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The combined effect of AIP and FI remains insufficiently studied. This study aimed to investigate the association between a combined AIP-FI measure and the risk of arthritis. This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS) database between 2011 and 2020. A total of 4437 participants aged\u2009\u2265\u200945 years without arthritis at baseline were included. Cox proportional hazards regression models and restricted cubic spline (RCS) models were employed to explore the relationship between the AIP-FI and the risk of incident arthritis. Over a 10-year follow-up period, a total of 1470 participants developed arthritis, with an incidence rate of 33.13%. Cox regression analysis revealed that each 1-unit increase in AIP-FI was associated with a 3% increase in arthritis risk (HR\u2009=\u20091.03; 95% CI: 1.02 to 1.04). Participants in the highest tertile (T3) of AIP-FI had a 55% higher risk compared to those in the lowest tertile (T1) (HR\u2009=\u20091.55; 95% CI: 1.35 to 1.78). The RCS curve demonstrated a significant nonlinear positive association between AIP-FI and arthritis risk (P for overall\u2009&lt;\u20090.001, P for nonlinear\u2009&lt;\u20090.001). This study indicates that a higher AIP-FI is significantly associated with an increased risk of arthritis. By integrating metabolic and frailty data, the AIP-FI was associated with arthritis risk and may help identify older Chinese adults at higher risk. However, these findings require further validation in independent cohorts before any clinical consideration.<\/jats:p>","DOI":"10.1038\/s41598-026-58737-y","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T14:36:30Z","timestamp":1782484590000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association of the combined atherosclerosis index of plasma and frailty index with arthritis in middle-aged and older adults: a cohort study"],"prefix":"10.1038","volume":"16","author":[{"given":"Bo","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangyi","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"58737_CR1","doi-asserted-by":"publisher","first-page":"1409578","DOI":"10.3389\/fnut.2024.1409578","volume":"11","author":"H Zhang","year":"2024","unstructured":"Zhang, H. et al. Vitamin C intake and osteoarthritis: findings of NHANES 2003\u20132018 and Mendelian randomization study. Front. Nutr. 11, 1409578. https:\/\/doi.org\/10.3389\/fnut.2024.1409578 (2024).","journal-title":"Front. Nutr."},{"key":"58737_CR2","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/j.rehab.2016.01.006","volume":"59","author":"C Palazzo","year":"2016","unstructured":"Palazzo, C., Nguyen, C., Lefevre-Colau, M. M., Rannou, F. & Poiraudeau, S. Risk factors and burden of osteoarthritis. Ann. Phys. Rehabil Med. 59, 134\u2013138 (2016).","journal-title":"Ann. Phys. Rehabil Med."},{"issue":"11","key":"58737_CR3","doi-asserted-by":"publisher","first-page":"1397","DOI":"10.1016\/j.joca.2024.07.014","volume":"32","author":"A Courties","year":"2024","unstructured":"Courties, A., Kouki, I., Soliman, N., Mathieu, S. & Sellam, J. Osteoarthritis year in review 2024: Epidemiology and therapy. Osteoarthr. 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The present secondary data analysis was conducted in accordance with the ethical principles of the Declaration of Helsinki.","order":2,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"28497"}}