# Application of the China Diet Balance Index (DBI-2022) in a Region with a High-Quality Dietary Pattern and Its Association with Hypertension: A Cross-Sectional Study in the Lingnan Population

## TL;DR

This study uses the China Diet Balance Index to assess dietary quality in the Lingnan region and finds that poor diet, especially low intake of healthy foods, is linked to higher rates of hypertension.

## Contribution

The study applies the new DBI-2022 index to the Lingnan population and identifies its association with hypertension for the first time.

## Key findings

- Dietary insufficiency was more prevalent than excessive intake in the Lingnan population.
- Poor dietary quality, especially low intake of soybeans and fruits, was linked to higher odds of hypertension.
- Participants with the worst diet quality scores had significantly higher hypertension risk.

## Abstract

Background: The China Diet Balance Index 2022 (DBI-2022), released in 2024, is the latest dietary quality assessment tool developed in alignment with the updated Dietary Guidelines for Chinese Residents (2022). However, its association with hypertension in the Lingnan region—a geographic area distinguished by a unique dietary culture—has not been fully examined. Objective: This study aimed to systematically evaluate the dietary quality of Lingnan residents using DBI-2022 and explore its association with hypertension. Methods: We analyzed cross-sectional data from the 2015 China Adults Chronic Diseases and Nutrition Surveillance, focusing on 2982 Lingnan residents aged 45 years and older. Dietary information was collected via 3 consecutive days of 24-h dietary recalls and food frequency questionnaires, supplemented by standardized anthropometric measurements. We assessed the contribution of specific dietary components to overall quality and investigated the association between DBI-2022 indices and hypertension using multivariable regression models. Results: Among the 2982 participants, 821 (27.5%) were identified with hypertension. The primary dietary imbalances in the Lingnan population were characterized by moderate insufficient consumption (Low Bound Score [LBS] = 40.48) and moderate excessive intake (High Bound Score [HBS] = 22.58), with insufficient intake being the more prominent concern. Cereals, cooking oils, and salt emerged as key contributors to poor dietary quality, whereas soybeans, fruits, adequate water consumption, and dietary diversity were associated with better dietary quality. After adjusting for potential confounders, participants in the highest quartile of Diet Quality Distance (DQD) had significantly higher odds of hypertension (OR = 1.57, 95% CI: 1.05–2.35) compared to those in the lowest quartile. Similarly, the odds were elevated for those with high LBS (OR = 1.88, 95% CI: 1.24–2.87). Conclusions: Dietary insufficiency appears to be a more critical issue than excessive consumption among the Lingnan population. Poor dietary quality, particularly insufficient intake of protective foods, is significantly associated with elevated odds of hypertension. These findings support the applicability of DBI-2022 for regional dietary surveillance and highlight key priorities for targeted nutritional intervention strategies.