Diet Quality, Adiposity, and Hypertension Among Malaysian Adults: A Cross-Sectional Analysis from the May Measurement Month 2025 Participants

Background: Hypertension is a leading modifiable risk factor for cardiovascular disease. Excess adiposity and poor diet quality contribute to elevated blood pressure (BP), yet few studies have examined both factors simultaneously using standardized diet quality measures in Southeast Asian populations. This study investigated the associations between diet quality, body composition, hypertension presence, and BP control among Malaysian adults. Methods: In this cross-sectional study, 998 adults were assessed. Hypertension was defined as systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg, or self-reported prior physician diagnosis. Diet quality was evaluated using the Diet Quality Questionnaire (DQQ) of the Global Diet Quality Project, generating Dietary Diversity Score (DDS), NCD Protect, NCD Risk, ALL5, and Global Dietary Recommendation (GDR) indicators. Anthropometric and body composition measures included body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), total body fat (TBF), visceral fat level (VFL), and skeletal muscle mass (SM). Multivariable models adjusted for sociodemographic and lifestyle factors. Results: Hypertension prevalence was 35.3%. Hypertensive participants had significantly higher WC, BMI, TBF, and VFL and lower SM than normotensive participants (all p <0.001). High VFL (OR 2.22), high TBF (OR 2.10), overweight (OR 1.86), and obesity (OR 2.04) were independently associated with hypertension, whereas high SM was inversely associated (OR 0.57). Among hypertensive individuals, uncontrolled BP was strongly associated with central adiposity. Diet quality differences between normotensive and hypertensive participants were modest; however, hypertensives with uncontrolled BP were associated with lower DDS and NCD Protect scores. Conclusions: Central and visceral adiposity were significantly associated with hypertension and poor BP control. Diet quality, assessed using the DQQ, was more closely associated with BP control among hypertensives than with hypertension presence.