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Although ketogenic dietary patterns have been linked to weight reduction, decreased systemic inflammation, and improved metabolic profiles, their relationship with OAB remains unclear. This study aimed to examine the association between the dietary ketogenic ratio (DKR) and OAB, and to explore the potential mediating roles of the Weight\u2010adjusted\u2010waist index (WWI) and the Dietary Inflammatory Index (DII). Data were derived from 23,763 participants in the 2009\u20132018 National Health and Nutrition Examination Survey (NHANES), including 4991 individuals reporting OAB. Dietary intake was assessed using two 24\u2010h dietary recalls. DKR, DII, and WWI were calculated using validated approaches. Multivariable logistic regression, subgroup analyses, and smoothed curve fitting were performed to evaluate the association between DKR and OAB, and mediation analyses were conducted to assess indirect effects. Each unit increase in DII was associated with 11% higher odds of OAB (OR\u2009=\u20091.11, 95% CI: 1.06\u20131.16), whereas each unit increase in DKR was associated with 43% lower odds of OAB (OR\u2009=\u20090.57, 95% CI: 0.42\u20130.77). Compared with the lowest quartile, participants in the highest quartile of DKR had a significantly lower prevalence of OAB. Mediation analyses suggested that DII and WWI accounted for 8.29% and 6.57% of the association between DKR and OAB, respectively. Higher DKR was associated with a lower prevalence of OAB, and this relationship was partially mediated by dietary inflammatory potential and central adiposity. These findings highlight the potential relevance of dietary patterns in OAB prevention and warrant further prospective investigation.<\/jats:p>","DOI":"10.1002\/fsn3.71587","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T16:55:47Z","timestamp":1772988947000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Ketogenic Diet and Overactive Bladder: The Mediating Roles of Dietary Inflammatory Index and Weight\u2010Adjusted Waist Index"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4234-644X","authenticated-orcid":false,"given":"Xuefeng","family":"Jin","sequence":"first","affiliation":[{"name":"Department of Urology, the Third Affiliated Hospital of Jinzhou Medical University Jinzhou Medical University  Jinzhou Liaoning China"},{"name":"Organ Transplantation Clinical Medical Centre of Xiamen University, Department of General Surgery, Xiang'an Hospital of Xiamen University, School of Medicine Xiamen University  Xiamen China"},{"name":"Organ Transplantation Institute of Xiamen University, Xiamen Human Organ Transplantation Quality Control Centre, Xiamen Key Laboratory of Regeneration Medicine, School of Medicine Xiamen University  Xiamen China"},{"name":"Department of Urology, Affiliated Taikang Xianlin Drum Tower Hospital Medical School of Nanjing University  Nanjing China"},{"name":"Department of Urology Clinical College of Wuhan University  Nanjing Jiangsu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Organ Transplantation Clinical Medical Centre of Xiamen University, Department of General Surgery, Xiang'an Hospital of Xiamen University, School of Medicine Xiamen University  Xiamen China"},{"name":"Organ Transplantation Institute of Xiamen University, Xiamen Human Organ Transplantation Quality Control Centre, Xiamen Key Laboratory of Regeneration Medicine, School of Medicine Xiamen University  Xiamen China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Li","sequence":"additional","affiliation":[{"name":"Organ Transplantation Clinical Medical Centre of Xiamen University, Department of General Surgery, Xiang'an Hospital of Xiamen University, School of Medicine Xiamen University  Xiamen China"},{"name":"Organ Transplantation Institute of Xiamen University, Xiamen Human Organ Transplantation Quality Control Centre, Xiamen Key Laboratory of Regeneration Medicine, School of Medicine Xiamen University  Xiamen China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Wang","sequence":"additional","affiliation":[{"name":"Organ Transplantation Clinical Medical Centre of Xiamen University, Department of General Surgery, Xiang'an Hospital of Xiamen University, School of Medicine Xiamen University  Xiamen China"},{"name":"Organ Transplantation Institute of Xiamen University, Xiamen Human Organ Transplantation Quality Control Centre, Xiamen Key Laboratory of Regeneration Medicine, School of Medicine Xiamen University  Xiamen China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiquan","family":"Xu","sequence":"additional","affiliation":[{"name":"Organ Transplantation Institute of Xiamen University, Xiamen Human Organ Transplantation Quality Control Centre, Xiamen Key Laboratory of Regeneration Medicine, School of Medicine Xiamen University  Xiamen China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingping","family":"Ge","sequence":"additional","affiliation":[{"name":"Department of Urology, Affiliated Taikang Xianlin Drum Tower Hospital Medical School of Nanjing University  Nanjing China"},{"name":"Department of Urology Clinical College of Wuhan University  Nanjing Jiangsu 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