The prevalence of dyslipidaemia has been increasing in developing countries that are undergoing nutrition transition. However, the association of diet quality and lipid profile has not been well-understood in these countries. The aim of the current study was to compare the ability of three diet quality indices—the Mediterranean diet scale (MDS), healthy eating index-2005 (HEI-2005), and diet quality index-international (DQI-I) in relation to changes in lipid profile between baseline and 6.7 years of follow-up. Baseline data from two 24-hour dietary recalls provided by 469 adults with mean age of 38.7±12.3 years, who were participants of the Tehran Lipid and Glucose Study, were analyzed to describe dietary intakes. Data on anthropometry, sociodemography, physical activity, and other lifestyle variables were recorded, and a comparison of baseline and follow-up data revealed changes in the concentrations of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). A general linear model was used in assessing changes in lipid profile depending on adherence to diet quality indices at baseline, after adjustment for age, smoking status, waist-circumference, body mass index, physical activity, and energy intake. A significant interaction was observed between scores and sex, and upon stratification, males in the highest quartile score of the HEI-2005 had significantly lower TG changes than those in the lowest quartile, after adjusting for confounders (-8.8 vs 2.9, p=0.038). No association was apparent in females (-0.2 vs 11.2, p=0.297). In addition, a positive association was found between DQI-I and HDL-C (Q1=0.6 vs Q4=-2.0, p=0.044) in males. In both sexes, all these indices were weakly associated with TC while none was associated with LDL-C. It is concluded: adherence to the HEI-2005 recommendations was weakly associated with reduced TG concentration in an urban Iranian adult population. The MDS and DQI-I were not related to change in lipid profile.