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

Paula Brauer¹, Dawna Royall², Airu Li², Ariellia Rodrigues², Jennifer Green^{2

3}, Sharon Macklin⁴, Alison Craig⁴, Miranda Chan⁴, Jennifer Pasanen⁴, Lucie Brunelle⁵, Rupinder Dhaliwal^{6

7}, Doug Klein⁸, Angelo Tremblay⁵, Caroline Rheaume⁹, David M Mutch¹⁰, Khursheed Jeejeebhoy¹¹

Affiliations

¹ Department of Family Relations & Applied Nutrition, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada. pbrauer@uoguelph.ca.
² Department of Family Relations & Applied Nutrition, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada.
³ Current address: Trillium Health Partners, Mississauga, ON, Canada.
⁴ Edmonton Oliver Primary Care Network, Edmonton, AB, Canada.
⁵ Department of Kinesiology, Laval University, Québec, QC, Canada.
⁶ Metabolic Syndrome Canada, Kingston, ON, Canada.
⁷ Current address: Canadian Nutrition Society, Kemptville, ON, Canada.
⁸ Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.
⁹ Department of Family Medicine and Emergency Medicine, Laval University, Québec, QC, Canada.
¹⁰ Department of Human Health & Nutritional Sciences, University of Guelph, Guelph, ON, Canada.
¹¹ Department of Medicine, University of Toronto, Toronto, ON, Canada.

PMID: 35534841
PMCID: PMC9081667
DOI: 10.1186/s40795-022-00540-9

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

Paula Brauer et al. BMC Nutr. 2022.

. 2022 May 9;8(1):45.

doi: 10.1186/s40795-022-00540-9.

Authors

Affiliations

¹ Department of Family Relations & Applied Nutrition, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada. pbrauer@uoguelph.ca.
² Department of Family Relations & Applied Nutrition, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada.
³ Current address: Trillium Health Partners, Mississauga, ON, Canada.
⁴ Edmonton Oliver Primary Care Network, Edmonton, AB, Canada.
⁵ Department of Kinesiology, Laval University, Québec, QC, Canada.
⁶ Metabolic Syndrome Canada, Kingston, ON, Canada.
⁷ Current address: Canadian Nutrition Society, Kemptville, ON, Canada.
⁸ Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.
⁹ Department of Family Medicine and Emergency Medicine, Laval University, Québec, QC, Canada.
¹⁰ Department of Human Health & Nutritional Sciences, University of Guelph, Guelph, ON, Canada.
¹¹ Department of Medicine, University of Toronto, Toronto, ON, Canada.

PMID: 35534841
PMCID: PMC9081667
DOI: 10.1186/s40795-022-00540-9

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.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**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

See this image and copyright information in PMC

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

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