A new study published in The Journal of The American Medical Association Internal Medicine demonstrates that a culturally tailored food is medicine program featuring traditional Navajo foods significantly reduces all-cause hospitalizations and emergency room visits among patients with heart failure. 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. Within 90 days post-randomization, 40.6% of participants in the intervention group experienced a hospitalization or emergency room visit, compared with 57.0% in the usual care group—a 28% relative reduction in risk. 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 who received the tailored meals experienced significant physical health improvements. They lost an average of 6.3 pounds more than the control group and saw significant reductions in systolic and diastolic blood pressure. Researchers also observed healthier eating patterns, including increased daily consumption of fruits and vegetables. Overall quality of life, measured by the Kansas City Cardiomyopathy Questionnaire, improved meaningfully, with better physical functioning and social participation.
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 sourced through Native producers when possible, while meeting American Heart Association 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 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. “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.”
Lead author Lauren Eberly, M.D., MPH, noted, “This study shows the power of leveraging the strengths and priorities of communities to advance health. By combining traditional Indigenous foods with evidence-based nutrition support, we were able to improve health outcomes while honoring culture, identity and community knowledge.” At baseline, 53.4% of participants were food insecure, underscoring the dual burden of food insecurity and chronic disease.
The Health Care by Food initiative, launched in 2023 with foundational support from The Rockefeller Foundation, funds early-stage clinical research on food is medicine interventions. The American Heart Association provides more information on heart.org and stroke.org.
