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The association between dietary fiber intake and osteoarthritis: a cross-sectional study from the 1999–2018 U.S. National Health and Nutrition Examination Survey

Journal of Orthopaedic Surgery and Research volume 20, Article number: 209 (2025) Cite this article

Abstract

Objective

The relationship between dietary fiber intake and osteoarthritis (OA) remains unclear. This cross-sectional study, using data from the National Health and Nutrition Examination Survey (NHANES), aimed to examine the association between dietary fiber intake and OA.

Methods

A cross-sectional analysis was conducted using NHANES data from 1999 to 2018 to assess the association between dietary fiber intake and OA. Univariate and multivariate weighted logistic regression models, along with restricted cubic spline (RCS) curves, were used to evaluate the relationship.

Results

A total of 30,620 participants were included in this study, of whom 1,864 were diagnosed with OA, yielding a prevalence of 5.74%. Multivariate weighted logistic regression revealed a consistent inverse association between dietary fiber intake and OA (OR = 0.99, 95% CI: 0.97–0.99, P = 0.018). When dietary fiber was treated as a categorical variable, the highest quartile of intake (Q4) was associated with a 27% lower risk of OA compared to the lowest quartile (Q1) (OR = 0.73, 95% CI: 0.58–0.92, P = 0.007). The RCS analysis indicated a non-linear association between dietary fiber intake and OA risk (non-linear P = 0.013). The threshold effect interval suggested that dietary fiber intake in the range of 14.4–26.7 g was associated with a reduced risk of OA, while intake above this level did not provide significant additional protection.

Conclusion

The findings demonstrate a negative linear association between dietary fiber intake and OA risk. Increasing dietary fiber consumption may reduce the risk of OA, offering potential strategies for its prevention and management. Further studies are needed to confirm these findings.

Introduction

Osteoarthritis (OA) is a degenerative joint disease primarily affecting articular cartilage, subchondral bone, and synovial membranes [14]. It is characterized by joint pain, stiffness, and functional limitations, which can significantly reduce the quality of life [12]. OA is one of the most common musculoskeletal disorders worldwide, affecting millions of adults, especially those over the age of 60 [29]. With the global population aging and obesity rates rising, the incidence of OA is expected to increase gradually [13]. By 2050, the number of people with OA is projected to nearly double, with approximately 642 million people expected to suffer from knee OA, representing a 74.9% increase [29]. The etiology of OA is multifactorial, involving genetic predisposition, mechanical stress, and systemic inflammation [10]. Several clinical studies have provided evidence that long-term consumption of ultra-processed foods can predispose individuals to a range of chronic diseases [6, 28], whereas dietary fiber intake may help reduce the inflammatory response associated with chronic inflammation [24]. Despite its prevalence and significant impact, effective preventive and therapeutic strategies for OA remain an ongoing challenge.

Diet is closely linked to a variety of diseases, and numerous studies have investigated the relationship between diet and arthritis [22, 33]. A longitudinal cohort study of 2375 patients with OA using dietary questionnaires found a significant association between specific dietary patterns and reduced knee pain, as well as improved quality of life [35]. Recent research has shown that high dietary fiber intake can modulate the gut microbiome and reduce systemic inflammation, which in turn alleviates osteoarthritic lesions through the gut-bone axis [32]. Dr. Dai et al. conducted an 8-year prospective study and found that high dietary fiber intake plays an important role in knee protection in people with a high prevalence of osteoarthritis [3]. Furthermore, obesity is a well-established risk factor for arthritis, and dietary fiber may reduce the risk of arthritis by modulating the gut microbiota to facilitate weight loss [30]. However, the relationship between dietary fiber intake and OA risk remains poorly understood, largely due to the challenges in accurately quantifying dietary fiber intake and the limited sample sizes of previous studies.

In this study, we aim to explore the association between dietary fiber intake and the prevalence of OA in U.S. adults. We analyze data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 to examine this relationship.

Materials and methods

Study population and design options

NHANES is a series of cross-sectional surveys conducted by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC) [2]. The study is designed to collect data on the health, nutritional status, and behaviors of non-institutionalized adults and children in the U.S. NHANES collects this data through personal interviews, physical examinations, and laboratory assessments on demographics and dietary habits. For more information about the survey and related research data, visit the official NHANES website (https://www.cdc.gov/nchs/nhanes/). NHANES is widely used for the analysis of various diseases.

A total of 135,310 participants were enrolled in this study, and 10 NHANES data cycles (NHANES 1999–2000, 2001–2002, 2003–2004, 2005–2006, 2007–2008, 2009–2010, 2011–2012, 2013–2014, 2015–2016, 2017–2018 cycles) in which the survey was completed. Of these, we excluded 67,842 participants who lacked OA, 8201 who lacked dietary fiber, 153 for whom educational attainment was unavailable, 435 for whom marital status was unavailable, 4899 for whom poverty-to-income ratios were unavailable, 585 for whom body mass index (BMI) information was unavailable, 10 for whom diabetes mellitus (DM) history was not missing at this time, 10 for whom blood pressure information, 17 were unable to obtain smoking status, and 7191 were unable to obtain alcohol consumption status. Therefore, a total of 32,484 participants were ultimately included in this study. A flowchart detailing the study design can be seen in Fig. 1. The NHANES data were approved by the National Center for Health Statistics Research Ethics Review Board, and all participants provided informed consent [7].

Fig. 1
figure 1

Flowchart of participant selection procedure

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Data collection

Exposure variable

We exposed data using dietary fiber intake, and this data source was collected primarily through two recall interviews. Participants were asked to recall what they had eaten in the past 24 h, with the first interview taking place at a mobile examination center (MEC) and the second follow-up visit taking place by telephone 3–10 days later [15]. Detailed information on all foods and beverages consumed by participants in the past 24 h was collected through the dietary recall method. To obtain detailed nutritional content of each diet, the researchers used the USDA’s Food and Nutrition Dietary Studies database (FNDDS) [23]. This database summarizes individual nutrient intakes, and dietary fiber intake was assessed according to the NHANES guidelines, with the final dietary fiber intake being the average of the two dietary interviews that were calculated.

Outcome variable

To assess whether a patient had OA, all participants were asked two questions about osteoarthritis. Firstly, if they answered “yes” to the question “Your doctor said you have arthritis” then they were considered to have arthritis (MCQ160A). However, there are many types of arthritis, and to further differentiate between the types of arthritis suffered, participants who answered “yes” to the first question were asked, “What type of arthritis” (MCQ195). Response options included “rheumatoid arthritis”, “osteoarthritis”, “psoriatic arthritis”, “other “, “refused” and “don’t know”, and only those who answered “osteoarthritis” were considered to have OA.

Covariates

Covariates were selected based on prior literature and OA risk assessment and included age, gender, race, marital status, education level, body mass index (BMI), smoking and alcohol use, PIR, and baseline medical history status (hypertension and diabetes). We categorized race into four total: Mexican American, non-Hispanic white, non-Hispanic black, and other. Marital status was categorized into two categories, widowed/divorced/separated/never married or married/living with partner. The PIR is calculated as the ratio of household income to the federal poverty threshold, adjusted for family size and inflation. PIR is categorized as < 1.30, 1.31–3.49, or ≥ 3.50, corresponding to low income, middle income, and high income, respectively. Educational level was categorized using high school as the dividing line into less than a high school degree, a high school degree, and more than a high school degree (which includes college graduates or higher).BMI was measured offline by height and weight measurements at the first interview, and was categorized as normal weight (BMI < 25 kg/m2), overweight (25 kg/m2 ≤ BMI < 30 kg/m2), and obese (BMI ≥ 30 kg/m2) based on BMI. Smoking status was categorized into three types, never smoked/previously smoked/currently smoked. Alcohol consumption was defined as at least 12 drinks per year.

Standardized diagnoses were used for both hypertension and diabetes. Higher than normal systolic and diastolic blood pressure or a self-reported diagnosis of hypertension or currently taking antihypertensive medication were considered to be hypertension. Diabetes mellitus was defined as a physician diagnosis of diabetes mellitus or higher than normal values of glycosylated hemoglobin, fasting glucose, random glucose, or being on glucose-lowering medications or insulin. Measurement details for these variables are available at https://www.cdc.gov/nchs/nhanes/.

Statistical analysis

To mitigate the effects associated with the intricate multi-stage sampling design employed by NHANES, we utilized the Day 1 dietary sample weight (WTDRD1) as delineated by the guidelines established by NHANES and performed weighted analyses to augment the precision of the data. Continuous variables are presented as weighted means with standard errors, and categorical variables are presented as counts with corresponding percentages. Subsequently, Subsequently, participants’ baseline features were assessed based on OA status using the Kruskal–Wallis and chi-square tests. To estimate the adjusted odds ratio (OR) and their 95% confidence interval (CI) for dietary fiber quartiles, weighted logistic regression models were employed. The study constructed three weighted logistic regression models: Model 1 had no adjustments; Model 2 was adjusted for age, race, marital status, education level, and PIR; and Model 3 included further adjustments for BMI, hypertension, diabetes, smoking status, and alcohol consumption. Additionally, the study applied weighted restricted cubic splines (RCS) to clarify the dose–response relationship between dietary fiber and OA risk, adjusting for potential confounders. In order to investigate any potential differential connections between subgroups, we subsequently stratified the patients by age, race, BMI, smoking status, alcohol intake, hypertension, and diabetes and performed interaction analyses. Multicollinearity among the covariates was assessed using the Variance Inflation Factor (VIF). A VIF value below 10 was considered acceptable and indicative of no severe multicollinearity. Finally, the results were analyzed again based on different genders and RCS curves were plotted. Statistical analyses were performed using R software (version 4.4.1; R Foundation, Vienna, Austria; http://www.R-project.org), with statistical significance set at a two-sided P-value of less than 0.05.

Results

Baseline population characteristics

A total of 32,484 eligible participants, aged between 20 and 85 years, were included in the final analysis. As shown in Table 1, of these participants, 1,864 self-reported having osteoarthritis and 30,620 reported normal joint function, resulting in a prevalence of OA of 5.74%. In the OA group, approximately 56.17% of the subjects were ≥ 60 years of age, 7.66% had less than high school education, 30.29% had low household income, 46.45% had a body mass index ≥ 30 kg/m2, 65.92% had a history of smoking, and 79.59% had a background of alcohol consumption. In addition, in the OA group, 17.02% of the subjects were diagnosed with diabetes and 62.03% with hypertension. Statistically significant differences were found between the two groups of subjects in terms of age, race, gender, PIR, education, BMI, smoking status, drinking status, and prevalence of hypertension, diabetes mellitus, and dietary fiber (P < 0.05). The VIF analysis revealed that all covariates had VIF values between 1 and 3, indicating no significant multicollinearity. Detailed results of the VIF analysis are provided in Table 2.

Table 1 Characteristics of the study participants
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Table 2 Variance inflation factor values for the covariates of the relationship between dietary fiber and OA
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Association between dietary fiber and OA

We used weighted multivariate logistic regression analysis to investigate the relationship between dietary fiber levels and OA risk in different models. The results, as shown in Table 3, showed a negative association between dietary fiber levels and OA risk. Both univariate and multivariate weighted logistic regression models showed a negative association between dietary fiber and lower OA risk. In addition, we transformed dietary fiber into a categorical variable expressed in quartiles to enhance analytic scrutiny. In Model 3, after adjusting for all possible covariates, participants in the highest quartile of dietary fiber (Q4) had a 27% lower risk of developing OA compared with those in the lowest quartile (Q1) (Q4 vs. Q1, OR: 0.73; 95% CI: 0.58–0.92; P = 0.007, trend P = 0.006). Finally, we analyzed the association between dietary fiber intake and OA by gender. In the female population, dietary fiber intake showed a negative association with OA after multivariate adjustment (OR: 0.60; 95% CI: 0.41–0.88; P = 0.009) (Table 3).

Table 3 The association between dietary fiber and OA
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Dose–response curve analyses using the RCS showed a nonlinear relationship between dietary fiber intake and OA risk, with OA risk decreasing with increasing dietary fiber intake within a certain range (total P < 0.001; nonlinear P = 0.013; Fig. 2). By calculating the threshold interval for the restricted cubic sample plot, it was found that dietary fiber intake in the range of 14.4–26.7 g was a reduction in the risk of OA, and intake above this dose was not significantly protective. In addition, we performed RCS analysis for different genders, and the results showed a linear relationship between dietary fiber intake and the risk of OA in the female population, in contrast to a nonlinear relationship in the male population (Fig. 3).

Fig. 2
figure 2

The dose–response relationship of the dietary fiber with the risk of OA

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Fig. 3
figure 3

Dose–response relationship between dietary fiber and risk of OA by gender. P1 and the orange line and green confidence interval are the results of the RCS curves for dietary fiber intake and OA in the male population. P2 and the blue line and light blue confidence interval are the results of the RCS curves for dietary fiber intake and OA in the female population

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Subgroup analysis

We performed stratified analyses to assess whether the relationship between dietary fiber and OA differed across subgroups (Fig. 4). Our findings showed no significant difference in the relationship between dietary fiber and OA risk in the subgroup analysis (interaction P > 0.05). No significant gender difference was found in the association between dietary fiber intake and OA.

Fig. 4
figure 4

Relationship between dietary fiber and OA in each subgroup. Each subgroup was adjusted for all factors except the grouping factor itself

Full size image

Discussion

Our study conducted a national cross-sectional analysis of the association between dietary fiber intake and risk of osteoarthritis (OA) using data from the NHANES surveys from 1999 to 2018. It was found that both univariate and multivariate models indicated an inverse relationship between dietary fiber levels and OA risk, regardless of whether dietary fiber was quantified as a continuous variable or in quartiles. These findings suggest that increased dietary fiber intake plays a protective role in preventing OA. By calculating the threshold interval for the restricted cubic sample plot, it was found that dietary fiber intake in the range of 14.4–26.7 g was a reduction in the risk of OA, and intake above this dose was not significantly protective.

Different dietary patterns are closely related to the physical health of the human body. Dietary fiber is an important component of foods such as vegetables, fruits and grains [31]. Dietary fiber in food contains a variety of organic polymers, which play important physiological roles through the small intestine to the large intestine [16].Previous studies have confirmed that dietary fiber can positively regulate intestinal flora and metabolically form beneficial products such as short-chain fatty acids, which have significant advantages in reducing the risk of gastrointestinal diseases such as inflammatory bowel disease and irritable bowel syndrome [8, 11]. In addition, dietary fiber intake plays a positive role in cardiovascular disease [27], liver disease [25], and dyslipidemia [17].

OA belongs to the list of culprits that affect the health of most people’s lives and its prevalence is increasing every year. In studying the pathogenesis of OA, we have found that aging, inflammation and weight gain are very important influencing factors. With the concept of the gut-skeletal axis, studies have shown that aging and obesity in the body have a great impact on the composition of the gut microbiota and that gut flora modulates joint inflammation [32]. Dietary fiber is an easily overlooked nutrient, but most studies have shown that it has a positive impact on the health of the organism. Studies have confirmed that consuming a certain amount of dietary fiber can help slow down aging or reduce the risk of obesity [5, 19]. However, an analysis of ten years of data on dietary fiber intake among adults in the United States showed that bread and cereals were their main sources of dietary fiber, with low levels of both overall intake [20]. A large-sample prospective cohort study through 4,796 participants found that higher total dietary fiber intake was associated with a lower risk of osteoarthritis [4].

More previous studies on the relationship between diet and arthritis exist, and a number have found that specific dietary intake can slow arthritis symptoms [18, 21, 22]. However, there is a lack of analyzing the elements of the diet that work to get more precise access to beneficial foods. The present study, for example, found that increased dietary fiber intake was associated with a reduced risk of OA through a large sample. Our study provides insight into the health benefits of dietary fiber and helps raise awareness of the need for dietary fiber intake. This provides ideas for clinicians in the treatment of OA, as well as prevention for patients with joint pain and OA. More studies between dietary fiber and OA should be added in the future, which will also reduce the NHS burden of OA.

The exact mechanism by which rational dietary fiber intake prevents OA is unknown, but dietary fiber may prevent arthritis through the following mechanisms. Increased dietary fiber intake helps maintain the diversity and stability of the gut microbiota. Changes in intestinal flora induced by increased dietary fiber intake modulate the development of OA by promoting the upregulation of SESN2 expression in the knee joint to maintain chondrocyte activity and reduce synovial inflammation [26]. In addition, obesity is an important factor in the development of OA, and dietary fiber intake stimulates gastrointestinal-related signals that feed back to brain regions involved in appetite regulation, thereby preventing obesity by reducing hunger and prolonging satiety [1]. Inflammatory factors play a critical role throughout the development of OA, and fiber is fermented in the gut to produce short-chain fatty acids (SCFAs), such as butyrate, which reduce joint inflammation by inhibiting pro-inflammatory cytokines like TNF-α and IL-6, while also modulating immune responses [9, 34]. Moreover, increased dietary fiber intake can activate inflammatory pathways such as the NF-kB pathway, promoting a healthy balance in the gut microbiome and reducing the production of pro-inflammatory metabolites, thus playing a crucial role in reducing systemic inflammation.

In future studies, to better understand the long-term effects of dietary fiber on OA, a longitudinal cohort study design could be used to track the progression of dietary fiber intake and OA over time. Moreover, whether dietary intake of specific dietary fiber is better protective against OA and what the optimal dose is still needs to be validated in large-scale clinical trials. The molecular biological mechanism of the protective effect of dietary fiber on OA still needs more in-depth studies in animal experiments, especially in terms of how dietary fiber-induced changes in the gut microbiota affect the development of OA.

The strength of this study is that it focuses on the relationship between dietary fiber intake and OA and is supported by a large sample. There are then some limitations to the study. First, the diagnosis of OA that we used was self-reported from participants, and although this method allows for rapid data collection from a large population, there is a risk of lack of accuracy. And, because the study was retrospective in design, it was not possible to confirm a causal relationship between exposure and outcome. Second, although we adjusted for common confounders affecting OA, there may still be residual confounders, which could potentially affect the relationship between dietary fiber and OA. Third, the population we studied was the US population, and further, larger-sample studies are needed to determine whether the benefits of dietary fiber intake can be generalized to other populations.

Conclusions

In conclusion, this cross-sectional study based on NHANES data (1999–2018) found a negative association between dietary fiber intake and OA risk in the U.S. population after adjusting for potential confounders. Our findings provide new insights into dietary interventions that may help reduce OA incidence. Future randomized controlled trials are necessary to confirm these results and identify optimal dietary fiber intake levels for OA prevention and treatment.

Availability of data and materials

All datasets used during the current study can be found on the NHANES website (https://www.cdc.gov/nchs/nhanes).

References

  1. Akhlaghi M. The role of dietary fibers in regulating appetite, an overview of mechanisms and weight consequences. Crit Rev Food Sci Nutr. 2024;64(10):3139–50.

    Article  CAS  PubMed  Google Scholar 

  2. Bailey RL, Pac SG, Fulgoni VL 3rd, Reidy KC, Catalano PM. Estimation of total usual dietary intakes of pregnant women in the United States. JAMA Netw Open. 2019;2(6):e195967.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Dai Z, Lu N, Niu J, Felson DT, Zhang Y. Dietary fiber intake in relation to knee pain trajectory. Arthritis Care Res (Hoboken). 2017;69(9):1331–9.

    Article  CAS  PubMed  Google Scholar 

  4. Dai Z, Niu J, Zhang Y, Jacques P, Felson DT. Dietary intake of fibre and risk of knee osteoarthritis in two US prospective cohorts. Ann Rheum Dis. 2017;76(8):1411–9.

    Article  CAS  PubMed  Google Scholar 

  5. Delzenne NM, Olivares M, Neyrinck AM, Beaumont M, Kjølbæk L, Larsen TM, Benítez-Páez A, Romaní-Pérez M, Garcia-Campayo V, Bosscher D, Sanz Y, van der Kamp JW. Nutritional interest of dietary fiber and prebiotics in obesity: lessons from the MyNewGut consortium. Clin Nutr. 2020;39(2):414–24.

    Article  PubMed  Google Scholar 

  6. Elliott PS, Kharaty SS, Phillips CM. Plant-based diets and lipid, lipoprotein, and inflammatory biomarkers of cardiovascular disease: a review of observational and interventional studies. Nutrients. 2022;14(24):5371.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Fang Zhang F, Liu J, Rehm CD, Wilde P, Mande JR, Mozaffarian D. Trends and disparities in diet quality among US adults by supplemental nutrition assistance program participation status. JAMA Netw Open. 2018;1(2):e180237.

    Article  PubMed  Google Scholar 

  8. Gill SK, Rossi M, Bajka B, Whelan K. Dietary fibre in gastrointestinal health and disease. Nat Rev Gastroenterol Hepatol. 2021;18(2):101–16.

    Article  CAS  PubMed  Google Scholar 

  9. Graff E, Vedantam S, Parianos M, Khakoo N, Beiling M, Pearlman M. Dietary intake and systemic inflammation: Can we use food as medicine? Curr Nutr Rep. 2023;12(2):247–54.

    Article  PubMed  Google Scholar 

  10. Guan SY, Zheng JX, Sam NB, Xu S, Shuai Z, Pan F. Global burden and risk factors of musculoskeletal disorders among adolescents and young adults in 204 countries and territories, 1990–2019. Autoimmun Rev. 2023;22(8):103361.

    Article  PubMed  Google Scholar 

  11. Guan ZW, Yu EZ, Feng Q. Soluble dietary fiber, one of the most important nutrients for the gut microbiota. Molecules. 2021;26(22):6802.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Hawker GA, King LK. The burden of osteoarthritis in older adults. Clin Geriatr Med. 2022;38(2):181–92.

    Article  PubMed  Google Scholar 

  13. Hu Y, Chen X, Wang S, Jing Y, Su J. Subchondral bone microenvironment in osteoarthritis and pain. Bone Res. 2021;9(1):20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Jang S, Lee K, Ju JH. Recent updates of diagnosis, pathophysiology, and treatment on osteoarthritis of the knee. Int J Mol Sci. 2021;22(5):2619.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Li T, Yu L, Yang Z, Shen P, Lin H, Shui L, Tang M, Jin M, Chen K, Wang J. Associations of diet quality and heavy metals with obesity in adults: a cross-sectional study from National Health and Nutrition Examination Survey (NHANES). Nutrients. 2022;14(19):4038.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Lovegrove A, Edwards CH, De Noni I, Patel H, El SN, Grassby T, Zielke C, Ulmius M, Nilsson L, Butterworth PJ, Ellis PR, Shewry PR. Role of polysaccharides in food, digestion, and health. Crit Rev Food Sci Nutr. 2017;57(2):237–53.

    Article  CAS  PubMed  Google Scholar 

  17. Lu K, Yu T, Cao X, Xia H, Wang S, Sun G, Chen L, Liao W. Effect of viscous soluble dietary fiber on glucose and lipid metabolism in patients with type 2 diabetes mellitus: a systematic review and meta-analysis on randomized clinical trials. Front Nutr. 2023;10:1253312.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lv X, Liang F, Liu S, Deng X, Lai R, Du J, Luo J. Causal relationship between diet and knee osteoarthritis: a Mendelian randomization analysis. PLoS ONE. 2024;19(1):e0297269.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Matt SM, Allen JM, Lawson MA, Mailing LJ, Woods JA, Johnson RW. Butyrate and dietary soluble fiber improve neuroinflammation associated with aging in mice. Front Immunol. 2018;9:1832.

    Article  PubMed  PubMed Central  Google Scholar 

  20. McGill CR, Fulgoni VL 3rd, Devareddy L. Ten-year trends in fiber and whole grain intakes and food sources for the United States population: National Health and Nutrition Examination Survey 2001–2010. Nutrients. 2015;7(2):1119–30.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Messier SP, Beavers DP, Queen K, Mihalko SL, Miller GD, Losina E, Katz JN, Loeser RF, DeVita P, Hunter DJ, Newman JJ, Quandt SA, Lyles MF, Jordan JM, Callahan LF. Effect of diet and exercise on knee pain in patients with osteoarthritis and overweight or obesity: a randomized clinical trial. JAMA. 2022;328(22):2242–51.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Morales-Ivorra I, Romera-Baures M, Roman-Viñas B, Serra-Majem L. Osteoarthritis and the mediterranean diet: a systematic review. Nutrients. 2018;10(8):1030.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Pan J, Hu Y, Pang N, Yang L. Association between dietary niacin intake and nonalcoholic fatty liver disease: NHANES 2003–2018. Nutrients. 2023;15(19):4128.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Sánchez-Rosales AI, Guadarrama-López AL, Gaona-Valle LS, Martínez-Carrillo BE, Valdés-Ramos R. The effect of dietary patterns on inflammatory biomarkers in adults with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Nutrients. 2022;14(21):4577.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Shen H, Zhou L, Zhang H, Yang Y, Jiang L, Wu D, Shu H, Zhang H, Xie L, Zhou K, Cheng C, Yang L, Jiang J, Wang S, Han Y, Zhu J, Xu L, Liu Z, Wang H, Yin S. Dietary fiber alleviates alcoholic liver injury via Bacteroides acidifaciens and subsequent ammonia detoxification. Cell Host Microbe. 2024;32(8):1331-1346.e1336.

    Article  CAS  PubMed  Google Scholar 

  26. Shen T, Alvarez-Garcia O, Li Y, Olmer M, Lotz MK. Suppression of Sestrins in aging and osteoarthritic cartilage: dysfunction of an important stress defense mechanism. Osteoarthr Cartil. 2017;25(2):287–96.

    Article  CAS  Google Scholar 

  27. Shivakoti R, Biggs ML, Djoussé L, Durda PJ, Kizer JR, Psaty B, Reiner AP, Tracy RP, Siscovick D, Mukamal KJ. Intake and sources of dietary fiber, inflammation, and cardiovascular disease in older us adults. JAMA Netw Open. 2022;5(3):e225012.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Srour B, Kordahi MC, Bonazzi E, Deschasaux-Tanguy M, Touvier M, Chassaing B. Ultra-processed foods and human health: from epidemiological evidence to mechanistic insights. Lancet Gastroenterol Hepatol. 2022;7(12):1128–40.

    Article  CAS  PubMed  Google Scholar 

  29. GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(9):e508-e522.

    Article  Google Scholar 

  30. Tian S, Chu Q, Ma S, Ma H, Song H. Dietary fiber and its potential role in obesity: a focus on modulating the gut microbiota. J Agric Food Chem. 2023;71(41):14853–69.

    Article  CAS  PubMed  Google Scholar 

  31. Turner ND, Lupton JR. Dietary fiber. Adv Nutr. 2021;12(6):2553–5.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Wu Y, Li X, Meng H, Wang Y, Sheng P, Dong Y, Yang J, Chen B, Wang X. Dietary fiber may benefit chondrocyte activity maintenance. Front Cell Infect Microbiol. 2024;14:1401963.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Xie Z, Qin Y. Is diet related to osteoarthritis? A univariable and multivariable Mendelian randomization study that investigates 45 dietary habits and osteoarthritis. Front Nutr. 2023;10:1278079.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Xiong RG, Zhou DD, Wu SX, Huang SY, Saimaiti A, Yang ZJ, Shang A, Zhao CN, Gan RY, Li HB. Health benefits and side effects of short-chain fatty acids. Foods. 2022;11(18):2863.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Zheng Z, Luo H, Xue Q. Association between niacin intake and knee osteoarthritis pain and function: a longitudinal cohort study. Clin Rheumatol. 2024;43(2):753–64.

    Article  PubMed  Google Scholar 

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Funding

This research received no external funding.

Author information

Author notes

  1. Xiaofeng Lv, Xinmin Deng and Rui Lai have contributed equally to this work and shared first authorship.

Authors and Affiliations

  1. School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China

    Xiaofeng Lv, Rui Lai, Zihao Zou, Xuechun Dai, Yalan Luo & Ying Li

  2. Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, Sichuan, China

    Xiaofeng Lv & Qiang Yuan

  3. School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan, China

    Xinmin Deng

  4. Sichuan Integrative Medicine Hospital, Chengdu, Chengdu, 610041, Sichuan, China

    Shanshan Liu

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  1. Xiaofeng Lv
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Contributions

All authors contributed to the study conception and design. Study design, data collection and statistical analysis, XFL, XMD, RL, Writing-original draft, XFL, XMD, RL; Writing-review & editing, XFL, XMD, RL, SSL ZHZ, YLL, XCD, QY, YL; Supervision: QY, YL.

Corresponding authors

Correspondence to Qiang Yuan or Ying Li.

Ethics declarations

Ethics approval and consent to participate

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Lv, X., Deng, X., Lai, R. et al. The association between dietary fiber intake and osteoarthritis: a cross-sectional study from the 1999–2018 U.S. National Health and Nutrition Examination Survey. J Orthop Surg Res 20, 209 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13018-025-05625-2

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Journal of Orthopaedic Surgery and Research

ISSN: 1749-799X