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Effect of BASNEF‑based nutrition
education on nutritional behaviors
among elderly people and Mini
Nutritional Assessment on
nutritional status in elderly with
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DOI:
10.4103/jehp.jehp_222_18 diabetes with type 2 diabetes
(A clinical trial intervention)
Neda Ahmadzadeh Tori, Davoud Shojaeizadeh1, Shima Sum2, Karimallah Hajian3

Abstract:
INTRODUCTION: The number of elderly people is growing in different communities like Iran,
increasingly. Malnutrition prevalence is unknown among elderly patients with diabetes. Malnutrition
is a common risk factor in elderly people with diabetes that may affect their health.
SUBJECTS AND METHODS: This study is a random clinical trial. There are 200 samples in this
study chosen randomly and divided into two intervention and control groups (100 each). Data of
both groups were collected in the same way, before and 3 months after the intervention. Educational
intervention was based on pretest, baseline BASNEF model, and Mini Nutritional Assessment
questionnaire in four sessions.
STATISTICAL ANALYSIS USED: Descriptive indices were used to analyze the data while
Chi‑square, t‑test, one‑way ANOVA, and correlation tests were used to examine the relationship
between variables.
RESULTS: The results were significantly different after intervention (P < 0.05), but they were not
Department of Health
significantly different in control group after 3 months (P > 0.05). It was clear that 22% of samples
Promotion and Health
had normal nutrition (score >24), 29% of participants were exposed to malnutrition, and 51% of
Education, Tehran
samples were suffering from malnutrition. These numbers were 20% for normal nutrition, 30% for
University, 1School of
exposing to malnutrition, and 50% for suffering from malnutrition in the control group, respectively.
Tehran Medical Sciences,
Fifty percent of elderly people with diabetes suffered from malnutrition and almost half of them had
Tehran University of
normal nutrition that was 20%.
Medical Sciences, Tehran,
Iran, 2Department of Social CONCLUSIONS: BASNEF‑based nutrition education intervention improves nutritional behaviors in
Medicine, Babol University addition to knowledge and attitude of elderly people with type 2 diabetes. It led to improve indices
of Medical Sciences, of glucose control during 3‑month intervention.
3
Department of Statistics, AIMS: The aim of this study was to investigate the nutritional status of elderly people with diabetes
Babol University of and the effect of educational intervention based on the BASNEF model on promoting nutritional
Medical Sciences, Babol, behaviors in the elderly with type 2 diabetes in Babol city, Iran.
Iran Keywords:
Address for Elderly people, Mini Nutritional Assessment, type 2 diabetes
correspondence:
Dr. Davoud Shojaeizadeh,
Department of Health
Education and Promotion, This is an open access journal, and articles are
Faculty of Medical distributed under the terms of the Creative Commons How to cite this article: Ahmadzadeh Tori N,
Sciences, Tehran Attribution‑NonCommercial‑ShareAlike 4.0 License, which Shojaeizadeh D, Sum S, Hajian K. Effect of BASNEF-
University of Medical allows others to remix, tweak, and build upon the work based nutrition education on nutritional behaviors
Sciences, Tehran, Iran. non‑commercially, as long as appropriate credit is given and among elderly people and Mini Nutritional Assessment
E‑mail: shojaei@tums.ac.ir the new creations are licensed under the identical terms. on nutritional status in elderly with diabetes with type
2 diabetes (A clinical trial intervention). J Edu Health
Received: 20‑08‑2018 Promot 2019;8:94.
Accepted: 27‑02‑2019 For reprints contact: reprints@medknow.com

© 2019 Journal of Education and Health Promotion | Published by Wolters Kluwer - Medknow 1
 Ahmadzadeh Tori, et al.: Effect of BASNEF‑based nutrition education on nutritional behaviors among elderly people

Introduction and 2 months after intervention (P < 0.001).[11] According

to the studies, it is necessary to provide educational

D iabetes is one of the most important problems in

health system all over the world. Almost 90%–95%
of patients with diabetes are suffering from type 2
programs for controlling diabetes. Previous researches
pointed to essential role of nutrition education in
controlling blood glucose and metabolic indices among
diabetes. However, type 2 diabetes is the diseases of fat elderly people with diabetes[12] and stated that elderly
elderly people.[1] In addition, studies have shown that people need to be trained for changing their nutritional
with increasing age, the prevalence of diabetes increases behavior.[13] In addition, the value of nutrition education
by an average of 10%–20%. Aging is one of the most programs depends on the effectiveness of these
important challenges in the world. Until 2025, about programs. A behavioral change model that is potentially
one‑third of the European population will be 60 years old suitable for nutrition education programs is the model
or above that. Growing the number of people aged above for changing the behavior of the Hubble. BASNEF
80 years, as a demographic change, effects on main social model constructs include belief, attitude, subjective
domains such as economics and health.[2] Population norm and enables factors of precede proceed model.
aging is becoming a phenomenon by the name of “elderly Attitude toward behavior was defined as the result
population explosion.” Today, >600 million people are of personal reasonable belief. In fact, attitude toward
above 60 years and it is predicted that it will be 1 billion behavior refers to people positive or negative evaluation
and 600 million people by 2020 and >1970 billion people about the performed activity. Subjective norms refer to
by 2025. In Iran, like other parts of the world, elderly how others whom we think they are effective would
population in increasing and the percentage of people engage in a particular behavior; this happens based on
aged above 60 years will increase to 9.4% and 9.1% in social pressures and reflections. Enabling factors are the
2020, respectively.[3] Now, epidemiology of various sources and skills that turn people intention and will to
diseases has been changed and chronic diseases are behavior and action.[14]
increasing while different factors make them happened.
Unchangeable factors such as age, sex, and family Assessing nutritional status is the first step in designing
background are not the only causes of contagious a successful nutritional care program and needs using
diseases, but other adjustable factors such as lack of appropriate tools for assessing nutritional status
physical exercise, abnormal diet, and overweight play an among elderly people. Applying useful tools can help
important role in the diseases.[4] Undesirable nutritional to determine and prevent short‑ and long‑term effects
status results in diseases among elderly people such as of malnutrition effectively. It is necessary to diagnose
diabetes and cardiovascular disease.[5] Malnutrition is a the problems to inform elderly people with diabetes
common problem affecting on 30%–50% elderly people about effective factors on their nutritional status and
with diabetes.[6] Nutrition is a considerably important finding people at risk of malnutrition, suffered from
variable for health care of elderly people.[7] Nevertheless, malnutrition, and perform malnutrition interventions.
this procedure results in inappropriate defects among As above‑mentioned, few interventions were done
elderly patients while diabetes comes with malnutrition. on nutrition education for elderly people, so this
Aging is followed by weight lose and decreased food study aims to investigate the effect of BASNEF‑based
intake.[8] Nutrition therapy plays an important role in nutrition education on improving nutritional behaviors
controlling diabetes. The purposes of nutrition therapy among elderly people with diabetes. This study aims to
in diabetes are keeping blood glucose in its normal level, determine the nutritional status among elderly people
improving blood lipid level, decreasing blood pressure, with diabetes in Babol city, Iran Interventions have been
treating and preventing diabetes effects, and providing done for diabetic patients. However, first, nutritional
nutritional needs in people.[9] It is recommended to status and then educational intervention with it have
decrease simple sugars, saturated fats, cholesterol not been done and educational models are different. In
and increase fruits, vegetables, and dietary fibers. The this study, educational intervention was based on the
interventions improve serum lipids, regulate blood BASNEF model. The aim of this paper was to determine
glucose, keep or decrease body weight, and reduce the effect of intervention on the BASNEF model in
diabetes side effects. Scientific evidence indicates that assessing the nutritional status of the elderly.
following the recommendations is effective in treating
and preventing diabetes and reducing visits to doctors, Subjects and Methods
requiring to drugs, hospitalizing, and other diabetes
side effects.[10] This study is a random clinical trial intervention. The
community includes all elderly people with diabetes
Savoca and et al. applied educational intervention and in health centers of Babol city, Iran. They are above
found that mean knowledge score increased in test 60 years old and the inclusion criteria were lasting 1 year
group significantly after gathering the questionnaires since confirmed diagnosis and having no cognitive
2 Journal of Education and Health Promotion | Volume 8 | May 2019
 Ahmadzadeh Tori, et al.: Effect of BASNEF‑based nutrition education on nutritional behaviors among elderly people

problems. The exclusion criteria were as follows: Lack Scores <17 indicates malnutrition, scores between
of desire to participate in the study and absence for two 17 and 23.5 indicate exposing to malnutrition and
sessions of four ones. This study includes 200 samples scores >23.5 indicate good nutritional status. United
that were chosen randomly in two intervention and States Department of Health and Human Services,
control groups (100 each) through clustering sampling. National Health Statistics Reports Center, Centers for
Among the health care centers, eight ones were chosen Disease Control and Prevention confirmed the reliability
randomly, four centers as intervention group and four of this tool and Cronbach’s alpha coefficient was 98%.[16]
ones as control group (100 samples each group).
Fixed scale with 0.5 kg accuracy was used to measure
As the clinics’ principles allowed, we explained to samples weight and a cloth stadiometer with 0.1 cm
elderly people and their attendants and assured that accuracy for measuring samples height. A tape was
the questionnaires would be kept in secret. Then, they used to measure mid‑upper arm muscle circumference
agreed orally and were informed that their participation and gastrocnemius muscle circumference with 0.1 cm
is voluntarily. If the samples were illiterate or could not accuracy.[15] Author measured fasting blood sugar with
answer the questions, their attendants helped them. a glucometer. A small drop of blood was tested by
Collecting the data includes two questionnaires. The pinching the skin with a lens tick needle on a single‑use
researcher‑made questionnaire was designed based screen, which was calculated using the device and
on BASNEF model and includes demographic features blood glucose. Then, nutrition education intervention
(14 questions), knowledge questions (15 questions), was done aiming to increase the number of meals, to
believes in two parts including attitude toward decrease eating simple carbohydrates and fats, and to
behavior results (5 questions) and attitude toward increase eating fruits and vegetables for elderly people
action (5 questions), enabling factors (5 questions), and with diabetes of intervention group for 1 month in four
subjective norms (5 questions). educational sessions. In addition, explanatory classes
were held for doctors, nurses, and nutritionist. Each
(Z α + Z1− β )2 × 2σ 2 session took 70 min. Last session involved patients’
1− (1.96 + 1.28)2 × 2 × 202
n= 2
2
= = 200 family with nurses’ presence.
∆ 102
Educational contents were provided for main group by
The questionnaires were completed through organized lecturing, question and answer, and group discussion.
interviews. Scoring was done in a way that correct Educational pamphlets were given to the families to
answers took 1 and the incorrect ones took zero. Believes engage them for last session. Phone following up in weeks
were assessed with 3‑option Likert scale: 1‑disagree, 4 and 8 and after educational intervention (for 5–10 min)
2‑no idea, 3‑agree. Two‑option questions were designed with patients and their families focused on educational
for subjective norms and enabling factors. Scores scale issues. In these callings, the questions were answered
was 100 and the total score was determined after and the roles of families in interventions were focused.
calculating all parts. Validity of the questionnaire was Then, the questionnaires were completed 3 months
measured by content‑validity and face‑validity methods. after educating two intervention and control groups
While the questionnaire was provided according to to determine the effect of educational intervention. We
reliable books and resources, then five experts expressed lost 10% due to lack of time and then the distance and
their opinions in person and correspondence. The disability of the elderly.
authors studied them and some comments were applied
in final questionnaire. The questionnaires were given to Results
some elderly people with diabetes (assimilated and not
participated in the study) to determine the face validity As above‑mentioned, the participants were above
and find the defects from their viewpoints.[15] One of 60 years old and maximum age of samples in
the most useful and suitable methods for this is using both intervention and control groups were 81 and
the Mini Nutritional Assessment (MNA) Summary 80 years old and average age were 68.09 and 67.36,
Questionnaire, which has been confirmed in several respectively. The results of independent t‑test did not
studies on the nutritional status of the elderly for its indicate any significant difference between these two
validity and reliability. This questionnaire includes two groups (P = 0.83). Moreover, the groups were similar
parts: First part is screening including 6 questions, used for other demographic variables and there was no
for all participants. Scores under 11 indicate malnutrition significant difference between them [Table 1]. There
and scores of 12 or above show good nutritional status. were no significant differences among participants of
If the score was <11, interviewer should complete more intervention and control groups for nutritional behavior,
evaluations. Malnutrition part of the questionnaire BASNEF constructs, fasting blood sugar, and glycated
includes 18 questions and assessed malnutrition status. hemoglobin.
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 Ahmadzadeh Tori, et al.: Effect of BASNEF‑based nutrition education on nutritional behaviors among elderly people

Table 1: Comparison of demographic variables Discussion

between educational intervention and control groups
Records Intervention group Control group P According to the findings, a vast majority of the study
Age 68.09±0.543 67.36±5.391 0.83 participants suffered from malnutrition. Some had
Sex normal nutrition. Iizaka et al. indicated that 4% of studied
Female 48 48 99%
elderly people had good nutrition, 12.6% were exposed
Male 52 52
to malnutrition, and no one suffered from malnutrition
Education
in their research.[17] Wyka et al. evaluated the nutritional
High school 88 100 0.594
status of above 60 years old people in rural areas and
Graduated 80 20
Duration of diabetes 13.95±4.217 14.42±4.661 0.521
found that none of them were suffered from malnutrition
Family history of 49 56 025
because none of them had <17 scores in MNA model. In
diabetes this regard, 16% old men and women were exposed to
malnutrition.[18]
Scores of model constructs increased before and
Sanz París et al. found that 39.1% of hospitalized
3 months after intervention in the intervention group,
old patients suffered from malnutrition and 21.2%
significantly. Furthermore, the tests indicated that
were exposed to malnutrition.[7] Alfonso‑Rosa et al.
there were significant differences between control
investigated 238 old people and indicated that 90% of the
and intervention groups for mean knowledge score,
participants had malnutrition.[19] Our data were different
attitude toward action, attitude toward behavior
from the rest of the country due to the lack of awareness
results, enabling factors, and subjective norms, after
and disability of the elderly and the lack of access because
intervention (P < 0.001) [Table 2]. In control group, 20%
of participants had normal nutrition (scores above 24), of the distance from the city.
30% were exposed to malnutrition (17–24), and 11%
In this study, 20% of participants had normal
were suffering from malnutrition (<11). These numbers
nutrition (scores above 24), 30% of them were exposed
were 32% for normal nutrition,[11‑17] respectively, in the
to malnutrition, and 50% of samples suffered from
intervention group, 22% of participants had normal
malnutrition, in control group.
nutrition (scores above 24), and 29% were exposed to
malnutrition, and 51% were suffering from malnutrition.
Doostan, in their investigation in Kerman Province,
These numbers were 20% for normal nutrition, 30% for
found that research samples who referred to clinics
exposing to malnutrition, and 50% for suffering from
continuously and applied specific treatment schedules,
malnutrition in control group, respectively [Table 3]. In
nutrition education, and consulting had normal
intervention group, significant changes were observed in
nutrition, while they were exposed to malnutrition and
cereals decrease and fruits increase in daily food basket
its effects.[20] The study Joing has similar results with this
after educational intervention (P < 0.001).
study. This study showed that receiving energy, protein,
However, there were no significant changes in using fat, and vitamins is lower than the recommended dose
these two nutrients in control group. In intervention for elderly people.[21]
group, eating vegetables and milk and dairy products
increased significantly after education intervention This study found similar results and indicated that
(P < 0.001). better‑educated people are exposed to malnutrition less
than others are, so education improves patients’ status.
Nevertheless, there were no significant changes in using In intervention group, 22% had normal nutrition (scores
these two nutrients in control group. In intervention above 24), 29% of participants were exposed to
group, eating meat and fats decreased significantly after malnutrition, and 51% of samples were suffering from
education intervention (P < 0.001). malnutrition. BASNEF‑based nutrition education was
effective on increasing knowledge level.[22] In other
Nevertheless, there were no significant changes in using studies, teaching methods for group discussion and
these two nutrients in control group. In intervention question and answer have been described as effective
group, fasting blood sugar decreased significantly, methods for changing attitudes.[23]
3 months after the first measuring (P = 0.393).
Effective use of this model confirmed its effectiveness on
In this study, we used glucose control indices (fasting people knowledge. Another result is improving attitudes
blood sugar and glycated hemoglobin) to evaluate after educational intervention that was aligned with
exactly which were decreased after 3 months in Faghihi et al.’s study.[24] Attitude toward behavior is a
intervention group. Findings are summarized in Table 4 prerequisite for behavior and should be made before
(P < 0.001). behavior.[25] It seems that theory‑based educations and
4 Journal of Education and Health Promotion | Volume 8 | May 2019
 Ahmadzadeh Tori, et al.: Effect of BASNEF‑based nutrition education on nutritional behaviors among elderly people

Table 2: BASNEF model constructs before and 3 months after educational intervention in both groups
Nutritional status Variable Before intervention After intervention P T
Knowledge Intervention 40.58±8.982 59.35±8.545 0.001˃ 15.651
Control 40.57±8.777 40.91±8.792 0.042 2.064
Attitude toward action Intervention 6.585±61.82 7.955±75.10 13.788 0.001˃
Control 60.08±7.136 61.84±6.755 1.886 0.062
Attitude toward behavior Intervention 7.136±57.08 8.427±73.93 15.453 0.001˃
Control 7.342±56.30 7.075±58.13 1.654 0.101
Subjective norms Intervention 38.69±4.939 67.97±7.954 0.001˃ 30.746
Control 38.30±8.025 39.29±7.324 0.006 4.174
Enabling factors Intervention 52.96±4.870 72.79±5.279 0.001˃ 27.246
Control 52.66±4.926 53.97±4.939 0.634 6.029

Table 3: Nutritional status of the elderly people according to studied variables

Variable Nutritional status P
Normal Exposing to malnutrition Suffering from malnutrition
Sex
Female 10 61 25 0.192
Male 19 51 34
Marital status
Single 10 47 24 0.928
Married 19 65 35
Education
Illiterate 13 59 30 0.038
Primary school 19 58 29
Secondary school 3 29 3
University 13 9 ‑
Job
Unemployed and retired 21 87 36 0.0109
Employed 23 25 8
Lifestyle
Independent 1 4 3 0.898
Family 26 104 51
Center 2 4 5

Table 4: Comparison of average food eating and glucose control indices before and 3 months after educational
intervention
Nutrition group Group Before intervention After intervention P T
Bread and cereals Intervention 2.029±10.27 1.858±7.39 0.001˃ 10.040
Control 2.029±9.73 1.986±9.79 0.222 1.228
Fruits Intervention 0.882±2.01 1.096±4.46 0.001˃ 18.992
Control 0.809±2.05 0.798±1.90 1.174 1.37
Vegetables Intervention 1.182±2.58 1.123±4.54 0.001˃ 11.575
Control 1.136±2.39 1.116±2.37 0.672 0.425
Milk and dairy products Intervention 1.120±3.06 1.448±3.72 0.001 3.570
Control 1.367±3.03 1.51±2.89 0.492 0.69
Meat Intervention 1.478±4.09 1.155±2.6 0.001˃ 8.052
Control 1.432±3.97 1.208±3.57 0.006 2.814
Fats Intervention 1.428±2.95 1.128±2.40 0.004 2.982
Control 1.432±2.94 1.208±2.44 0.007 2.751
Fasting blood sugar Intervention 7.567±158.31 6.538±142.71 0.001˃ 15.659
Control 6.411±158.55 10.798±159.56 0.393 0.858
Glycated hemoglobin Intervention 2.002±7.99 1.477±7.02 0.001˃ 4.189
Control 1.935±7.71 2.107±8.80 0.211 1.26

the applied educational methods played important roles We applied BASNEF model in planning and administering
in changing participants’ attitude in this study. intervention and educational methods for group
Journal of Education and Health Promotion | Volume 8 | May 2019 5
 Ahmadzadeh Tori, et al.: Effect of BASNEF‑based nutrition education on nutritional behaviors among elderly people

discussion and question and answer in educational performance before intervention, had good performance
sessions to improve elderly people attitude. Kashfi et al. in following diets after intervention. We did not observe
and Najimi stated using educational theories improved any progress in control group. It seems that the indicators
their studies.[22] However, Shabbidar and Fathi indicated of blood glucose control may be due to a reduction in
that they could not change people attitude as it was carbohydrate intake and an increase in the consumption
difficult to change elderly people habits.[26] of fruits and vegetables in the intervention group. In
support of this, a meta‑analysis study showed that the
The results of this study indicated that mean score of decrease in high carbohydrate foods reduced the blood
subjective norms increased after intervention while glucose control indexes.[31]
it was not significant in control group. Subjective
norms are important believes and ideas of people.[24] Borzu found that patients with diabetes had weak
Findings indicated that when someone is supported by performance before intervention. Some studies
his/her interested people socially in order to receive investigated the role of educational interventions in
diabetes treatment, his/her behavior toward treatment using diets by 91 73‑year‑old patients with diabetes and
is increased that is measurable by assessing blood concluded that the interventions improved nutritional
glucose.[27] Trief et al. found that supporting by spouse behavior and controlled their blood glucose.[32]
is most important support for patients.[28]
Hence, some authors studied the effect of educational
Our findings indicated that enabling factors, as main programs in applying suitable diets for patients with
constructs of intervention model, increased significantly. diabetes and stated that glycated hemoglobin increased
The factors include the preliminaries of behavioral to an ideal level by using the interventions.[33] Rezaei et al.
change or environmental changes such as source, skill investigated 30 patients with diabetes through interventions
and information access, nutritional skills, nutritional and concluded decreased glycated hemoglobin in
education consulting, and other opportunities in intervention group comparing to control group.[34]
intervention group that guided the attitude of elderly 1. The lack of timely involvement of some individuals
people with type 2 diabetes toward intended nutritional in the intervention group at designated training
behaviors. The factor did not change in control group sessions due to diabetes‑related health problems,
significantly and is aligned with Hazavehei et al.[29] This such as physical problems
study aims to change elderly people’s food habits and 2. The lack of cooperation of some patients in pursuit
improve diets including increased number of meals, of participation in educational sessions due to the
decreased amount of fats and simple carbohydrates, frustration and specific nature of diabetes
and increased consumption of fruits and vegetables. 3. The lack of attention of the elderly and the repeated
The number of means increased in intervention group. content
While average amount of consuming carbohydrates 4. Problems of forgetfulness
and fats decreased significantly, average amount of 5. Lack of literacy and lack of mastery of some patients
consuming fruits and vegetables decreased significantly, in Farsi and the problem of filling in the questionnaire
after nutrition education in intervention group. Eating and study materials.
dairy products increased in intervention group, too.
Larijani et al. found no significant difference among Novelty: In addition, it measures the effect of training
consuming energy, macronutrients, and micronutrients intervention and the amount of nutrition is also
in three studied groups. In addition to, specified ratios measured.
to saturated fatty acids and simple sugar in diets of the
three groups were more than recommended ones.[30] Conclusions
Our findings are aligned with Najimi and Sharifirad’s
research. [10] In this study, we used glucose control BASNEF‑based nutrition education intervention
indices (fasting blood sugar and glycated hemoglobin) improves nutritional behaviors in addition to knowledge
to evaluate exactly which were decreased after and attitude of elderly people with type 2 diabetes. It led
3 months in intervention group. There was a significant to improving indices of glucose control during 3‑month
difference between the level of fasting blood glucose intervention. According to the findings, this educational
and hemoglobin glycosylated in the intervention and intervention enhanced status of patients with diabetes
control groups after intervention (P < 0.001). Our findings while exposing people to malnutrition and the ones who
indicated that BASNEF‑based nutrition education suffer from malnutrition should be paid attention.
affected on performance of patients with type 2 diabetes,
according to the kind of consumed diet, and improved Acknowledgment
intervention group comparing to control group. While This paper is adopted from the research thesis of MS.
none of the participants, in both groups, had good C approved at Tehran University of Medical Sciences
6 Journal of Education and Health Promotion | Volume 8 | May 2019
 Ahmadzadeh Tori, et al.: Effect of BASNEF‑based nutrition education on nutritional behaviors among elderly people

by IR. TUMS. SPH. REC.1395.940 number. I would like of nutritional status and associated factors in the healthy,
to express my sincere gratitude to education research community‑dwelling elderly. Geriatr Gerontol Int 2008;8:24‑31.
18. Wyka J, Biernat J, Mikołajczak J, Piotrowska E. Assessment of
administrator. My sincere thanks also go to all who dietary intake and nutritional status (MNA) in polish free‑living
helped me in this research and the participants who elderly people from rural environments. Arch Gerontol Geriatr
cooperated tolerantly. 2012;54:44‑9.
19. Alfonso‑Rosa RM, Del Pozo‑Cruz B, Del Pozo‑Cruz J,
Financial support and sponsorship Del Pozo‑Cruz JT, Sañudo B. The relationship between nutritional
status, functional capacity, and health‑related quality of life in
This study was financially supported by Tehran older adults with type 2 diabetes: A pilot explanatory study.
University of Medical Sciences. J Nutr Health Aging 2013;17:315‑21.
20. Doostan F, Safizadeh H, Kazemzadeh H, Asadi MR, Delbari A,
Conflicts of interest Borhaninejad VR. Nutritional Status and Its Associated Factors
There are no conflicts of interest. in Elderly With Diabetes, Sija 2016;11:384-91.
21. de Jong N, Chin A Paw MJ, de Groot LC, de Graaf C, Kok FJ,
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