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Association of Diet Quality with Risk of Incident Rheumatoid Arthritis in the Women’s Health Initiative
Journal article   Peer reviewed

Association of Diet Quality with Risk of Incident Rheumatoid Arthritis in the Women’s Health Initiative

Kanika Malani, Sushaili Pradhan, Mir Moafi Madani, Mary B. Roberts, Aladdin Shadyab, Matthew Allison, Theodore M. Brasky, Peter F. Schnatz, Linda Snetselaar and Charles B. Eaton
Journal of the Academy of Nutrition and Dietetics, Vol.124(11), pp.1451-1473
11/2024
DOI: 10.1016/j.jand.2024.07.009
PMID: 39025233

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Abstract

Background Various foods and nutrients are linked with higher or lower risk of rheumatoid arthritis (RA), yet these associations are inconsistent across studies. Limited research has been done evaluating the association between diet quality and RA in a larger scale prospective study on postmenopausal women. Objective The objective of this study was to evaluate the association between dietary quality and risk of incident RA in postmenopausal women. Design This is a prospective cohort study as part of the Women’s Health Initiative (WHI) with an average follow-up time of 8.1 years. Baseline diet was measured using a food frequency questionnaire (FFQ). Diet quality was evaluated by the Healthy Eating Index (HEI) - 2015 total score. In addition, intake of food groups/nutrients that align with HEI-2015 components was assessed. Participants/setting 109,591 postmenopausal women were included in this study, which was conducted at various clinical centers across the US with recruitment from 1993 to 1998. WHI participants who were missing outcome data, had unreliable/missing FFQ data, or had RA at baseline were excluded. Main outcome measures The primary outcome measure is incident RA. Statistical analyses performed Multivariable Cox proportional regression analysis was performed evaluating the association of diet quality with self-reported physician-diagnosed RA after adjusting for age, race, ethnicity, education status, income, and body mass index (BMI). Results During 857,517 person-years of follow-up, 5,823 incident RA cases were identified. After adjustment for multiple comparisons, compared to quartile 1, quartiles 2, 3, and 4 of the HEI-2015 total scores were associated with a lower RA risk of 1%, 10%, and 19%, respectively (p-trend < 0.001). Greater consumption of total fruits (p-trend=0.014), whole fruits (p-trend<0.0002), total vegetables (p-trend=0.008), greens and beans (p-trend<0.0002), whole grains (p-trend=0.008), and dairy (p-trend=0.018) were significantly associated with lower rates of incident RA. Conversely, higher consumption of saturated fat (p-trend=0.002) was significantly associated with higher rates of incident RA. Conclusion A higher quality diet reflected by higher HEI-2015 total scores was inversely associated with incident rheumatoid arthritis in post-menopausal women.
 Rheumatoid arthritis Nutrition Diet quality Dietary components Postmenopausal women

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