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Proof – food is medicine

A decent eating program can keep you out of hospital, according to US research into the value of providing ready-to-consume meals to a select adult population.

The retrospective cohort study involved just over 1000 participants, average age 53, almost 500 of whom were allocated to receive 10 meals a week, tailored to a recipient’s specific medical needs, for a period of just over two years. This group was then compared to a control group who had been matched for age and area of residence etc.

Overall the study found the medically tailored meal delivery program was associated with approximately half the number of inpatient admissions over the duration of the study. Similarly, receiving the set meals was associated with significantly fewer admissions to skilled nursing facilities and a substantial reduction in health care costs.

A pretty impressive result, yes? But before we go demanding an MBS item number for Meals on Wheels, even the researchers themselves advise caution in interpreting these results. Firstly, the study was not randomised. People who were allocated to receive the meal delivery intervention were generally more ill than the control patients – they were significantly more likely to have HIV, cancer and diabetes.

“It is unlikely that similar results would be seen were the intervention applied to a healthier population, as the risk of admission or high health care costs, even in the absence of intervention would be substantially lower,” the study authors said in The Journal of the American Medical Association (JAMA) Internal Medicine. 

And we don’t know whether it was the actual healthy food that made the difference, or whether it was the fact that they were getting their food for free thereby enabling the recipients to have more money for other things such as medications (remembering we are talking about the US health system here).

Nonetheless, the study raises some valuable points.

It is well-recognised that ‘following an appropriate diet is a cornerstone of maintaining health and managing illness.’ But this is often difficult for patients with complex medical conditions, especially if they are socioeconomically disadvantaged.

As an accompanying editorial points out, much of the more recent focus has been on diet-related diseases and the health and economic burden they increasingly represent. Diseases such as diabetes, cardiovascular disease and obesity-related cancers have claimed much of the spotlight.

But nutrition as a solution, and how we can use specific nutritional interventions to effectively manage a patient’s health care has been less well defined.

“One obstacle has been demonstrating the efficacy and cost implications of specific nutritional interventions,” the editorial authors said.

This JAMA study does that. Specifically, the researchers have shown that the provision of free, medically tailored meals at home is associated with reduced health care use and net cost savings.

More importantly for Australians, the study supports the incorporation of nutrition into health care to improve patient health outcomes and keep vulnerable patients out of tertiary care.

“Given their potential for significant health benefits and cost-savings, [medically tailored meals] may represent the tip of the spear for a national evolution toward such food-is-medicine approaches,” the editorial concludes.

Reference

Berkowitz SA, Terranova J, Randall L, Cranston K, Waters DB, Hsu J. Association Between Receipt of a Medically Tailored Meal Program and Health Care Use. JAMA Intern Med. Published online April 22, 2019. doi:10.1001/jamainternmed.2019.0198

Mozaffarian D, Mande J, Micha R. Food Is Medicine—The Promise and Challenges of Integrating Food and Nutrition Into Health Care. JAMA Intern Med. Published online April 22, 2019. doi:10.1001/jamainternmed.2019.0184