Nutrition Counseling Frequency and Telehealth Integration on Cardiometabolic Outcomes in Metabolic Syndrome: A Randomized Controlled Trial in Turkey

<i>Background and Objectives:</i> As the demand for dietitian services continues to grow in high-volume healthcare settings, optimizing both the frequency and modality of follow-up has become crucial for sustaining and enhancing the effectiveness of medical nutrition therapy (MNT). This study evaluated a stepwise intensification model ranging from quarterly in-person visits to monthly in-person visits and weekly telehealth follow-ups in metabolic syndrome (MetS). <i>Materials and Methods:</i> Ninety-three patients with MetS were randomized into three groups based on the intensity of dietary consultations: the intervention group (IG, <i>n</i> = 31), the intensive intervention group (IIG, <i>n</i> = 30), and the control group (CG, <i>n</i> = 32). IG received four in-person visits (baseline and weeks 4, 8, and 12); IIG received the same four visits plus weekly telehealth calls; and CG received two at baseline and week 12. Nutrient intake, anthropometric and biochemical measurements were compared across groups. A regression model was applied to examine associations between the frequency of nutritional counseling and MetS components. <i>Results:</i> Higher counseling frequency was associated with greater improvements in dietary intake, anthropometric, biochemical and blood pressure parameters. Both intervention groups achieved greater reductions in waist circumference (<i>p</i> < 0.001), BMI (<i>p</i> < 0.001), and body weight (<i>p</i> = 0.002) than CG, with the IIG improvements in FPG (<i>p</i> < 0.001, η² = 0.215) and blood pressure benefits (systolic: <i>p</i> < 0.001, η² = 0.276; diastolic: <i>p</i> < 0.001, η² = 0.148). In multivariable regression, counseling frequency independently predicted improvement in MetS diagnostic criteria (F = 9.395; <i>p</i> < 0.001, adjusted R² = 0.313). <i>Conclusions:</i> These findings highlight that integrating telehealth into MNT for MetS may enhance its effectiveness while minimizing the burden on healthcare systems.