Changes in Eating Competence and Its Association with Dietary and Clinical Outcomes in Brazilian Older Adults with Type 2 Diabetes or Prediabetes Attending a Public Health Service

Background/Objectives: This prospective, longitudinal, quasi-experimental study evaluated changes in eating competence (EatC) and its association with nutritional risk, dietary markers, and clinical outcomes, including body mass index (BMI), body fat percentage, and glycated hemoglobin (HbA1c), in Brazilian older adults with type 2 diabetes (T2DM) or prediabetes. Methods: Thirty-three older adults (87.9% female, predominantly inactive, regarding occupational status, and with low educational level) participated in a 12-month food and nutrition education (FNE) program at a public Primary Health Care unit in Ceilândia, Distrito Federal, Brazil. EatC was assessed using the validated ecSI2.0™BR; nutritional risk was measured by the Determine Your Nutritional Health (DNH) Checklist; and dietary intake was characterized using VIGITEL markers. Body composition was measured by bioelectrical impedance and HbA1c using standardized methods. Results: At baseline, regarding occupational status, active participants had significantly higher total EatC scores than inactive participants (p = 0.021). After 12 months, body fat percentage decreased significantly (p = 0.011), whereas BMI and HbA1c remained stable. Total EatC scores and its domains did not change significantly and most participants were already competent eaters at baseline (84.8%). However, variation in specific EatC domains was associated with important outcomes. Variation in food acceptance was negatively correlated with DNH variation (r = −0.417, p = 0.016), indicating an association between increased food acceptance and reduced nutritional risk. Variation in internal regulation was positively correlated with DNH variation (r = 0.492, p = 0.004). Variation in contextual skills was negatively associated with variation in body fat percentage (r = −0.412, p = 0.019). Additionally, variation in soda or artificial juice consumption was positively associated with variation in nutritional risk (r = 0.503, p = 0.003). Conclusions: Improvements in contextual skills and food acceptance were associated with better clinical and nutritional outcomes in older adults with T2DM or prediabetes. Public health interventions should prioritize meal planning, food preparation, and contextual skills as factors potentially associated with nutritional risk.