{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T19:28:46Z","timestamp":1793647726486,"version":"4.5.1"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"42","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Postdoctoral Fellowship Program of CPSF","award":["GZB20230664"],"award-info":[{"award-number":["GZB20230664"]}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10,16]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      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\u2013RA 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\u2005\u2265\u200520 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 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2005&lt;\u2005.001). 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: \u22125.33% 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.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/md.0000000000051165","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:01:20Z","timestamp":1792173680000},"page":"e51165","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Association of the dietary carbohydrate-to-fiber ratio with prevalent rheumatoid arthritis in NHANES 2009\u20132018"],"prefix":"10.1097","volume":"105","author":[{"given":"Yanhao","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Rheumatology and Immunology, The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine Classics, School of Basic Medical Sciences, Zhejiang University of Chinese Medicine, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengqi","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hangzhou TCM Hospital of Zhejiang Chinese Medical University (Hangzhou Hospital of Traditional Chinese Medicine), Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqi","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine Classics, School of Basic Medical Sciences, Zhejiang University of Chinese Medicine, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Bao","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine Classics, School of Basic Medical Sciences, Zhejiang University of Chinese Medicine, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuo","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine Classics, School of Basic Medical Sciences, Zhejiang University of Chinese Medicine, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8646-7757","authenticated-orcid":false,"given":"Yongsheng","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, The Second Affiliated Hospital of Zhejiang Chinese Medical University (Xinhua Hospital of Zhejiang Province), Hangzhou, China."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20261102","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1016\/S0140-6736(23)01525-8","article-title":"Rheumatoid arthritis.","volume":"402","author":"Di Matteo","year":"2023","journal-title":"Lancet (London, England)"},{"key":"R2-20261102","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1038\/s41584-018-0070-0","article-title":"Rheumatoid arthritis and the mucosal origins hypothesis: protection turns to destruction.","volume":"14","author":"Holers","year":"2018","journal-title":"Nat Rev Rheumatol"},{"key":"R3-20261102","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1186\/s12872-024-03963-3","article-title":"Risk for cardiovascular disease development in rheumatoid arthritis.","volume":"24","author":"Bedekovi\u0107","year":"2024","journal-title":"BMC Cardiovasc 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mechanisms.","volume":"388","author":"Gravallese","year":"2023","journal-title":"N Engl J Med"},{"key":"R8-20261102","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1136\/annrheumdis-2021-220546","article-title":"Determining in which pre-arthritis stage HLA-shared epitope alleles and smoking exert their effect on the development of rheumatoid arthritis.","volume":"81","author":"Wouters","year":"2022","journal-title":"Ann Rheum Dis"},{"key":"R9-20261102","doi-asserted-by":"crossref","first-page":"901223","DOI":"10.3389\/fimmu.2022.901223","article-title":"Systematic evaluation of rheumatoid arthritis risk by integrating lifestyle factors and genetic risk scores.","volume":"13","author":"Yu","year":"2022","journal-title":"Front Immunol"},{"key":"R10-20261102","doi-asserted-by":"crossref","first-page":"650","DOI":"10.3390\/antiox10050650","article-title":"Dietary oleocanthal supplementation prevents inflammation and oxidative stress in collagen-induced arthritis in 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of developing rheumatoid arthritis in women.","volume":"100","author":"Hu","year":"2014","journal-title":"Am J Clin Nutr"},{"key":"R35-20261102","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s12887-022-03810-4","article-title":"An investigation into the relationship between nutritional status, dietary intake, symptoms and health-related quality of life in children and young people with juvenile idiopathic arthritis: a systematic review and meta-analysis.","volume":"23","author":"Zare","year":"2023","journal-title":"BMC Pediatr"},{"key":"R36-20261102","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.3390\/jcm11041089","article-title":"Celiac disease in juvenile idiopathic arthritis and other pediatric rheumatic disorders.","volume":"11","author":"Poddighe","year":"2022","journal-title":"J Clin Med"},{"key":"R37-20261102","doi-asserted-by":"crossref","first-page":"102015","DOI":"10.1016\/j.arr.2023.102015","article-title":"The roles of the Hippo-YAP signalling 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Rheumatol"},{"key":"R47-20261102","first-page":"1390","article-title":"The accuracy of self-report of physician diagnosed rheumatoid arthritis in moderately to severely disabled older women. Women\u2019s Health and Aging Collaborative Research Group.","volume":"27","author":"Ling","year":"2000","journal-title":"J Rheumatol"}],"container-title":["Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/MD.0000000000051165","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T19:00:49Z","timestamp":1793646049000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/MD.0000000000051165"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,16]]},"references-count":47,"journal-issue":{"issue":"42","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/md.0000000000051165","relation":{},"ISSN":["0025-7974","1536-5964"],"issn-type":[{"value":"0025-7974","type":"print"},{"value":"1536-5964","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,16]]},"assertion":[{"value":"2026-04-22","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-30","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}