The impact of medically tailored meals and nutrition therapy on biometric and dietary outcomes among food-insecure patients with congestive heart failure: a matched cohort study

• Type of Material: Article
• Authors: Lauren Belak, Massachusetts General Hospital; Caroline Owens, Emory University; Margaret Smith, University of California San Diego; Eric Calloway, Gretchen Swanson Center for Nutrition; Laura Samnadda, Open Hand Atlanta; Heartley Egwuogu, Grady Memorial Hospital, Atlanta; Stacie Schmidt, Emory University
• Language: English
• Date: 2022-12-01
• Publisher: Emory University Libraries
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s40795-022-00602-y
• Title of Journal or Parent Work: BMC Nutrition
• Volume: 8
• Issue: 1
• Start Page: 108
• End Page: 108
• Grant/Funding Information: Funding for this intervention was granted by the Kaiser Foundation Health Plan of Georgia, Inc. to Open Hand Atlanta.; The Kaiser Foundation Health Plan of Georgia, Inc. neither had any roles in the design of this study, nor the collection, analysis, and interpretation of data. Kaiser also did not contribute to writing this manuscript.
• Keywords: Nutrition intervention; Medically tailored meals; Food insecurity; Congestive heart failure; Program evaluation
• Research Categories: Health Sciences, Medicine and Surgery; Anthropology, Medical and Forensic

Abstract

Background: To evaluate the impact of home-delivered, medically tailored meals and medical nutrition therapy among food-insecure patients following hospitalization for congestive heart failure by comparing clinical outcomes to a retrospectively matched cohort. Methods: Patients at high risk for readmission and food insecurity received up to three months of medically tailored meals and medical nutrition therapy after discharge. Pre-intervention and post-intervention weight, body mass index, blood pressure, and dietary intake were assessed. A combination of difference-in-difference and logistic regression models were used to compare changes between cohorts and evaluate impact attributable to the program. Results: Thirty-nine program participants were compared to a matched cohort of 117 unexposed patients. Participants experienced a marginal reduction in body mass index and an increase in systolic and diastolic blood pressure; however, these results were not statistically significant. To determine relevance to clinical cut-offs, logistic regressions were used, demonstrating that exposure to the intervention resulted in higher odds of a categorical reduction in blood pressure (OR: 1.85), though this did not reach statistical significance (95% CI: 0.67–5.32). Pre vs. post trends indicated that more-healthful foods and drinks increased numerically or remained similar to baseline, while less-healthful foods decreased numerically or remained similar to baseline. Conclusions and implications: These findings highlight the need for more longitudinal research on medically tailored meals and medical nutrition therapy interventions using clinical outcomes while setting realistic suggestions for program implementation. This study additionally illustrates the promise of integrating electronic medical record data and matched cohorts into medical nutrition program evaluation within the health sector.