A groundbreaking study published today in JAMA Internal Medicine reveals that a culturally tailored food is medicine program using traditional Navajo foods significantly reduced hospitalizations and emergency room visits among adults with heart failure in the Navajo Nation. The MUTTON-HF (Medically Utilized Tailored Traditional foods to Optimize Nutrition in Heart Failure) trial, funded by the American Heart Association’s Health Care by Food initiative with anchor funding from The Rockefeller Foundation, is the first randomized clinical trial to evaluate an Indigenous food is medicine intervention for cardiovascular health.
The study enrolled 206 adults receiving care at two Indian Health Service sites in rural Navajo Nation, spanning northern New Mexico and Arizona. Participants were randomized to receive either usual care or eight weeks of medically tailored meals that incorporated traditional Navajo ingredients and recipes, sourced from Native producers when possible. Within 90 days, 40.6% of those in the intervention group experienced an all-cause emergency room visit or hospitalization, compared with 57.0% in the usual care group—a relative risk reduction of nearly 29%. All-cause hospitalizations were cut by more than half (12.3% vs. 26.0%), and heart failure-specific hospitalizations were nearly 70% lower (3.8% vs. 13.0%).
Beyond reducing acute care utilization, participants receiving the tailored meals lost an average of 6.3 pounds more than the control group and experienced significant reductions in systolic and diastolic blood pressure. They also reported healthier eating patterns, including increased daily consumption of fruits and vegetables, and meaningful improvements in quality of life as measured by the Kansas City Cardiomyopathy Questionnaire.
“This trial provides strong evidence that a culturally grounded, medically tailored Indigenous food is medicine intervention can improve both health outcomes and social determinants of health,” said Kevin Volpp, M.D., Ph.D., American Heart Association’s Health Care by Food scientific lead and the Mark V. Pauly Professor at the Perelman School of Medicine and the Wharton School, University of Pennsylvania. “This is a compelling proof point that food is medicine programs are most effective when they are not only medically appropriate, but also culturally relevant and well designed with relevant stakeholders.”
The MUTTON-HF program was developed through extensive community engagement, including listening sessions, focus groups, and surveys with Navajo Nation community members. It brought together Navajo dietitians, local farmers and ranchers, and Tocabe, a Native-owned kitchen, to create meals that honored traditional foods while meeting the American Heart Association’s heart-healthy nutrition guidance. To ensure participation across the geographically large reservation, the program established food distribution hubs, mini-hubs, and home delivery options, and provided appliances such as microwaves, freezers, and propane-powered refrigeration for households without reliable electricity.
“This study shows the power of leveraging the strengths and priorities of communities to advance health,” said Lauren Eberly, M.D., MPH, assistant professor of Cardiovascular Medicine at the Perelman School of Medicine, University of Pennsylvania, a staff cardiologist for the Indian Health Service, and the lead author. “By combining traditional Indigenous foods with evidence-based nutrition support, we were able to improve health outcomes while honoring culture, identity and community knowledge.”
The findings underscore the potential of food is medicine interventions to address diet-related diseases, especially in underserved communities. With 53.4% of participants food insecure at baseline, the program not only improved clinical outcomes but also addressed social determinants of health. The American Heart Association’s Health Care by Food initiative, launched in 2023 with support from The Rockefeller Foundation, continues to fund research and policy analysis to advance these interventions.
