Key process features of personalized diet counselling in metabolic syndrome: secondary analysis of feasibility study in primary care

Abstract

Background: Personalized diet counselling, as part of lifestyle change programs for cardiometabolic risk conditions (combinations of prediabetes or type 2 diabetes, hypertension, dyslipidemia and high waist circumference) has been shown to reduce progression to type 2 diabetes overall. To identify key process of care measures that could be linked to changes in diet, we undertook a secondary analysis of a Canadian pre-post study of lifestyle treatment of metabolic syndrome (MetS). Diet counselling process measures were documented and association with diet quality changes after 3 months were assessed. Results of the primary study showed 19% reversal of MetS after 1 year.

Methods: Registered dietitians (RDs) reported on contact time, specific food behaviour goals (FBG), behaviour change techniques (BCT; adapted from the Michie CALO-RE taxonomy) and teaching resources at each contact. Diet quality was measured by 2005 Canadian Healthy Eating Index (HEI-C) and assessed for possible associations with individual BCT and FBG.

Results: Food behaviour goals associated with improved HEI-C at 3 months were: poultry more than red meat, increased plant protein, increased fish, increased olive oil, increased fruits and vegetables, eating breakfast, increased milk and alternatives, healthier fats, healthier snacks and increased nuts, with an adverse association noted for more use (> 2 times/ 3 months) of the balanced meal concept (F test; p < 0.001). Of 16 BCT, goal setting accounted for 15% of all BCT recorded, yet more goal setting (> 3 times/3 months) was associated with poorer HEI-C at 3 months (F test; p = 0.007). Only self-monitoring, feedback on performance and focus on past success were associated with improved HEI-C.

Conclusions: These results identify key aspects of process that impact diet quality. Documentation of both FBG and BCT is highly relevant in diet counselling and a summary diet quality score is a promising target for assessing short-term counselling success.

Keywords: Behaviour change techniques; Cardiometabolic conditions; Health behaviour change; Implementation; Metabolic syndrome; Nutrition care process; Personalized diet counselling; Process.

Fig. 1

Frequency of each behaviour change technique (BCT) used by the dietitians. Results are shown during 0 to 3 months and 4 to12 months, displayed as percentage of all BCT during each period, ranked by percentage calculated over the first three months. Over the first 3 months, there were 7049 mentions of BCTs with an average of 2.0 BCT per person/contact and 4634 mentions over 4–12 months or 2.2 BCT per person/contact

Fig. 2

Frequency of each food behaviour goal (FBG) being selected by the dietitians. Results are shown during 0 to 3 months and 4 to 12 months, displayed as percentage of all FBG used during each period, ranked by percentage calculated over the first three months. Over the first three months, there were 8283 mentions of FBG, with an average of 2.3 goals per person/contact, and 8293 mentions over 4–12 months, or 2.7 goals per person/contact

Fig. 3

Frequency of each resource being used by the dietitians. Results are shown during 0 to 3 months and 4 to12 months, displayed as percentage of all resources used during each period, ranked by percentage calculated over the first three months. Over the first 3 months, there were 1030 resources used and 266 resources used over 4–12 months