Document Type : Original Article(s)


1 Shahid Motahari Hospital, Fooladshahr, Isfahan, Iran

2 Food Security Research Center AND Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran

3 Professor, Food Security Research Center AND Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan AND Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute AND Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences Tehran, Iran


BACKGROUND: Concurrent with increase in life expectancy, the prevalence of chronic diseases such as cardiovascular diseases (CVD) has also increased. Therefore, the aim of this study was to evaluate the association between healthy eating index (HEI) score and CVD risk factors among Iranian elderly. METHODS: This cross-sectional study was performed on a sample of elderly persons from Isfahan, Iran, in 2013. Totally, 107 retired subjects were entered in statistical analysis. A semi- quantitative food frequency questionnaire was used to assess the dietary intake of participants. Anthropometric measurements and blood pressure of participants were determined. Fasting blood samples were taken for biochemical assessments. RESULTS: The results of linear regression determined a significant inverse association between HEI score and homeostasis model assessment of insulin resistance [HOMA-IR, β = -0.238 (-0.426, -0.048)], fasting blood glucose [β = -0.194 (-0.383, -0.004)], and high-sensitivity C-reactive protein [hs-CRP, β = -0.196, (-0.386, -0.005)]. In addition, a significant positive association was observed between HEI score and high density lipoprotein cholesterol [HDL-C, β = 0.196 (0.006, 0.385)] levels. However, after adjusting for confounding variables, these significant associations were disappeared except for hs-CRP [β = -0.074 (-0.145, -0.003)]. CONCLUSION: Healthy eating index was associated with reduced risk of cardiovascular risk factors in old people. It seems that more adherence with healthy eating index could provide cardio-protective effects in elderly persons.   


  1. Tyrovolas S, Panagiotakos DB. The role of Mediterranean type of diet on the development of cancer and cardiovascular disease, in the elderly: A systematic review. Maturitas 2010; 65(2): 122-30.
  2. Mejia-Lancheros C, Estruch R, Martinez-Gonzalez MA, Salas-Salvado J, Corella D, Gomez-Gracia E, et al. Socioeconomic status and health inequalities for cardiovascular prevention among elderly Spaniards. Rev Esp Cardiol (Engl Ed) 2013; 66(10): 803-11.
  3. Taheri TP, Moradinazar M, Esmail MM, Najafi F. The prevalence of diabetes mellitus (DM) type II among Iranian elderly population and its association with other age-related diseases, 2012. Arch Gerontol Geriatr 2015; 60(3): 373-9.
  4. Kourlaba G, Polychronopoulos E, Zampelas A, Lionis C, Panagiotakos DB. Development of a diet index for older adults and its relation to cardiovascular disease risk factors: The Elderly Dietary Index. J Am Diet Assoc 2009; 109(6): 1022-30.
  5. Tourlouki E, Matalas AL, Panagiotakos DB. Dietary habits and cardiovascular disease risk in middle-aged and elderly populations: A review of evidence. Clin Interv Aging 2009; 4: 319-30.
  6. Tyrovolas S, Psaltopoulou T, Pounis G, Papairakleous N, Bountziouka V, Zeimbekis A, et al. Nutrient intake in relation to central and overall obesity status among elderly people living in the Mediterranean islands: The MEDIS study. Nutr Metab Cardiovasc Dis 2011; 21(6): 438-45.
  7. Diaz-Lopez A, Bullo M, Martinez-Gonzalez MA, Corella D, Estruch R, Fito M, et al. Dairy product consumption and risk of type 2 diabetes in an elderly Spanish Mediterranean population at high cardiovascular risk. Eur J Nutr 2016; 55(1): 349-60.
  8. Izadi V, Azadbakht L. Is there any association between rice consumption and some of the cardiovascular diseases risk factors? A systematic review. ARYA Atheroscler 2015; 11(Suppl 1): 109-15.
  9. Safaeiyan A, Pourghassem-Gargari B, Zarrin R, Fereidooni J, Alizadeh M. Randomized controlled trial on the effects of legumes on cardiovascular risk factors in women with abdominal obesity. ARYA Atheroscler 2015; 11(2): 117-25.
  10. Atkins JL, Whincup PH, Morris RW, Lennon LT, Papacosta O, Wannamethee SG. High diet quality is associated with a lower risk of cardiovascular disease and all-cause mortality in older men. J Nutr 2014; 144(5): 673-80.
  11. Gao SK, Beresford SA, Frank LL, Schreiner PJ, Burke GL, Fitzpatrick AL. Modifications to the Healthy Eating Index and its ability to predict obesity: The Multi-Ethnic Study of Atherosclerosis. Am J Clin Nutr 2008; 88(1): 64-9.
  12. Malta MB, Papini SJ, Corrente JE. Assessment of the diets of elderly people in a city in Sao Paulo state: Application of the Healthy Eating Index. Cien Saude Colet 2013; 18(2): 377-84.
  13. Closs VE, Pandolfo Feoli AM, Gomes I, Augustin Schwanke CH. Healthy eating index of elderly: Description and association with energy, macronutrients and micronutrients intake. Arch Latinoam Nutr 2014; 64(1): 34-41.
  14. Basakha M, Yavari K, Sadeghi H, Naseri A. Health care cost disease as a threat to Iranian aging society. J Res Health Sci 2014; 14(2): 152-6.
  15. Azadbakht L, Esmaillzadeh A. Red meat intake is associated with metabolic syndrome and the plasma C-reactive protein concentration in women. J Nutr 2009; 139(2): 335-9.
  16. Azadbakht L, Mirmiran P, Azizi F. Dietary diversity score is favorably associated with the metabolic syndrome in Tehranian adults. Int J Obes (Lond) 2005; 29(11): 1361-7.
  17. Kennedy ET, Ohls J, Carlson S, Fleming K. The Healthy Eating Index: Design and applications. J Am Diet Assoc 1995; 95(10): 1103-8.
  18. Azadbakht L, Akbari F, Esmaillzadeh A. Diet quality among Iranian adolescents needs improvement. Public Health Nutr 2015; 18(4): 615-21.
  19. Kant AK, Schatzkin A, Ziegler RG. Dietary diversity and subsequent cause-specific mortality in the NHANES I epidemiologic follow-up study. J Am Coll Nutr 1995; 14(3): 233-8.
  20. Garmaroudi GR, Moradi A. Socio-economic status in Iran: A study of measurement index. Payesh Health Monit 2010; 9(22): 137-44. [In Persian].
  21. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28(7): 412-9.
  22. Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G, et al. Quantitative insulin sensitivity check index: A simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab 2000; 85(7): 2402-10.
  23. Hamer M, McNaughton SA, Bates CJ, Mishra GD. Dietary patterns, assessed from a weighed food record, and survival among elderly participants from the United Kingdom. Eur J Clin Nutr 2010; 64(8): 853-61.
  24. Gopinath B, Rochtchina E, Flood VM, Mitchell P. Diet quality is prospectively associated with incident impaired fasting glucose in older adults. Diabet Med 2013; 30(5): 557-62.
  25. Adherence to predefined dietary patterns and incident type 2 diabetes in European populations: EPIC-InterAct Study. Diabetologia 2014; 57(2): 321-33.
  26. Kim DM, Ahn CW, Nam SY. Prevalence of obesity in Korea. Obes Rev 2005; 6(2): 117-21.
  27. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004; 363(9403): 157-63.
  28. Cho YA, Shin A, Kim J. Dietary patterns are associated with body mass index in a Korean population. J Am Diet Assoc 2011; 111(8): 1182-6.
  29. Khodabandehloo H, Gorgani-Firuzjaee S, Panahi
  30. G, Meshkani R. Molecular and cellular mechanisms linking inflammation to insulin resistance and beta-cell dysfunction. Transl Res 2016; 167(1): 228-56.
  31. Avignon A, Hokayem M, Bisbal C, Lambert K. Dietary antioxidants: Do they have a role to play in the ongoing fight against abnormal glucose metabolism? Nutrition 2012; 28(7-8): 715-21.
  32. Lavoie ME, Faraj M, Strychar I, Doucet E, Brochu M, Lavoie JM, et al. Synergistic associations of physical activity and diet quality on cardiometabolic risk factors in overweight and obese postmenopausal women. Br J Nutr 2013; 109(4): 605-14.
  33. Frazier-Wood AC, Kim J, Davis JS, Jung SY, Chang S. In cross-sectional observations, dietary quality is not associated with CVD risk in women; in men the positive association is accounted for by BMI. Br J Nutr 2015; 113(8): 1244-53.
  34. Nicklas TA, O'Neil CE, Fulgoni VL 3rd. Diet quality is inversely related to cardiovascular risk factors in adults. J Nutr 2012; 142(12): 2112-8.
  35. Asghari G, Mirmiran P, Hosseni-Esfahani F, Nazeri P, Mehran M, Azizi F. Dietary quality among Tehranian adults in relation to lipid profile: Findings from the Tehran Lipid and Glucose Study. J Health Popul Nutr 2013; 31(1): 37-48.
  36. Haghighatdoost F, Sarrafzadegan N, Mohammadifard N, Sajjadi F, Maghroon M, Boshtam M, et al. Healthy eating index and cardiovascular risk factors among Iranians. J Am Coll Nutr 2013; 32(2): 111-21.
  37. Shahar DR, Yu B, Houston DK, Kritchevsky SB, Lee JS, Rubin SM, et al. Dietary factors in relation to daily activity energy expenditure and mortality among older adults. J Nutr Health Aging 2009; 13(5): 414-20.
  38. Park KH, Zaichenko L, Peter P, Davis CR, Crowell JA, Mantzoros CS. Diet quality is associated with circulating C-reactive protein but not irisin levels in humans. Metabolism 2014; 63(2): 233-41.
  39. Ko BJ, Park KH, Shin S, Zaichenko L, Davis CR, Crowell JA, et al. Diet quality and diet patterns in relation to circulating cardiometabolic biomarkers. Clin Nutr 2016; 35(2): 484-90.
  40. Tsai HJ, Tsai AC. The association of plasma C-reactive protein levels with anthropometric and lipid parameters in elderly Taiwanese. Asia Pac J Clin Nutr 2008; 17(4): 651-6.
  41. Albert MA, Glynn RJ, Ridker PM. Plasma concentration of C-reactive protein and the calculated Framingham Coronary Heart Disease Risk Score. Circulation 2003; 108(2): 161-5.
  42. Esmaillzadeh A, Kimiagar M, Mehrabi Y, Azadbakht L, Hu FB, Willett WC. Fruit and vegetable intakes, C-reactive protein, and the metabolic syndrome. Am J Clin Nutr 2006; 84(6): 1489-97.
  43. Saraf-Bank S, Esmaillzadeh A, Faghihimani E, Azadbakht L. Effect of non-soy legume consumption on inflammation and serum adiponectin levels among first-degree relatives of patients with diabetes: A randomized, crossover study. Nutrition 2015; 31(3): 459-65.
  44. Jiao J, Xu JY, Zhang W, Han S, Qin LQ. Effect of dietary fiber on circulating C-reactive protein in overweight and obese adults: A meta-analysis of randomized controlled trials. Int J Food Sci Nutr 2015; 66(1): 114-9.
  45. Fleming KM, West J, Aithal GP, Fletcher AE. Abnormal liver tests in people aged 75 and above: prevalence and association with mortality. Aliment Pharmacol Ther 2011; 34(3): 324-34.
  46. Koehler EM, Sanna D, Hansen BE, van Rooij FJ, Heeringa J, Hofman A, et al. Serum liver enzymes are associated with all-cause mortality in an elderly population. Liver Int 2014; 34(2): 296-304.
  47. Lopez-Legarrea P, de la Iglesia R, Abete I, Bondia-Pons I, Navas-Carretero S, Forga L, et al. Short-term role of the dietary total antioxidant capacity in two hypocaloric regimes on obese with metabolic syndrome symptoms: The RESMENA randomized controlled trial. Nutr Metab (Lond) 2013; 10(1): 22.
  48. Tzima N, Pitsavos C, Panagiotakos DB, Chrysohoou C, Polychronopoulos E, Skoumas J, et al. Adherence to the Mediterranean diet moderates the association of aminotransferases with the prevalence of the metabolic syndrome; the ATTICA study. Nutr Metab (Lond) 2009; 6: 30.
  49. Fargnoli JL, Fung TT, Olenczuk DM, Chamberland JP, Hu FB, Mantzoros CS. Adherence to healthy eating patterns is associated with higher circulating
  50. total and high-molecular-weight adiponectin and lower resistin concentrations in women from the Nurses' Health Study. Am J Clin Nutr 2008; 88(5): 1213-24.
  51. Monfort-Pires M, Folchetti LD, Previdelli AN, Siqueira-Catania A, de Barros CR, Ferreira SR. Healthy Eating Index is associated with certain markers of inflammation and insulin resistance but not with lipid profile in individuals at cardiometabolic risk. Appl Physiol Nutr Metab 2014; 39(4): 497-502.
  52. Heidari Z, Feizi A, Azadbakht L, Sarrafzadegan N. Usual Intake Distribution of Vitamins and Prevalence of Inadequacy in a Large Sample of Iranian At-Risk Population: Application of NCI Method. J Am Coll Nutr 2016; 35(3): 193-204.
  53. Oldewage-Theron WH, Kruger R. Food variety and dietary diversity as indicators of the dietary adequacy and health status of an elderly population in Sharpeville, South Africa. J Nutr Elder 2008; 27(1-2): 101-33.
  54. Schroder H, Vila J, Marrugat J, Covas MI. Low energy density diets are associated with favorable nutrient intake profile and adequacy in free-living elderly men and women. J Nutr 2008; 138(8): 1476-81.