Abstract: Starch is the main carbohydrate source in the food system, and its hydrothermal stability during food processing is closely related to its pasting properties and nutritional functionalities. By improving the hydrothermal stability of starch, the digestion rate and degree of starch in vivo can be significantly delayed, which is of great significance for the regulation of blood glucose in vivo. From the viewpoint of the intrinsic relationships between the multi-scale structures and functionalities of starch, this review summarizes the evaluation index and evaluation method of starch hydrothermal stability and systematically discusses the key structures and processing technologies affecting starch hydrothermal stability. The pathways to modulate starch hydrothermal stability are also discussed. Additionally, perspectives regarding the current of starch hydrothermal stability modulation are proposed, which may provide theoretical foundation for the development of starch-based functional foods.