Dietary Intake Adequacy Among Iranian Older Adults: Evidence From National Household Survey Data and Two Population-Based Cohorts Publisher



Shokri A ; Omidvar N ; Ghodsi D ; Eini Zinab H ; Sharifi F ; Rezazadeh A
Source: Frontiers in Nutrition Published:2026

Abstract

Introduction – Iran’s aging population faces significant nutritional challenges. Comprehensive data on the dietary adequacy of older adults (OAs) using multiple sources are limited. This study assessed the adequacy of energy, macro- and micronutrient intake among Iranian OAs using data from the national household survey and two population-based cohorts. Methods – To comprehensively assess dietary intake patterns and nutrient adequacy among Iranian OAs, a multi-source analysis was conducted using: (1) the Iranian Household Expenditure and Income Survey (IHEIS, 2019–2022, n = 110, 765 OAs) to estimate population-level intake via the Older Adult Male Equivalent (OAME) method; and (2) individual-level data from two cohorts, the Tehran Lipid and Glucose Study (TLGS, n = 1, 839) and the Birjand Longitudinal Aging Study (BLAS, n = 1, 325). Nutrient Adequacy Ratios (NAR) and Mean Adequacy Ratios (MAR) were calculated. Due to methodological differences, the datasets were analyzed separately, and the findings were interpreted in a complementary manner. Results – IHEIS estimates revealed low intakes of fruits, vegetables, dairy, and meat, alongside a grain-dominant dietary pattern. Mean energy intake was below recommended levels and declined with age. Severe and persistent inadequacy was observed in the intake of several micronutrients, particularly vitamin D (NAR ≤ 0.04), vitamin A (NAR < 0.25), calcium (NAR 0.22–0.35), zinc (NAR 0.25–0.39), folate, and vitamin B12. MAR values ranged from 0.51 to 0.61, indicating that only about half of cumulative nutrient requirements were met, with consistently lower adequacy among women. Cohort data showed higher mean energy and nutrient intakes than those in IHEIS; however, substantial inter-individual variability was evident, and inadequacies in calcium, vitamin D, folate, and vitamin B12 persisted across cohorts. Discussion – The diet of Iranian OAs is characterized by low dietary diversity, a high reliance on grains, and critical inadequacies in multiple micronutrients, with notable disparities by sex and age. Integrating adequacy-based indicators with multiple data sources provides a more accurate assessment of dietary vulnerability in older populations. The convergence of findings from household and individual-level data underscores an urgent need for targeted nutritional interventions to support healthy aging in Iran. Copyright © 2026 Shokri, Omidvar, Ghodsi, Eini-Zinab, Sharifi and Rezazadeh.