Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health

Abstract

Food insecurity is associated with negative chronic health outcomes, yet few studies have examined how providing medically appropriate food assistance to food-insecure individuals may improve health outcomes in resource-rich settings. We evaluated a community-based food support intervention in the San Francisco Bay Area for people living with HIV and/or type 2 diabetes mellitus (T2DM) to determine the feasibility, acceptability, and potential impact of the intervention on nutritional, mental health, disease management, healthcare utilization, and physical health outcomes. The 6-month intervention provided meals and snacks designed to comprise 100% of daily energy requirements and meet nutritional guidelines for a healthy diet. We assessed paired outcomes at baseline and 6 months using validated measures. Paired t tests and McNemar exact tests were used with continuous and dichotomous outcomes, respectively, to compare pre-post changes. Fifty-two participants (out of 72 initiators) had both baseline and follow-up assessments, including 23 with HIV, 24 with T2DM, and 7 with both HIV and T2DM. Median food pick-up adherence was 93%. Comparing baseline to follow-up, very low food security decreased from 59.6% to 11.5% (p < 0.0001). Frequency of consumption of fats (p = 0.003) decreased, while frequency increased for fruits and vegetables (p = 0.011). Among people with diabetes, frequency of sugar consumption decreased (p = 0.006). We also observed decreased depressive symptoms (p = 0.028) and binge drinking (p = 0.008). At follow-up, fewer participants sacrificed food for healthcare (p = 0.007) or prescriptions (p = 0.046), or sacrificed healthcare for food (p = 0.029). Among people with HIV, 95% adherence to antiretroviral therapy increased from 47 to 70% (p = 0.046). Among people with T2DM, diabetes distress (p < 0.001), and perceived diabetes self-management (p = 0.007) improved. Comprehensive, medically appropriate food support is feasible and may improve multiple health outcomes for food-insecure individuals living with chronic health conditions. Future studies should formally test the impact of medically appropriate food support interventions for food-insecure populations through rigorous, randomized controlled designs.

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Abbreviations

ARV:

Antiretroviral

ED:

Emergency department

GED:

General Educational Development

HbA1c:

Glycated hemoglobin

HFSSM:

Household Food Security Survey Module

PDSMS:

Perceived Diabetes Self-Management Scale

POH:

Project Open Hand

SNAP:

Supplemental Nutrition Assistance Program

SSDI:

Social Security Disability Income

SRO:

Single room occupancy

SSI:

Supplemental Security Income

T2DM:

Type 2 diabetes mellitus

UCSF:

University of California, San Francisco

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Acknowledgements

We deeply thank our research participants for sharing their experiences and time with this study. We also thank the Project Open Hand staff and Food = Medicine leadership team for their hard work, dedication, and collaboration. Finally, we thank student interns Irene Ching and Ajikarunia Palar for assisting with data collection, preliminary analyses, and data entry.

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Correspondence to Kartika Palar.

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Financial Support

Project Open Hand (POH) provided funding for this study as an external evaluation, but had no role in data collection or analysis, nor in scientific interpretation of the data. Funding from Burke Global Health supported student and intern participation in data collection. The authors acknowledge the following sources of salary support: NIH/NIDDK K01DK107335 (Dr. Palar) and NIH/NIMH R01MH095683 (Dr. Weiser).

Conflict of Interest

K Palar, T Napoles, LL Hufstedler, H Seligman, FM Hecht, EA Frongillo, and SD Weiser report no conflicts of interest. M Ryle and K Madsen are current POH employees; S Pitchford was a POH employee at the time of the study.

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Kartika Palar and Tessa Napoles share co-first authorship.

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Palar, K., Napoles, T., Hufstedler, L.L. et al. Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health. J Urban Health 94, 87–99 (2017). https://doi.org/10.1007/s11524-016-0129-7

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Keywords

  • Food
  • Nutrition
  • HIV
  • Diabetes
  • Community-based
  • Food security
  • Food support
  • Food assistance
  • Intervention
  • Medically tailored