At a hospital serving the Navajo Nation, a research team led by University of Pennsylvania LDI Senior Fellow and cardiologist Lauren Eberly, MD, MPH, tested whether medically tailored meals featuring traditional Navajo foods could improve outcomes for patients with heart failure. Participants received meals prepared with mutton, beans, squash, corn, and other Diné (Navajo) staples. Her randomized trial found the culturally tailored meal program reduced hospitalizations and emergency department visits.

The study was grounded in the recognition that heart failure is one of the leading causes of hospitalization in Indigenous communities. Many people living in the Navajo Nation face major barriers to healthy eating. Grocery stores are scarce, fresh food is often difficult to obtain, and food insecurity is common. The researchers wanted to see whether providing healthy meals based on traditional Navajo foodways could improve both health and quality of life.

Titled “An Indigenous Food Is Medicine Intervention: The MUTTON-HF Randomized Clinical Trial,” the work was published in the July 27 issue of the JAMA Internal Medicine journal. It is the first randomized clinical trial to show that a medically tailored meal program built around traditional Indigenous foods can reduce hospitalizations among heart failure patients living in a Native community. The acronym MUTTON (Medically Utilized Tailored Traditional Food to Optimize Nutrition) also refers to the meat that is a cultural cornerstone of Navajo life, reflected in the community’s ubiquitous phrase, “Dibé bé iiná” (“Sheep is life”).

More than Just Food

Eberly explained, “The concept of food as medicine is really a longstanding belief among many Native populations. Traditional foods are sacred, they’re healing, and are not only physically nourishing, but also can advance spiritual and emotional dimensions of well-being, as well as foster connections to culture, to ancestors, and to the land. And so there’s a lot of excitement, a lot of momentum in Native communities to reclaim traditional pre-contact foods, to advance health. So within that context, using community-based participatory methods, we designed MUTTON-HF.”

Eberly, a Staff Cardiologist at the New Mexico Gallup Indian Medical Center of the Indian Health Service (IHS), is also an Assistant Professor of Cardiovascular Medicine at Penn. She was recently appointed National Chief Clinical Consultant for Cardiology for the IHS.

She grew up in New Mexico and earned her MD from the University of New Mexico School of Medicine and her MPH from the Harvard School of Public Health. She also completed a Residency in Global Health Equity and Internal Medicine before coming to Penn for a fellowship in Cardiovascular Medicine. She then returned to New Mexico to practice and conduct research in the Navajo Nation.

What the Study Did

For the study, researchers enrolled 206 adults with heart failure receiving care at two IHS facilities in the Navajo Nation. Participants had all been hospitalized or visited an emergency department within the previous year.

Half of the participants received:

• Eight weeks of medically tailored meals
• Two prepared meals each day
• Meals made with traditional Navajo recipes and locally sourced Indigenous ingredients

Significant Declines

The other half received the usual dietary advice typically given to heart failure patients. Everyone was followed for 12 weeks.
The findings:

Compared with patients receiving standard dietary advice, those receiving the traditional meal program experienced:

• About a 29% lower risk of being hospitalized or visiting an emergency department for any reason within 90 days (41% vs. 57%)
• Roughly half as many hospitalizations overall (12.3% vs. 26.0%)
• About a 70% lower rate of hospitalizations specifically for heart failure (3.8% vs. 13.0%)

Patients receiving the Indigenous meal program also showed improvements in several areas:

• Better quality of life and ability to perform everyday activities
• Less food insecurity
• Less financial stress
• Lower blood pressure
• Modest weight loss
• Increased fruit and vegetable consumption
• More weekly physical activity

Researchers suggest the benefits may have resulted not only from healthier nutrition, but also from reconnecting patients with culturally meaningful foods.

They also point out that the study took place only in the Navajo Nation, so the results may not be generalizable to other populations or communities with different levels of food insecurity. The intervention lasted 12 weeks, so longer-term benefits remain to be studied.

A Broad Community Collaboration

From the very beginning, Eberly and her team approached the project as a broad collaboration with the Diné community, incorporating community members into the study’s design as well as the creation and operation of the technical and logistical systems required to carry out the complex project.

“Our challenge, similar to many other rural and tribal communities, is inadequate infrastructure, the lack of paved roads, lack of physical addresses, lack of electricity, huge distances between patients, and limited transportation, all of which introduce daunting challenges to programs like this,” said Eberly.

Overcoming those barriers required building an extensive community infrastructure well beyond a typical clinical trial. Researchers partnered with Navajo farmers and ranchers to source the meat and produce used in the meals, supporting local agriculture and food sovereignty, and worked with a Native-run commercial kitchen to prepare the meals at scale. To ensure participants could safely store and heat the food, the study supplied household appliances, including microwaves, mini refrigerators, and, for homes without electricity, propane-powered appliances and fuel. Because about 95% of participants did not receive mail delivery, researchers also created a reservation-wide distribution network with central and satellite pickup hubs, while community health workers delivered meals directly to the homes of participants who could not travel.

Expansion to Other IHS Areas

Researchers say the MUTTON-HF model is attracting interest from other Indigenous communities and could be adapted to fit different cultural and geographic settings. While some elements were tailored specifically to the Navajo Nation, the team believes core components, including culturally appropriate meals, locally sourced foods, community food hubs, and partnerships with community health workers, could be replicated elsewhere. With support from IHS leadership, researchers hope to expand the program to other IHS service areas while adapting it to each community’s priorities. They are also evaluating the program’s economic impact on local food systems and food sovereignty, as well as its overall cost-effectiveness, and have begun piloting the approach among other high-risk populations, including women at elevated cardiovascular risk.

“We really think that other food as medicine programs in other settings should similarly consider tailoring not only for the medical needs, but for the strengths of the community, the strengths of the local food environment, and local food systems,” said Eberly. “Lastly, we really believe that community-centered food as medicine programs have the potential to support long-term local food system resilience, and that food as medicine programs can really be intentionally designed to not only uplift patients, but communities as well.”

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