Associations of the Dietary Diversity Score and Food Variety Score with Serum Magnesium and Ferritin Status

Document Type : Research Paper


1 MSc, Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.

2 PhD, Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.

3 PhD, Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.

4 Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.

5 Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

6 Shariati hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

7 Children hospital of excellence, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.


Introduction: Dietary diversity score (DDS) and Food variety score (FVS) are the appropriate measures used to evaluate the overall quality of dietary patterns. However, their associations with the serum levels of micronutrients remain unclear. The present study aimed to investigate the correlations between DDS/FVS and serum ferritin and magnesium status in the non-athlete females joining the sports clubs in Tehran, Iran. Methods: This cross-sectional survey was conducted on 397 non-athlete women, who were members of the sports clubs in Tehran, Iran in 2013. Dietary intake was assessed using a 24-hour recall questionnaire. DDS and FVS were calculated and classified into two groups based on the guidelines of the minimum dietary diversity of women (MDD-W) and median, respectively. Serum ferritin was measured using the ELISA assay, and serum magnesium was measured using atomic absorption spectrophotometry. Results: Mean DDS and FVS was 5.7±1.4 (range: 2-9) and 15.3±4.7 (range: 5-32), respectively. After adjustment for the confounding factors, serum magnesium in the group with high FVS was significantly higher compared to the other group (P=0.01). In the group with high FVS, serum ferritin was also higher, and the difference was considered significant (P=0.058). In addition, linear regression analysis indicated a significant association between high FVS and serum magnesium level (P=0.02). However, no significant correlations were observed between the serum levels of micronutrients and DDS. Conclusion: According to the results, higher FVS may be associated with higher serum magnesium and ferritin levels. Further investigations are required to assess the correlations between DDS, FVS, and the status of serum micronutrients. 


Food variety score is associated with serum Mg and possibly the serum ferritin status.

There is no relationship between DDS and serum micronutrients.

It is recommended that an increase in the variety of diet may be useful in modifying the levels of some blood micronutrients


1.Tulchinsky TH. Micronutrient Deficiency Conditions: Global Health Issues. Public Health Rev. 2010; 32(1): 243-55.
2. Arigony ALV, de Oliveira IM, Machado M, Bordin DL, Bergter L, Pra D, et al. The influence of micronutrients in cell culture: a reflection on viability and genomic stability. Biomed Res Int. 2013: 1-22.
3. Cheng WW, Zhu Q, Zhang HY. Mineral Nutrition and the Risk of Chronic Diseases: A Mendelian Randomization Study. Nutrients. 2019; 11(2): pii: E378.
4. Serefko A, Szopa A, Poleszak E. Magnesium and depression. Magnes Res. 2016; 29(3): 112-9.
5. Rude RK. Magnesium. In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, editors. Modern nutrition in health and disease. 11th ed2013. p. 159- 75.
6. Kim DJ, Xun P, Liu K, Loria C, Yokota K, Jacobs DR Jr, et al. Magnesium intake in relation to systemic inflammation, insulin resistance, and the incidence of diabetes. Diabetes Care. 2010; 33(12): 2604-10.
7. Barbagallo M, Dominguez LJ, Galioto A, Ferlisi A, Cani C, Malfa L, et al. Role of magnesium in insulin action, diabetes and cardio-metabolic syndrome X. Mol Aspects Med. 2003; 24(1-3): 39-52.
8. van den Brandt PA, Smits KM, Goldbohm RA, Weijenberg MP. Magnesium intake and colorectal cancer risk in the Netherlands Cohort Study. Br J Cancer. 2007; 96(3): 510-3.
9. Folsom AR, Hong CP. Magnesium intake and reduced risk of colon cancer in a prospective study of women. Am J Epidemiol. 2006; 163(3): 232-5.
10. Grossi E, Castiglioni S, Moscheni C, Antonazzo P, Cetin I, Savasi VM. Serum magnesium and calcium levels in infertile women during a cycle of reproductive assistance. Magnes Res. 2017; 30(2): 35-41.
11. Wessling-Resnick M. Iron. In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, editors. Modern nutrition in health and disease. 11th ed2013. p. 176- 88.
12. Cook RL, O'Dwyer NJ, Parker HM, Donges CE, Cheng HL, Steinbeck KS, et al. Iron Deficiency Anemia, Not Iron Deficiency, Is Associated with Reduced Attention in Healthy Young Women. Nutrients. 2017; 9(11): pii: E1216.
13. Percy L, Mansour D, Fraser I. Iron deficiency and iron deficiency anaemia in women. Best Pract Res Clin Obstet Gynaecol. 2017; 40: 55-67.
14. Pouraram H, Djazayery A, Mohammad K, Parsaeian M, Abdollahi Z, Dorosty Motlagh A, et al. Second National Integrated Micronutrient Survey in Iran: Study Design and Preliminary Findings. Arch Iran Med. 2018; 21(4): 137-44.
15. Yokoi K, Konomi A. Iron deficiency without anaemia is a potential cause of fatigue: meta-analyses of randomised controlled trials and cross-sectional studies. Br J Nutr. 2017; 117(10): 1422-31.
16. Bergis D, Tessmer L, Badenhoop K. Iron deficiency in long standing type 1 diabetes mellitus and its association with depression and impaired quality of life. Diabetes Res Clin Pract. 2019; 151: 74-81.
17. Nair MK, Augustine LF, Konapur A. Food-Based Interventions to Modify Diet Quality and Diversity to Address Multiple Micronutrient Deficiency. Front Public Health. 2016; 3: 277.
18. Ruel MT. Operationalizing dietary diversity: a review of measurement issues and research priorities. J Nutr. 2003; 133(11 Suppl 2): 3911S-26S.
19. Savy M, Martin-Prevel Y, Sawadogo P, Kameli Y, Delpeuch F. Use of variety/diversity scores for diet quality measurement: relation with nutritional status of women in a rural area in Burkina Faso. Eur J Clin Nutr. 2005; 59(5): 703-16.
20. Rathnayake KM, Madushani P, Silva K. Use of dietary diversity score as a proxy indicator of nutrient adequacy of rural elderly people in Sri Lanka. BMC Res Notes. 2012; 5: 469.
21. Mirmiran P, Mohammadi F, Azizi F. Determining the dietary diversity and its association with mean adequacy ratio. Research in Medicine. 2003; 27: 33-40.
22. Spector RE. Cultural Diversity in Health and Illness. J Transcult Nurs. 2002; 13(3): 197-9.
23. Azadbakht L, Esmaillzadeh A. Diet variety: a measure of nutritional adequacy and health. The Journal of Qazvin University of Medical Sciences. 2009; 13(2): 88-97. (Persian)
24. Huang YC, Wahlqvist ML, Kao MD, Wang JL, Lee MS. Optimal Dietary and Plasma Magnesium Statuses Depend on Dietary Quality for a Reduction in the Risk of All-Cause Mortality in Older Adults. Nutrients. 2015; 7(7): 5664-83.
25. Narmaki E, Siassi F, Koohdani F, Qorbani M, Shiraseb F, Ataie-Jafari A, et al. Dietary diversity as a proxy measure of blood antioxidant status in women. Nutrition. 2015; 31(5): 722-6.
26. Shiraseb F, Siassi F, Sotoudeh G, Qorbani M, Rostami R, Sadeghi-Firoozabadi V, et al. Association of blood antioxidants status with visual and auditory sustained attention. Nutr Neurosci. 2015; 18(8): 345-54.
27. Food and Agriculture Organization of the United Nations, FHI 360. Minimum Dietary Diversity for Women: A Guide for Measurement. Rome: FAO; 2016.
28. Steyn NP, Nel JH, Nantel G, Kennedy G, Labadarios D. Food variety and dietary diversity scores in children: are they good indicators of dietary adequacy? Public Health Nutr. 2006; 9(5): 644-50.
29. Aadahl M, Jorgensen T. Validation of a new self-report instrument for measuring physical activity. Med Sci Sports Exerc. 2003; 35(7): 1196-202.
30. Akizawa Y, Koizumi S, Itokawa Y, Ojima T, Nakamura Y, Tamura T, et al. Daily magnesium intake and serum magnesium concentration among Japanese people. J Epidemiol. 2008; 18(4): 151-9.
31. Mirmiran P, Azadbakht L, Esmaillzadeh A, Azizi F. Dietary diversity score in adolescents - a good indicator of the nutritional adequacy of diets: Tehran lipid and glucose study. Asia Pac J Clin Nutr. 2004; 13(1): 56-60.
32. Nikuyeh B, Sultan Ali M, A. R, Qaem Maqami J. Evaluation of nutritional status and serum zinc, iron and copper and their relationship with dietary and anthropometric indices in students of Tabriz University of Medical Sciences. Journal of Birjand University of Medical Sciences. 2005; 12: 9-15.
33. Broderstad AR, Melhus M, Brustad M, Lund E. Iron stores in relation to dietary patterns in a multiethnic population: the SAMINOR study. Public Health Nutr. 2011; 14(6): 1039-46.
34. Azadbakht L, Mirmiran P, Hoseini F, Azizi F. The relationship between variety of food groups andadequacy ofnutrient intakes in Tehranian men. Research in Medicine. 2006; 30: 31-9.
35. Kennedy G, Fanou-Fogny N, Seghieri C, Arimond M, Koreissi Y, Dossa R, et al. Food groups associated with a composite measure of probability of adequate intake of 11 micronutrients in the diets of women in urban Mali. J Nutr. 2010; 140(11): 2070S-8S.
36. Mirmiran P, Azadbakht L, Azizi F. Within Food Group Variety: An Indicator of Nutrient Adequacy in Tehranian Women. Razi Journal of Medical Sciences. 2005; 12(47): 155-65.
37. Oldewage-Theron W, Kruger R. Dietary diversity and adequacy of women caregivers in a peri-urban informal settlement in South Africa. Nutrition. 2011; 27(4): 420-7.
38. Torheim LE, Ouattara F, Diarra MM, Thiam FD, Barikmo I, Hatloy A, et al. Nutrient adequacy and dietary diversity in rural Mali: association and determinants. Eur J Clin Nutr. 2004; 58(4): 594-604.
39. Mirmiran P, Azadbakht L, Azizi F. Dietary diversity within food groups: an indicator of specific nutrient adequacy in Tehranian women. J Am Coll Nutr. 2006; 25(4): 354-61.
40. Vakili M, Abedi P, Sharifi M, Hosseini M. Dietary diversity and its related factors among adolescents: a survey in Ahvaz-Iran. Glob J Health Sci. 2013; 5(2): 181-6.