Participation in a farmers' market fruit and vegetable prescription program at a federally qualified health center improves hemoglobin A1C in low income uncontrolled diabetics

Abstract

Fruit and vegetable prescription programs have been shown to increase consumption of fresh produce, but whether they have an impact on medical outcomes is unknown. The purpose of this study was to examine the role of participation in a farmers' market and fruit and vegetable prescription program on changes in hemoglobin A1C (HbA1C), blood pressure (BP) and weight in patients with uncontrolled type 2 diabetes at a federally qualified health center (FQHC) in Detroit, MI.The 13-week Fresh Prescription program (June 2015–October 2015) was designed to improve access and consumption of produce among low-income patients with uncontrolled type 2 diabetes. The program allotted up to $40 ($10 per week for up to four weeks) for purchase of produce from a FQHC located farmers' market. Adult, non-pregnant patients with a history of type 2 diabetes that had an elevated HbA1C > 6.5 within three months before Fresh Prescription program were eligible to participate. HgA1c, BP and weight were collected within three months of program start and within three months of completion.There were 65 eligible participants with complete biometric data. A statistically significant (p = 0.001) decrease in HbA1C was found (9.54% to 8.83%). However, weight (208.3 lbs. to 209.0 lbs.) and BP (135.1/79.3 mm Hg to 135.8/77.6 mm Hg) did not change from pre- to post-study (p > 0.05).Access to a fruit and vegetable prescription program over a 13-week period led to decreased HbA1C concentrations in uncontrolled type 2 diabetic patients living in an urban area of predominately-lower socioeconomic status.

Child Consumption of Whole Fruit and Fruit Juice Following Six Months of Exposure to a Pediatric Fruit and Vegetable Prescription Program

“…With childhood consistently identified as a critical period for the establishment of lifelong dietary patterns [35][36][37], it is particularly important to support access to healthy food and foster the development of healthy eating behaviors among all individuals early in life. The approach and design of the current study were uniquely different from the majority of programs throughout the US that utilize fruit and vegetable prescriptions as a disease-management strategy for adults with diet-related chronic health conditions [32,33,[63][64][65]. Instead, pediatric fruit and vegetable prescriptions in this study were provided to all children, regardless of health condition or socioeconomic status, in an effort to emphasize the critical role of fruits and vegetables in chronic disease prevention during children's formative years [35][36][37].…”

“…The advice to replace 100% juice with whole fruit may be especially challenging for low-income children throughout the US, who are less likely to consume adequate amounts of whole fruit than their higher-income peers [11,24,[27][28][29]. To specifically address barriers to accessing fresh produce, some healthcare practices have introduced fruit and vegetable prescriptions that are written by physicians to exchange for fresh produce [30][31][32][33]. Thus far, no studies have examined whether exposure to pediatric fruit and vegetable prescription programs influence consumption of whole fruit among children.…”

Dietary Impact of Produce Prescriptions for Patients With Hypertension

“…A “prescription” refers patients to community resources providing fruit and vegetable access. These community-linked, health care provider–assisted models serve as powerful tools for motivating behavior change (14) and increasing fruit and vegetable consumption among low-income persons (10,12). …”

“…Although decreases in glycated hemoglobin A 1c were observed among people with diabetes, participants’ weight and blood pressure remained unchanged, and redemption and dietary behaviors were not examined (12). Others have demonstrated reduction in body mass index among low-income urban patients with chronic disease in a case–control design; however, it is unclear what effect the program had on intermediate outcomes such as fruit and vegetable consumption (13).…”

Lowering HbA1c in Food Insecure Type 2 Diabetics Through a Fruit and Vegetable Prescription Program

“…This is done while simultaneously providing a basic education on nutrition 28 . Previous FVRx programs have promising results in improving participants' immune systems, lowering weight, increasing fruit and vegetable intake, improving food security, lowering HbA1c, and better grocery shopping habits 29,30,31,32,33,34 . One practice employed by the Wholesome Wave FVRx program to make lasting changes in participants' shopping habits is motivational interviewing.…”