1. Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
  2. Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. mekramzade@gmail.com.
  3. Noncommunicable diseases research center, Fasa university of medical sciences, Fasa, Iran.
  4. Noncommunicable diseases research center, Fasa university of medical sciences, Fasa, Iran. r_homayounfar@yahoo.com.
  5. Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute Shahid Beheshti University of Medical Sciences, Tehran, Iran. r_homayounfar@yahoo.com.
bmj open


Background: Hypertension is a common chronic disease with various complications and is a main contributing factor to cardiovascular disease (CVD). This study aimed to assess the association of diet quality, assessed by dietary diversity score (DDS), Mediterranean dietary score (MDS), diet quality index-international (DQI-I), and healthy eating index-2015 (HEI-2015) with the risk of hypertension.

Methods: This study recruited a total of 10,111 individuals (45.14% male) with mean age of 48.63 ± 9.57 years from the Fasa Cohort Study, Iran. Indices of diet quality, including MDS, HEI-2015, DQI-I, and DDS were computed by a 125-item Food Frequency Questionnaire. Participants were diagnosed as hypertensive if they had a diastolic blood pressure (DBP) ≥90 mmHg, systolic blood pressure (SBP) ≥140 mmHg,, or used antihypertensive drugs.

Results: Hypertension was prevalent in 28.3% of the population (21.59% in males and 33.74% in females). In the whole population, after adjustment for potential covariates, including daily energy intake, age, gender, physical activity, smoking, family history of hypertension, body mass index, and the level of education, higher adherence to the MDS (OR: 0.86, 95%CI = 0.75-0.99) and HEI-2015 (OR: 0.79, 95%CI = 0.68-0.90) was significantly associated with decreased risk of hypertension. The protective effect of HEI-2015 against hypertension remained significant for both males (OR: 0.80, 95%CI = 0.64-0.99) and females (OR: 0.78, 95%CI = 0.66-0.94), while, for MDS, this relationship disappeared in the subgroup analysis by gender. DQI-I and DDS were not related to the odds of hypertension.

Conclusions: Adhering to MDS and HEI-2015 diets could contribute to the prevention of hypertension.

Keywords: Diet quality index-international; Dietary diversity score; Healthy eating index-2015; Hypertension; Mediterranean diet.

How to Cite

Motamedi A, Ekramzadeh M, Bahramali E, Farjam M, Homayounfar R. Diet quality in relation to the risk of hypertension among Iranian adults: cross-sectional analysis of Fasa PERSIAN cohort study. Nutr J. 2021 Jun 26;20(1):57. doi: 10.1186/s12937-021-00717-1. PMID: 34174902; PMCID: PMC8236133.