Abstract
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: Mediterranean diet, Diet quality index-international, Healthy eating index-2015, Dietary diversity score,
Hypertension