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Background <p>Diet–microbiota interactions may influence blood pressure via metabolic pathways, but prospective evidence on microbiota-supportive dietary patterns and incident hypertension, particularly in Middle Eastern populations, is limited. We examined the association between a Dietary Index for Gut Microbiota (DI-GM) and incident hypertension, and assessed whether insulin resistance, measured by homeostatic model assessment for insulin resistance (HOMA-IR), mediates this relationship.</p> Methods <p>This prospective cohort included 5,185 Iranian adults free of hypertension at baseline. Usual dietary intake was assessed using a validated 125-item food-frequency questionnaire, and a 12-component DI-GM was computed. Incident hypertension over five years was defined according to JNC-7 criteria. Multivariable logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for hypertension across DI-GM quartiles and per one-unit increment. Mediation by HOMA-IR was evaluated using bootstrapped mediation analysis with 10,000 resamples.</p> Results <p>During follow-up, 2,150 participants experienced incident hypertension (41.5%). In fully adjusted models, participants in the highest DI-GM quartile had 21% lower odds of hypertension than those in the lowest quartile (OR 0.79, 95% CI 0.66–0.95), and each one-unit higher DI-GM was associated with 4% lower odds (OR 0.96, 95% CI 0.93–0.99). Results were robust in multiple sensitivity analyses. Approximately 34.5% of the association between DI-GM and hypertension was mediated by HOMA-IR.</p> Conclusions <p>A microbiota-supportive dietary pattern is prospectively associated with a lower risk of incident hypertension, and about one-third of this relationship appears to operate through reduced insulin resistance. These findings support the promotion of gut-friendly dietary patterns in strategies for hypertension prevention.</p>

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Dietary index for gut microbiota and risk of hypertension: the mediating role of HOMA-IR in a five-year prospective cohort study in Iranian adults

  • 期刊论文

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  • 发表日期：

    2026年5月3日

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  • Ali Nikparast,
  • Mohsen Maleki,
  • Nazanin Zamanian,
  • Leila Sheikhi,
  • Elahe Etesami,
  • Gholamali Javdan,
  • Reza Homayounfar,
  • Jalaledin Mirzay Razaz

摘要

Background

Diet–microbiota interactions may influence blood pressure via metabolic pathways, but prospective evidence on microbiota-supportive dietary patterns and incident hypertension, particularly in Middle Eastern populations, is limited. We examined the association between a Dietary Index for Gut Microbiota (DI-GM) and incident hypertension, and assessed whether insulin resistance, measured by homeostatic model assessment for insulin resistance (HOMA-IR), mediates this relationship.

Methods

This prospective cohort included 5,185 Iranian adults free of hypertension at baseline. Usual dietary intake was assessed using a validated 125-item food-frequency questionnaire, and a 12-component DI-GM was computed. Incident hypertension over five years was defined according to JNC-7 criteria. Multivariable logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for hypertension across DI-GM quartiles and per one-unit increment. Mediation by HOMA-IR was evaluated using bootstrapped mediation analysis with 10,000 resamples.

Results

During follow-up, 2,150 participants experienced incident hypertension (41.5%). In fully adjusted models, participants in the highest DI-GM quartile had 21% lower odds of hypertension than those in the lowest quartile (OR 0.79, 95% CI 0.66–0.95), and each one-unit higher DI-GM was associated with 4% lower odds (OR 0.96, 95% CI 0.93–0.99). Results were robust in multiple sensitivity analyses. Approximately 34.5% of the association between DI-GM and hypertension was mediated by HOMA-IR.

Conclusions

A microbiota-supportive dietary pattern is prospectively associated with a lower risk of incident hypertension, and about one-third of this relationship appears to operate through reduced insulin resistance. These findings support the promotion of gut-friendly dietary patterns in strategies for hypertension prevention.