Dietary patterns and metabolic syndrome in a population living at a high altitude and consuming a halal diet: A cross-sectional study combining Dietary Approaches to Stop Hypertension (DASH) principles and locally derived patterns

Metabolic syndrome (MetS), characterized by the clustering of metabolic risk factors, substantially increases the risk of cardiovascular disease and type 2 diabetes. Although dietary patterns (DPs) are known to influence MetS, evidence remains limited regarding the applicability of established dietary principles in populations living at a high altitude in an environment with a halal diet. This study examined the associations between both a priori and locally derived DPs and MetS and its components, with particular emphasis on low high-density lipoprotein cholesterol (HDL-C). A cross-sectional analysis was performed among 1,133 adults ages 18-80 using data from an ongoing pilot cohort study (2024-2025). DPs were identified using a modified Dietary Approaches to Stop Hypertension (DASH) score and factor analysis. Associations with MetS and its components were assessed using inverse probability of exposure-weighted logistic regression. Subgroup and interaction analyses evaluated effect modification, and mediation analysis examined the mediating role of being overweight. The prevalence of MetS was 54.81%. Three major DPs were identified: the Sugary Drinks and Fast-Food Pattern, the Halal Protein-Rich Pattern, and the Traditional Grain and Tonic Pattern. The DASH score was moderately correlated with the Halal Protein-Rich Pattern (Spearman's r = 0.37). Participants in the highest tertile of the Halal Protein-Rich Pattern had a significantly lower risk of MetS compared to those in the lowest tertile (OR = 0.64, 95% CI: 0.45-0.92; p for trend < 0.05), as well as a 35% lower risk of low HDL-C. In contrast, higher adherence to the Sugary Drinks and Fast-Food Pattern was associated with an increased risk of low HDL-C. Similar protective associations were observed for higher DASH scores. Subgroup analyses showed that the Halal Protein-Rich Pattern was inversely associated with MetS among overweight participants (OR = 0.80, 95% CI: 0.66-0.96). Mediation analysis indicated that being overweight mediated 19.84% of the association between the Halal Protein-Rich Pattern and MetS. In conclusion, in a high-altitude environment with a halal diet, both DASH and a culturally adapted Halal Protein-Rich Pattern were inversely associated with MetS and low HDL-C in particular. DASH offers an evidence-based guideline, while the Halal Protein-Rich Pattern reflects a culturally appropriate and locally practical diet. Longitudinal studies are warranted to confirm these findings.