Field Notes

Healthful Food Prescriptions Could Save Lives and Money

Healthful food prescriptions through Medicare and Medicaid could generate substantial health gains and be highly cost-effective, according to a study published in the open-access journal PLOS Medicine by Yujin Lee, PhD, and Dariush Mozaffarian, MD, DrPh, of the Friedman School of Nutrition Science and Policy at Tufts University in Boston, and colleagues. As noted by the authors, the findings support the implementation and evaluation of such programs within private and public health care systems.

In nearly all nations, health care spending continues to increase dramatically, with diet-related diseases being a major driver. Economic incentives through health insurance may promote more healthful behaviors, but little is known about the health and economic impacts of incentivizing diet, a leading risk factor for diabetes and CVD, through Medicare and Medicaid. Fruit, vegetable, and other produce prescriptions recently have been funded in the United States through the Farm Bill with pilot programs. However, the health impacts, costs, and cost-effectiveness of the programs haven’t been evaluated at scale.

As a part of the Food-PRICE (Policy Review and Intervention Cost-Effectiveness) Project, Lee and colleagues estimated the health and economic impact of healthful food prescriptions for adults in Medicare and Medicaid, the two largest US federal health insurance programs, which together cover 1 in 3 Americans.

Using nationally representative data and a validated model, they evaluated two scenarios: 30% incentives for the cost of purchases of fruits and vegetables, and 30% incentives for the cost of purchases of several healthful foods, eg, fruits, vegetables, whole grains, nuts/seeds, seafood, and plant oils.

Over a lifetime, the study suggests that the first incentive could prevent 1.93 million CVD events, including 0.35 million cardiovascular deaths, and save about $40 billion in health care costs. The second incentive could prevent 3.28 million CVD events, including 0.62 million cardiovascular deaths and 0.12 million diabetes cases, and save $100 billion in health care costs.

Both programs would be highly cost-effective from health care and societal perspectives, with lifetime incremental cost-effectiveness ratios ranging from more than $9,000 to approximately $18,000 per quality-adjusted life year. Taken together, the findings suggest that implementing healthful food prescriptions within large government health care programs to promote more healthful eating could generate substantial health gains and be highly cost-effective.

— Source: PLOS


Blueberries Help Lower Blood Pressure in Small Study

A new study published in the Journal of Gerontology Series A has found that eating 200 g of blueberries every day for a month can lead to an improvement in blood vessel function and a decrease in systolic blood pressure in healthy people.

Researchers from King’s College London studied 40 healthy volunteers for one month. They were randomly given either a drink containing 200 g of blueberries or a matched control drink daily.

The team monitored chemicals in volunteers’ blood and urine as well as their blood pressure and flow-mediated dilation of the brachial artery—a measure of how the artery widens when blood flow increases, which is considered a sensitive biomarker of CVD risk.

In a further study, researchers compared the effects of a blueberry drink with those of purified anthocyanins, a type of phytochemical responsible for the blue, red, pink, and purple color of some fruits and vegetables such as berries and red grapes. They also compared this with control drinks containing either similar levels of fiber, minerals, or vitamins found in blueberries.

They found the following:

• Effects on blood vessel function were seen two hours after consumption of the blueberry drinks and were sustained for one month, even after an overnight fast.

• Over the course of the month, blood pressure was reduced by 5 mm Hg. This is similar to what is commonly seen in studies using blood pressure-lowering medication.

• The drinks containing purified anthocyanins led to improvements in endothelial function. Endothelial cells act as a barrier between the blood or lymph and the surrounding body tissue, as well as playing key roles in blood clotting and regulating blood pressure.

• Neither the control drink, the control with fiber, nor the control with minerals and vitamins had a significant effect on flow-mediated dilation at two and six hours after consumption.

Lead researcher Ana Rodriguez-Mateos, PhD, from the department of nutritional sciences at King’s College London, says, “Although it is best to eat the whole blueberry to get the full benefit, our study finds that the majority of the effects can be explained by anthocyanins.

“If the changes we saw in blood vessel function after eating blueberries every day could be sustained for a person’s whole life, it could reduce their risk of developing cardiovascular disease by up to 20%,” Rodriguez-Mateos says.

— Source: King’s College London