者信息
Radtke Marcela D, Tester June M, Xiao Lan, Chen Wei-Ting, Emmert-Aronson Benjamin O, Markle Elizabeth A, Chen Steven, Rosas Lisa G
机构信息
Propel Postdoctoral Research Fellow, Stanford University School of Medicine, Stanford, California, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA.
Osher Center for Integrative Medicine and Department of Family and Community Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA; Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA.
出版信息
Nutrition. 2025 Jun;134:112734. doi: 10.1016/j.nut.2025.112734. Epub 2025 Feb 27.
BACKGROUND
Increasingly, food-as-medicine (FAM) programs are being implemented as a strategy for improving the health of patients. However, current policies limit nutrition resources to patients with specific chronic condition diagnoses and do not include food insecurity as a qualifying condition.
OBJECTIVE
Explore the impact of Recipe4Health (R4H), a multicomponent FAM intervention, on behavioral and mental health outcomes in patients with and without food insecurity.
METHODS
Patients (n = 336) with diet-related chronic conditions and/or food insecurity were referred to R4H, which included 16-weekly produce deliveries and behavioral intervention sessions. Food security status was assessed using the U.S. Department of Agriculture 6-item survey. Outcomes included vegetable/fruit intake, physical activity (PA) and mental health. Within- and between-group pre-post changes were assessed using repeated-measures linear mixed-effects models, adjusting for baseline.
RESULTS
The majority of patients had one or more chronic conditions (96%) and identified as food insecure (62%). Patients with food insecurity experienced significant increases in daily servings of vegetables/fruit (+0.38 ± 0.15; P = 0.01) and minutes of moderate-to-vigorous PA per week (+28.94 ± 9.84; P < 0.01). Patients with food security did not experience significant increases in vegetables/fruit (P = 0.09) or PA (P = 0.06). Food-insecure and food-secure patients both experienced significant improvements in loneliness, anxiety, and depressive symptoms from baseline (P < 0.01 for all). Between-group differences were observed only for anxiety, where patients with food security experienced significant improvements in anxious symptoms compared to food-insecure patients (-1.24 [-2.33, -0.14]; P = 0.03).
CONCLUSION
Policymakers may consider expanding eligibility criteria to include food insecurity as an independent qualifying condition for FAM.
背景
越来越多的“食物即药物”（FAM）项目被作为改善患者健康的一项策略来实施。然而，当前政策将营养资源限制于患有特定慢性病诊断的患者，且未将粮食不安全状况列为合格条件。
目的
探讨多成分FAM干预措施“健康食谱”（R4H）对有和没有粮食不安全状况的患者行为和心理健康结局的影响。
方法
将患有与饮食相关慢性病和/或粮食不安全状况的患者（n = 336）转介至R4H，该项目包括每周一次的农产品配送和行为干预课程。使用美国农业部的6项调查评估粮食安全状况。结局指标包括蔬菜/水果摄入量、身体活动（PA）和心理健康。使用重复测量线性混合效应模型评估组内和组间前后变化，并对基线进行调整。
结果
大多数患者患有一种或多种慢性病（96%），且被认定为粮食不安全（62%）。粮食不安全的患者每日蔬菜/水果摄入量显著增加（+0.38±0.15；P = 0.01），每周中等至剧烈PA时间显著增加（+28.94±9.84；P < 0.01）。粮食安全的患者蔬菜/水果摄入量（P = 0.09）或PA（P = 0.06）没有显著增加。粮食不安全和粮食安全的患者与基线相比，孤独感、焦虑和抑郁症状均有显著改善（所有P < 0.01）。仅在焦虑方面观察到组间差异，与粮食不安全的患者相比，粮食安全的患者焦虑症状有显著改善（-1.24 [-2.33, -0.14]；P = 0.03）。
结论
政策制定者可考虑扩大资格标准，将粮食不安全状况列为FAM的独立合格条件。
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