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Heart FailureMUTTON-HFNCT06549699

Medically Used Tailored Traditional Food to Optimize Nutrition in Heart Failure

A study testing Medically Tailored Meal Program with Traditional Navajo Foods in people with Heart Failure, run by University of Pennsylvania at 2 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Study subjects with heart failure will receive either pre-prepared, home-delivered DASH/SRD-compliant meals incorporating local Navajo traditional foods or usual care for 60 days (14 meals weekly). Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Heart Failure
What is being tested?
Medically Tailored Meal Program with Traditional Navajo Foods
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
206 participants
Where
2 sitesUnited States
Study dates
12 May 2025to 1 Dec 2025
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age >=18 years
  • ICD I50* diagnosis
  • Clinical encounter in last 12 months
  • Primary care physician at the two IHS sites
  • Hospitalization (any-cause) or ER visit within last 12 months

Who cannot join

  • Hospice care
  • Living in acute rehabilitation or skilled nursing facility
  • Living outside the Gallup Service Unit (outside 50-mile catchment area)

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • Gallup Indian Medical Center

    Gallup, New Mexico, 87301

  • Tohatchi Health Clinic

    Tohatchi, New Mexico, 87325

Other trials in United States

About this study

Official title: MUTTON-HF (Medically Used Tailored Traditional Food to Optimize Nutrition) in Heart Failure)

Study subjects with heart failure will receive either pre-prepared, home-delivered DASH/SRD-compliant meals incorporating local Navajo traditional foods or usual care for 60 days (14 meals weekly).

Read the detailed description

The American Indian and Alaska Native population has experienced significant cardiovascular health disparities compared with other racial and ethnic groups in the U.S. [1] Heart failure, in particular, causes significant morbidity and mortality in Navajo Nation. For many Navajo patients, similar to other American Indian populations, food insecurity is a major driver of health disparities. [2][3] In fact, qualitative data from our heart failure patient advisory committee have found that 89% of patients with heart failure believe nutrition insecurity is a major barrier to optimal health. Dietary factors are believed to be an important cause of hospitalizations in patients with heart failure and cardiovascular outcomes. There is increasing evidence that direct dietary support, such as produce prescription or provision of medically tailored meals may improve cardiovascular outcomes and disease-specific quality of life.[4][5] Furthermore, there has been an increased focus in Indigenous communities to reclaim traditional indigenous foods to improve health. However, more evidence of the benefit of traditional Indigenous foods for cardiovascular health is needed.

The investigators, therefore, in discussion with community members and tribal partners at two Indian Health Service (IHS) sites in Navajo Nation, will implement and evaluate the effectiveness of a medically and Native-sourced culturally tailored meal delivery program to improve outcomes in heart failure in rural Navajo Nation. This study will include two phases, with a phase I pilot feasibility study, followed by phase II-a comparativeness effectiveness randomized control trial to compare the implementation of our medically and culturally tailored meal delivery program compared to usual care. Phase I outcomes will include implementation outcomes such as feasibility and acceptability to inform phase II. The primary outcome for the trial in Phase II will be the proportion of patients who have a hospitalization or ER visit for any cause within 90 days post implementation. Secondary outcomes will include: heart failure hospitalizations specifically, ER visits for volume overload specifically (ER visits for lower extremity edema, dyspnea, with clinical evaluation consistent with volume overload) within 90 days, Kansas City Cardiomyopathy Questionnaire clinical summary score at baseline and at 60 days; prescription adherence rates (% of filled prescriptions out of prescriptions made) for all medication as well as GDMT specifically at 60 days, weight at baseline (and BMI) at 60 days, and the following lab parameters and biomarkers at baseline and at 60 days: albumin, prealbumin, creatinine, NT-proBNP, HbA1c, Total cholesterol, LDL-C, HDL-C, Triglycerides, CRP, and measures of food insecurity. The investigators will also collect measures of Indigenous cultural connectiveness using the validated Cultural Connectedness Scale-California (CCS-CA) at baseline and at 60 days, as well as qualitative analyses of local food suppliers to evaluate how this program strengthens local food systems. The investigators will also evaluate food diaries and perform a survey at 90 days to evaluate for any sustainable change in diet and behavior post intervention. Semi-structured interviews will be performed of stakeholders including a subset of patients, primary care providers and food suppliers to assess implementation outcomes.

Conditions
Heart Failure
Being tested
Medically Tailored Meal Program with Traditional Navajo Foods, Usual Care
Keywords
Indigenous, Navajo, Traditional Foods, Nutrition security, food is medicine
Medical subject headings
Heart Failure

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Medically Tailored Meal Program with Traditional Navajo FoodsOther

    Patients will receive medically-tailored meals incorporating local traditional Navajo foods

  • Usual CareOther

    Usual care plus healthy recipes provided

Study groups in NCT06549699
Study groupRoleWhat they receive
Meal delivery programActive comparatorPatients will receive 2 meals daily (14 meals weekly) of medically-tailored meals incorporating traditional Navajo foods, followed by a cooking class at the end of the meal program (meals provided for 60 days).
Receives: Other: Medically Tailored Meal Program with Traditional Navajo Foods
Usual CarePlacebo comparatorPatients will receive usual care
Receives: Other: Usual Care

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Hospitalization or Emergency Department Visit

    Hospitalization or Visit to Emergency Department (All-cause)

    Measured: 90 days

Secondary outcomes (25)
  1. Cultural Connectedness Scale-California

    The investigators will measure cultural connectedness utilizing a 6-question modified version of the validated Cultural Connectedness Scale-California (CCS-CA) at baseline and at 60 days. This is a validated score, developed by Indigenous scholars to measure cultural connectiveness in Indigenous populations, and has been shown to correlate with physical health and be a social determinant of health. This scale has previously been modified for use in Diné populations specifically by the investigators. The investigators will evaluate total score, as well as subcomponents of identity, traditions, and spirituality.

    Measured: 60 days

  2. Kansas City Cardiomyopathy Questionnaire (KCCQ-12)

    This is a validated score for evaluating quality of life and symptom measures in heart failure patients. Score ranges from 0-100, with 0 meaning very poor quality of life/symptoms and health status, 100 meaning excellent quality of life/symptom burden/health status.

    Measured: 60 days

  3. Kansas City Cardiomyopathy Questionnaire (KCCQ-12) Quality of Life Subset

    Subset of this is a validated score for evaluating quality of life measures in heart failure patients. Score ranges from 0-100, with 0 meaning very poor quality of life/symptoms and health status, 100 meaning excellent quality of life/symptom burden/health status.

    Measured: 60 days

  4. Food Security

    The investigators will evaluate baseline and 60-day rates of food insecurity utilizing the USDA Adult Food Security: Six Item short Form survey (USDA FSSM 6-Item).[12] At the 60-day evaluation, the investigators will adapt the USDA FSSM 6-Item questionnaire to evaluate food insecurity within the last 2 (rather than 12 months).

    Measured: 60 days

  5. Biomarker Data

    albumin, prealbumin, creatinine, NT-proBNP, HbA1c, Total cholesterol, LDL-C, HDL-C, Triglycerides, CRP

    Measured: 60 days

  6. Weight

    Weight (kilograms). Weight and height will be combined to report BMI in kg/m^2

    Measured: 60 days

  7. ER visits

    All cause

    Measured: 90 days

  8. Hospitalizations

    All cause

    Measured: 90 days

  9. ER visit for Heart Failure

    ER visit for volume overload or HF symptoms

    Measured: 90 days

  10. Heart Failure hospitalization

    Measured: 90 days

  11. Diet Quality

    The investigators will assess diet quality using the 10-item DSQ [11] with an addition question to assess traditional Diné food intake (During the past month, how often did the participant eat traditional Diné foods (such as blue corn mush, steamed, roasted or dried corn, sumac berries, mutton, local varieties of squash or beans) at baseline and at the end of the intervention.

    Measured: 60 Days, 90 days

  12. Financial Stress

    The investigators will measure Financial Stress Scale at baseline and at 60 days using two questions:[16] How worried was the participant over the last 2 months about paying for housing (rent, mortgage, etc.)? How worried was the participant over the last 2 months about paying monthly bills?

    § All questions will be answered on a 4-point scale, where 1 = "not worried at all", 2 = "not too worried", 3 = "moderately worried", and 4 = "very worried"

    Measured: 60 Days

  13. Intervention characteristics: Partnership

    The investigators will evaluate the following:

    • % of meals that include locally sourced ingredients
    • % of food supply sourced by Diné producers/suppliers/farmers
    • % of meals sourced by Native suppliers/farmers

    Measured: 60 Days

  14. Implementation Outcomes: Feasibility

    The investigators will evaluate the percentage of meals delivered successfully to the patient (or percentage of meals that were successfully picked up by the patient if picked up from the food pantry or other location).

    Measured: 60 Days

  15. Implementation Outcomes: Fidelity

    The investigators will assess baseline dietary patterns through 3-day food diaries during week 1 and week 8 after enrollment. The investigators will also survey participants on the % of meals consumed at 60 days. Additionally at 90 days, the investigators will perform a survey to evaluate dietary patterns post intervention and adoption of any of the recipes/behavioral changes.

    Measured: 60 Days

  16. Implementation Outcomes: Acceptability

    The investigators will evaluate patient satisfaction by evaluating the Net Promoter Score (i.e. how likely is it that the patient would recommend this program to a community member?") post-intervention.

    Measured: 60 Days

  17. Qualitative Implementation Outcomes: Fidelity, acceptability, feasibility, adoption

    The investigators will perform semi-structured interviews of non-patient stakeholders (i.e. farmers that supplied produce, livestock farmers, food pantry) to assess acceptability and feasibility of providing produce for the meals, as well as the degree to which the program contributed to strengthening the local food system. The investigators will also perform semi-structured interviews of primary care providers and a subset of patients. Semi-structured interviews will be guided by the Consolidated Framework for Implementation Research (CFIR), and the investigators will explore multiple constructs within each CFIR domain that are hypothesized by the study team and based on existing literature to be relevant to acceptability and feasibility of the program.

    Measured: 60 Days

  18. Physical Activity

    The investigators will evaluate how much physical activity/exercise patients are participating in weekly at baseline, and at 60 days by asking patients to estimate the number of minutes weekly that they are participating in formal exercise or physical activity.

    Measured: 60 Days

  19. General Health Status

    The investigators will evaluate patients' general health status using a single general health status question (would the patient that in general their health is excellent, very good, good, fair, or poor) at baseline and post-intervention

    Measured: 60 Days

  20. KCCQ12-PL Physical Limitation Score

    Subsection of KCCQ-12 Score

    Measured: 60 Days

  21. KCCQ12-SF Symptom Frequency Score

    Subsection of KCCQ12 Score

    Measured: 60 Days

  22. KCCQ-SL Social Limitation Score

    Subsection of KCCQ-12 Score

    Measured: 60 Days

  23. Indigenous Nourishment Scale

    The investigators will evaluate the Indigenous Nourishment Scale (Measure A), which is a scale developed through community-based methods in Indigenous communities to encompass multiple dimensions of nourishment. The investigators will assign score of 0-6 for each response (0 for never-6 for always), for a total score 0-54 (with 0 meaning low levels of nourishment and 54 high levels of nourishment.

    Measured: Baseline, 60 days

  24. Height

    Height (cm). Weight and height will be combined to report BMI in kg/m^2.

    Measured: 60 days

  25. urine albumin:creatinine

    Urine albumin:creatinine ratio

    Measured: 60 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Aug 2024
  2. Study start12 May 2025
  3. Primary completion11 Nov 2025
  4. Study completion1 Dec 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
206 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06549699
Sponsor's protocol ID
08072024
Acronym
MUTTON-HF
Status last verified
Dec 2025
First submitted
8 Aug 2024
Last updated
29 Dec 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Eberly LA, George C, Sandman S, Bex D, Jones K, Yazzie A, Gray L, Morgan L, Tennison A, Williams C, Chandra M, Wickre R, Wickre B, Bolas M, Welbel R, Ignace D, Feliciano B, Hammer S, Damon-Mallette D, Lindsey E, Mora P, Ye A, Merino M, Schisterman EF, Shin SS. An Indigenous Food Is Medicine Intervention: The MUTTON-HF Randomized Clinical Trial. JAMA Intern Med. 2026 Jul 27:e262879. doi: 10.1001/jamainternmed.2026.2879. Online ahead of print.

    PubMed 42507456
  • Eberly LA, George C, Sandman S, Bex D, Jones K, Yazzie A, Gray L, Morgan L, Tennison A, Williams C, Chandra M, Wickre R, Wickre B, Bolas M, Welbel R, Ignace D, Feliciano B, Damon-Mallette D, Lindsey E, Mora P, Merino M, Schisterman EF, Shin SS. MUTTON-HF: Rationale and Design of a Study of an Indigenous Food is Medicine Intervention. Circ Heart Fail. 2026 Apr;19(4):e014013. doi: 10.1161/CIRCHEARTFAILURE.125.014013. Epub 2026 Mar 2.

    PubMed 41766529

Questions about this trial

What is this clinical trial studying?

A study testing Medically Tailored Meal Program with Traditional Navajo Foods in people with Heart Failure, run by University of Pennsylvania at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 29 Dec 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Hospitalization or Emergency Department Visit (time frame: 90 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06549699, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Dec 2025.

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