High pressure homogenization (HPH) is considered as a promising method for improving the ideal metabolic reaction of starch-based foods in the body, but there is still no comprehensive understanding of the structure-property relationship of starch treated with HPH. This study reviews the advantages and limitations of HPH in starch-based foods processing in recent years. It also elaborates the bidirectional regulation of HPH on starch structure-property and its potential in improving nutritional quality, which includes the regular modification effects of HPH on the multi-scale structure, physicochemical properties, and digestion characteristics of starch. It was found that HPH could lead to the degradation of amylopectin, destruction of amorphous structure, and homogenization of fine particles, promoting gelatinization and ultimately endowing starch with good solubility and digestibility. Moreover, it could reorganize and reorder the internal starch chains, or cause the particles to disintegrate into an amorphous state, thereby enhancing the anti-digestibility of starch. The interaction of starch with different nutrients during the HPH process could be further investigated in future studies and explored with other techniques for structure-property modifications, which would help expand the development of personalized starch foods to meet growing consumer demands.