Traditional Navajo Medically Tailored Meals Reduce Heart Failure Hospitalizations by More Than Half

A culturally tailored food is medicine program featuring traditional Navajo foods significantly reduced all-cause hospitalizations or emergency room visits among patients with heart failure, according to findings from the first randomized clinical trial to evaluate an Indigenous food is medicine intervention for cardiovascular health. The study, published in The Journal of the American Medical Association Internal Medicine, was funded by the American Heart Association’s Health Care by Food initiative, which has received anchor funding from The Rockefeller Foundation.

The MUTTON-HF (Medically Utilized Tailored Traditional foods to Optimize Nutrition in Heart Failure) study included 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, incorporating traditional Navajo ingredients and recipes. Within 90 days post randomization, all-cause emergency room visits or hospitalizations were relatively reduced by nearly 29% (40.6% vs. 57.0%). This was driven mainly by reductions in hospitalizations, which were reduced in the meal intervention group by more than half (12.3% vs. 26.0%), and heart failure-specific hospitalizations were nearly 70% lower among patients who received the medically tailored meals (13.0% to 3.8%).

Compared to those in the control group, the intervention resulted in several important physical health benefits. Participants receiving the tailored meals lost an average of 6.3 pounds more and experienced significant reductions in both systolic and diastolic blood pressure. Researchers also observed healthier eating patterns, including increased daily consumption of fruits and vegetables. Overall quality of life, measured using the Kansas City Cardiomyopathy Questionnaire, improved significantly, with participants reporting better physical functioning and social participation.

“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 and Director of the Penn Center for Health Incentives and Behavioral Economics, 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 conducted with Navajo Nation community members. The program brought together Navajo dietitians, local farmers and ranchers, and Tocabe, a Native-owned kitchen, to create meals that honored traditional foods, sourced through Native producers, when possible, 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. Participants also received appliances when needed, including 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, an assistant professor of Cardiovascular Medicine in the Perelman School of Medicine at the University of Pennsylvania, a staff cardiologist for the Indian Health Service, and the lead author of the study. “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 Health Care by Food initiative, which was launched in 2023 with foundational support from The Rockefeller Foundation, has funded 23 early-stage clinical research studies focused on identifying effective food is medicine interventions. The initiative also supports public policies that help advance scientific research and educate health care professionals about the potential of food is medicine to improve public health.