Traditional Navajo Medically Tailored Meals Reduced Heart Failure Hospitalizations by More Than Half in Landmark Randomized Trial
Key Insights
The MUTTON-HF trial showed that eight weeks of culturally tailored Navajo meals reduced all-cause hospitalizations or ER visits by 28% compared to usual care among 206 heart failure (search) patients.
All-cause hospitalizations were cut by more than half (12.3% vs. 26.0%), and heart failure (search)-specific hospitalizations dropped nearly 70% (3.8% vs. 13.0%).
Participants receiving tailored meals lost an average of 6.3 pounds more and experienced significant reductions in both systolic and diastolic blood pressure.
A culturally tailored Food is Medicine program featuring traditional Navajo foods significantly reduced all-cause hospitalizations and emergency room visits among patients with heart failure (search), according to findings from the first randomized clinical trial to evaluate an Indigenous Food is Medicine intervention for cardiovascular health. The MUTTON-HF (Medically Utilized Tailored Traditional foods to Optimize Nutrition in Heart Failure) study, published in JAMA Internal Medicine, included 206 adults receiving care at two Indian Health Service (search) sites in rural Navajo Nation, spanning northern New Mexico and Arizona.
Within 90 days post randomization, 40.6% of participants in the intervention group experienced a hospitalization or emergency room visit, compared with 57.0% of those receiving usual care — a 28% relative reduction in risk. All-cause hospitalizations were cut by more than half (12.3% vs. 26.0%), and heart failure (search)-specific hospitalizations were nearly 70% lower among patients who received the medically tailored meals (3.8% vs. 13.0%).
"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, MD, PhD, 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.
Physical health benefits beyond hospitalizations
Compared to those in the control group, the intervention resulted in several important physical health benefits. 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.
Participants who received culturally and medically tailored meals also experienced meaningful improvements in quality of life. Researchers found that 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, suggesting that participants felt better physically and were better able to engage in everyday activities and relationships.
A community-driven approach
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.
Traditional ingredients included mutton, grass-fed beef, steamed corn, fresh corn, blue corn, squash and a variety of pumpkins. 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, MD, 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 (search), 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."
Sonya Shin, an associate professor of medicine at Mass General Brigham and senior author of the study, added that the research demonstrated "that culturally grounded approaches are not only respectful but also clinically effective."
Study design and context
Researchers enrolled 206 adults with heart failure (search) receiving care through two Indian Health Service (search) sites in rural Navajo Nation. Notably, 53.4% of participants were food insecure at baseline. Participants were randomized to receive either eight weeks of culturally and medically tailored traditional Navajo meals — 14 meals per week with 100% of meals including Native-sourced ingredients — or usual care and dietary advice with no meals provided.
Overall quality of life was measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ), a widely used measure of heart failure (search) symptoms and well-being. The study was funded by the American Heart Association's Health Care by Food initiative, which has received anchor funding from The Rockefeller Foundation (search). The initiative, launched in 2023, has funded 23 early-stage clinical research studies focused on identifying effective Food is Medicine interventions that improve health by incorporating healthy food into the care of people with or at risk for chronic disease.
The American Indian and Alaska Native population has experienced higher rates of cardiovascular issues than other racial or ethnic groups, and limited access to healthy, affordable food drives cardiovascular disease in many Indigenous communities, according to those involved in the study.