Document Type : Original Article


1 School of Tehran Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Social Medicine, Babol University of Medical Sciences

3 Department of Statistics, Babol University of Medical Sciences, Babol, Iran


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
significantly different in control group after 3 months (P > 0.05). It was clear that 22% of samples
had normal nutrition (score >24), 29% of participants were exposed to malnutrition, and 51% of
samples were suffering from malnutrition. These numbers were 20% for normal nutrition, 30% for
exposing to malnutrition, and 50% for suffering from malnutrition in the control group, respectively.
Fifty percent of elderly people with diabetes suffered from malnutrition and almost half of them had
normal nutrition that was 20%.
CONCLUSIONS: BASNEF‑based nutrition education intervention improves nutritional behaviors in
addition to knowledge and attitude of elderly people with type 2 diabetes. It led to improve indices
of glucose control during 3‑month intervention.
AIMS: The aim of this study was to investigate the nutritional status of elderly people with diabetes
and the effect of educational intervention based on the BASNEF model on promoting nutritional
behaviors in the elderly with type 2 diabetes in Babol city, Iran.


1. Dorosti A, Alavi A. Its nutritional status in elderly with heart
disease and diabetes. J Sch Med 2002;65:68‑71.
2. Volkert D. Nutrition and lifestyle of the elderly in Europe. J Public
Health 2005;13:56‑61.
3. Roebuck J. When does old age begin? the evolution of the English
definition. J Soc Hist 1979;12:416‑28.
4. Abaszadeh SH, Ali T. Diabetes and aging. J Diabetes Metab Iran
5. Valery PC, Ibiebele T, Harris M, Green AC, Cotterill A, Moloney A,
et al. Diet, physical activity, and obesity in school‑aged indigenous
youths in Northern Australia. J Obes 2012;2012:893508.
6. Smeltzer SC, Bare BG, Hinkle JL, Cheever KH. Brunner and
Suddarths Text Book of Medical Surgical Nursing. 11th ed.
Philadephia: Lippincott William and Wilkins; 2008.
7. Sanz París A, García JM, Gómez‑Candela C, Burgos R, Martín Á,
Matía P, et al. Malnutrition prevalence in hospitalized elderly
diabetic patients. Nutr Hosp 2013;28:592‑9.
8. Wakimoto P, Block G. Dietary intake, dietary patterns, and
changes with age: An epidemiological perspective. J Gerontol A
Biol Sci Med Sci 2001;56:65‑80.
9. Rodin G, Olmsted MP, Rydall AC, Maharaj SI, Colton PA,
Jones JM, et al. Eating disorders in young women with type 1
diabetes mellitus. J Psychosom Res 2002;53:943‑9.
10. Najimi A, Sharifirad GH. Effect of nutrition education based on
the model Baznef On dietary behaviors and indicators of control
Blood sugar elderly patients with type 2 diabetes. IJEM 2011,
11. Savoca M, Miller C. Food selection and eating patterns: Themes
found among people with type 2 diabetes mellitus. J Nutr Educ
12. Sharifirad G, Entezari MH, Kamran A, Azadbakht L. The
effectiveness of nutritional education on the knowledge of diabetic
patients using the health belief model. J Res Med Sci 2009;14:1‑6.
13. Taylor‑Davis S, Smiciklas‑Wright H, Warland R, Achterberg C,
Jensen GL, Sayer A, et al. Responses of older adults to theory‑based
nutrition newsletters. J Am Diet Assoc 2000;100:656‑64.
14. Tavasoli E, Hasanzade A. The impact of the educational program
based on basnef model on adopting nutritional behaviors in
elderly patients with type 2 diabetes. Jims 2010;155:1247-58.
15. Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H,
Ilanne‑Parikka P, et al. Prevention of type 2 diabetes mellitus
by changes in lifestyle among subjects with impaired glucose
tolerance. N Engl J Med 2001;344:1343‑50.
16. Pollock SE, Christian BJ, Sands D. Responses to chronic illness:
Analysis of psychological and physiological adaptation. Nurs Res
17. Iizaka S, Tadaka E, Sanada H. Comprehensive assessment
of nutritional status and associated factors in the healthy,
community‑dwelling elderly. Geriatr Gerontol Int 2008;8:24‑31.
18. Wyka J, Biernat J, Mikołajczak J, Piotrowska E. Assessment of
dietary intake and nutritional status (MNA) in polish free‑living
elderly people from rural environments. Arch Gerontol Geriatr
19. Alfonso‑Rosa RM, Del Pozo‑Cruz B, Del Pozo‑Cruz J,
Del Pozo‑Cruz JT, Sañudo B. The relationship between nutritional
status, functional capacity, and health‑related quality of life in
older adults with type 2 diabetes: A pilot explanatory study.
J Nutr Health Aging 2013;17:315‑21.
20. Doostan F, Safizadeh H, Kazemzadeh H, Asadi MR, Delbari A,
Borhaninejad VR. Nutritional Status and Its Associated Factors
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,
van Staveren WA, et al. Functional biochemical and nutrient
indices in frail elderly people are partly affected by dietary
supplements but not by exercise. J Nutr 1999;129:2028‑36.
22. Kashfi SM, Khani Jeihooni A, Rezaianzadeh A, Amini Sh. The
effect of health belief model educational program and jogging
on control of sugar in type 2 diabetic patients. Iran Red Crescent
Med J 2012;14:442‑6.
23. Weickert MO, Möhlig M, Schöfl C, Arafat AM, Otto B, Viehoff H,
et al. Cereal fiber improves whole‑body insulin sensitivity in
overweight and obese women. Diabetes Care 2006;29:775‑80.
24. Faghihi, M. Assessing the effect of educational intervention on
some barriers of living with diabetes among type 2 diabetes:
Application of BAZNEF Model. Scientific Journal of School
of Public Health and Institute of Public Health Research
25. Rakhshanderou S, Gaffari M, Heydarnia A, Rajab A. Effectiveness
of educational interventions on metabolic control in diabetic
patients referred to the diabetes center of Iran. Iran J Diabetes
Lipid 2010;9:57‑64.
26. Shabbidar S, Fathi B. Effect of nutrition education on knowledge,
attitude, and practice of type 2 diabetic patients. J Birjand Univ
Med Sci 2007;14:31‑7.
27. Claude J, Amy J. Predicting treatment compliance with
Hispanic diabetes: An application of theory of reasoned action.
28. Trief PM, Himes CL, Orendorff R, Weinstock RS. The marital
relationship and psychosocial adaptation and glycemic control
of individuals with diabetes. Diabetes Care 2001;24:1384‑9.
29. Hazavehei M, Khani Jyhouni A, Hasanzadeh A, Rashidi M.
The effect of educational program based on BASNEF model
on diabetic (Type II) eyes care in Kazemi’s clinic, (Shiraz). Iran
JEndocrinol Metab 2008;10:145-54.
30. Larijani MB, Pajohi M, Talaie A, Sajadi SA, Shirzad M. Evaluation
of nutritional status of new patients with noninsulin dependent
diabetes, and impaired glucose tolerance. Q J Med Counc IRI
31. Livesey G, Taylor R, Hulshof T, Howlett J. Glycemic response
and health – A systematic review and meta‑analysis: Relations
between dietary glycemic properties and health outcomes. Am J
Clin Nutr 2008;87:258S‑68S.
32. Redmond EH, Burnett SM, Johnson MA, Park S, Fischer JG,
Johnson T, et al. Improvement in A1C levels and diabetes
self‑management activities following a nutrition and diabetes
education program in older adults. J Nutr Elder 2006;26:83‑102.
33. Roblin DW, Ntekop E, Becker ER. Improved intermediate clinical
outcomes from participation in a diabetes health education
program. J Ambul Care Manage 2007;30:64‑73.
34. Rezaei N, Tahbaz F, Kimiagar M. Effect of education on
knowledge, attitude and practice of diabetic patients. J Shahrekord
Univ Med Sci 2006;8:52-9.