Food as medicine? Exploring the impact of providing healthy foods on adherence and clinical and economic outcomes

Background: Chronic disease prevalence is increasing. Adherence to dietary guidelines is low (<50%) despite positive impacts in disease progression, clinical outcomes, and medical costs. It is important to summarize the impact of providing medically-tailored meals to patients on adherence rates, clinical outcomes, and potential economic outcomes. Methods: A systematic review was conducted to identify, extract, and appraise food-provision studies from January 1, 2013-May 1, 2018 for heart disease, diabetes (DM), and chronic kidney disease (CKD). The key findings related to adherence and clinical outcomes were compiled. Published literature was utilized to determine the economic impact of key clinical outcomes. Literature review showed these outcomes would result in decreased: cardiovascular (CV) event risk (20-30% reduction: $5-11 billion annually), hospitalization costs ($1-8 billion), and dialysis rates (25-50% reduction: $14-29 billion annually). For heart failure patients, results include: 16% fewer readmissions (saving $234,096 per 100 patients) and a 38-day shorter length of stay (saving $79,425 per hospitalization). Conclusion: Providing medically-tailored meals significantly increases dietary adherence above 90% and allows patients to realize significantly better chronic disease control. Through this, patients could experience fewer complications (CV events, hospital readmissions and dialysis), resulting in significant annual US healthcare cost reduction of $27-48 billion.