Enhancing Diet Quality in Early Stages of Change in Individuals at High Risk for Diabetes

Abstract Aims This study examines how readiness for change affects adherence to nutritional counseling and health outcomes in adults at high risk for diabetes, comparing a lifestyle intervention with usual care. Materials and methods To address this aim, a secondary analysis of a multicenter randomized controlled pilot trial (NCT05689658) compared the Brazilian Diabetes Prevention Program (PROVEN-DIA) to standard nutritional counseling over three months. Readiness for change, diet quality (measured by the Wheel of Cardiovascular Health Diet; high-quality diet > 70% of the graphical area), physical activity, smoking, body weight, blood pressure, and HbA1c were assessed at baseline and at three months. Participants were classified by stage of change and clustered: precontemplation/contemplation, preparation, or action/maintenance. Results Of 220 participants (71.8% women; mean age 48 ± 10 years; 65.5% with obesity; 38.2% with prediabetes), those in the PROVEN-DIA group at precontemplation/contemplation were more likely to report high diet quality at three months (OR = 4.7, 95% CI = 1.2–17.8). For those in the action/maintenance and preparation stages, the odds were 2.9 (95% CI: 0.5–18.3) and 1.9 (95% CI: 0.8–4.6), respectively. Health parameters improved in all groups and change stages, but no significant interaction was observed between time, stage, and group. Conclusion Findings show that adults at high risk for diabetes and those in earlier stages who received the PROVEN-DIA intervention were more likely to report improved diet quality than those in the control group after 3 months.