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, funded by the American Heart Association with anchor funding from The Rockefeller Foundation, was published in The Journal of the American Medical Association Internal Medicine.
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. Those who received the tailored meals were less likely to visit the emergency room or require hospitalization.
Within 90 days post randomization, all-cause emergency room visits or hospitalizations were relatively reduced by nearly 29% (40.6% vs. 57.0%), driven mainly by reductions in hospitalizations, which were cut by more than half (12.3% vs. 26.0%). 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, 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. The study was funded by the Heart Association’s Health Care by Food initiative.
“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.”
Beyond reducing hospitalizations and emergency room visits, participants who received culturally and medically tailored meals experienced meaningful improvements in quality of life. Researchers found that participants in the intervention group reported significantly better overall health status compared with those receiving usual care. Improvements were seen not only in overall quality of life, but also in physical functioning and social participation.
Study details: Researchers enrolled 206 adults with heart failure receiving care through two Indian Health Service sites in rural Navajo Nation; 53.4% of participants were food insecure at baseline. Participants were randomized to receive either 8 weeks of culturally and medically tailored traditional Navajo meals (14 meals/week, 100% of meals included Native-sourced ingredients) or usual care and dietary advice (no meals). Overall quality of life was measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ).
Additional resources from the American Heart Association include a scientific statement on 2026 Dietary Guidance to Improve Cardiovascular Health and a presidential advisory on Food Is Medicine.
