Association of the dietary carbohydrate-to-fiber ratio with prevalent rheumatoid arthritis in NHANES 2009-2018.
4 affiliations
- 1Department of Rheumatology and Immunology, The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
- 2Department of Traditional Chinese Medicine Classics, School of Basic Medical Sciences, Zhejiang University of Chinese Medicine, Hangzhou, China.
- 3Department of Nephrology, Hangzhou TCM Hospital of Zhejiang Chinese Medical University (Hangzhou Hospital of Traditional Chinese Medicine), Hangzhou, China.
- 4Department of Rheumatology and Immunology, The Second Affiliated Hospital of Zhejiang Chinese Medical University (Xinhua Hospital of Zhejiang Province), Hangzhou, China.
Abstract
This study examines the cross-sectional association between the carbohydrate-to-fiber ratio (CFR), an indicator of carbohydrate quality, and prevalent rheumatoid arthritis (RA) in the National Health and Nutrition Examination Survey (NHANES). The exposure was overall CFR, calculated from 2 days of dietary recall and categorized into population-wide quartiles. RA diagnosis was the outcome. Survey-weighted logistic regression was used to evaluate the CFR-RA association, adjusting for demographic, lifestyle, dietary, and metabolic covariates. Generalized additive models, subgroup analyses, and interaction tests were performed. An exploratory survey-weighted mediation analysis evaluated SII as a hypothesized intermediate factor. The study ultimately included 19,260 participants aged ≥ 20 years with valid 2-day dietary weights, with a survey-weighted RA prevalence of 4.31%. Higher CFR was significantly associated with increased RA odds, with the highest quartile showing 67% higher odds than the lowest (P < .001). After exclusion of CFR values above the upper fence defined using the interquartile range, the model 4 GAM showed an effectively linear positive association. A sensitivity analysis retaining all CFR observations showed curvature in the sparsely populated upper tail with wide uncertainty. In the exploratory model 4 mediation analysis, the estimated indirect association through SII was small (4.77% of the total association; 95% confidence interval: -5.33% to 14.87%), and its confidence interval included the null. Higher CFR was associated with greater odds of prevalent self-reported RA. Longitudinal and genetically informed studies are needed before causal or preventive interpretations can be made.
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BibTeX
@article{chen2026association,
title = {{Association of the dietary carbohydrate-to-fiber ratio with prevalent rheumatoid arthritis in NHANES 2009-2018.}},
author = {Yanhao Chen and Xiang Li and Jiao Zhang and Mengqi Wu and Jiaqi Peng and Jie Bao and Shuo Huang and Yongsheng Fan},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051165},
url = {https://europepmc.org/article/MED/42888585},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Association of the dietary carbohydrate-to-fiber ratio with prevalent rheumatoid arthritis in NHANES 2009-2018.
AU - Yanhao Chen
AU - Xiang Li
AU - Jiao Zhang
AU - Mengqi Wu
AU - Jiaqi Peng
AU - Jie Bao
AU - Shuo Huang
AU - Yongsheng Fan
PY - 2026
DA - 2026/10/01
JO - Medicine
DO - 10.1097/md.0000000000051165
UR - https://europepmc.org/article/MED/42888585
AB - This study examines the cross-sectional association between the carbohydrate-to-fiber ratio (CFR), an indicator of carbohydrate quality, and prevalent rheumatoid arthritis (RA) in the National Health and Nutrition Examination Survey (NHANES). The exposure was overall CFR, calculated from 2 days of dietary recall and categorized into population-wide quartiles. RA diagnosis was the outcome. Survey-weighted logistic regression was used to evaluate the CFR-RA association, adjusting for demographic, lifestyle, dietary, and metabolic covariates. Generalized additive models, subgroup analyses, and interaction tests were performed. An exploratory survey-weighted mediation analysis evaluated SII as a hypothesized intermediate factor. The study ultimately included 19,260 participants aged ≥ 20 years with valid 2-day dietary weights, with a survey-weighted RA prevalence of 4.31%. Higher CFR was significantly associated with increased RA odds, with the highest quartile showing 67% higher odds than the lowest (P < .001). After exclusion of CFR values above the upper fence defined using the interquartile range, the model 4 GAM showed an effectively linear positive association. A sensitivity analysis retaining all CFR observations showed curvature in the sparsely populated upper tail with wide uncertainty. In the exploratory model 4 mediation analysis, the estimated indirect association through SII was small (4.77% of the total association; 95% confidence interval: -5.33% to 14.87%), and its confidence interval included the null. Higher CFR was associated with greater odds of prevalent self-reported RA. Longitudinal and genetically informed studies are needed before causal or preventive interpretations can be made.
SN - 0304-5412
SN - 1536-5964
ER -