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Objective: We aim to evaluate the association of composite dietary antioxidant index (CDAI) and Benign Prostatic Hyperplasia (BPH) in a large population in the United States using a cross-sectional design. Methods: Data was retrieved from the National Health and Nutrition Examination Survey (NHANES) 2003–2008 and 2013–2020 datasets. Univariate and multivariate logistic regression were performed to explore the association between CDAI and BPH. The restricted cubic spline (RCS) model was also conducted to investigate the potential linear relationship. Sub-group analyses were also conducted. Results: Totally, this study included 13,419 participants with 1085 BPH patients among them. The higher continuous CDAI value was significantly related to higher BPH risk (OR = 1.05, 95%CI: 1.02, 1.08). Besides, individuals with the highest quartile (Q4) CDAI possessed 1.87 times risk of BPH than the lowest quartile (Q1, OR = 1.87, 95%CI: 1.41, 2.50). The RCS curve also showed a positive linear dose-response relationship between CDAI and BPH (cut-off = -0.64). The P for interaction in any subgroup was > 0.05, indicating that the main outcome was not affected by other covariates. The limitation of this study was the lack of data on the relationship between CDAI and the severity of BPH symptoms. Conclusions: This study reveals that an elevated CDAI may be associated with a linear higher risk of BPH. We do not recommend intentional or excessive antioxidant diet to prevent BPH based on the current results. [ABSTRACT FROM AUTHOR]

Objectives CONTExT-RA is a cross-sectional, non-interventional multicentre study which enrolled patients diagnosed with RA and receiving DMARD treatment in a secondary care setting. The study evaluated disease control and associated disease burden amongst this Irish population. Methods Patients with RA attending six Irish rheumatology centres were invited to participate. Each consented patient attended a single routine study visit. Disease activity was assessed using Clinical Disease Activity Index (CDAI). The primary endpoint was EuroQol-5 dimensions (EQ-5D-5L) stratified by CDAI, compared using a non-parametric Wilcoxon Rank-Sum test. Results 130 patients were included. Using CDAI, 34 (26.2%) patients were in clinical remission (CR), 42 (32.3%) had low disease activity (LDA), 41 (31.5%) had moderate disease activity (MDA) and 13 (10.0%) had high disease activity (HDA). QoL (EQ-5D-5L index (median)) scores were significantly (P  < 0.001) greater for patients in CR or CR/LDA than for those with MDA/HDA, 0.866 (0.920), 0.777 (0.822) vs 0.578 (0.691), respectively. Patients in CR reported higher levels of work productivity, mean (s. d.) rating of 1.7 (2.52) vs those in MDA/HDA of 4.2 (3.28) (higher rating indicates greater impairment). Similar findings were observed for non-work-related activities. Conclusion Disease control for many patients with RA, treated in secondary care in Ireland, is sub-optimal with only 1 in 4 in CDAI remission. The impact of poor disease control on QoL is significant, and the superior outcomes for patients in CR provide compelling evidence that by achieving greater disease control, the burden of disease on patients can be greatly reduced. [ABSTRACT FROM AUTHOR]

Introduction: The use of infliximab to treat Crohn's disease patients has been evaluated for decades. The current work aimed to identify the historical roots of this research topic. Methods: The literature database Web of Science Core Collection was searched to identify relevant papers. Cited reference analysis on the identified literature set was performed using CRExplorer, a dedicated bibliometric software. The disruption index was computed with an automated routine described by Leydesdorff and Bornmann, which is freely available online. Based on data from citation count and reference list, the disruption index can range from −1 to +1, with −1 meaning a continuity from existing research and +1 meaning a disruption. Results: This analysis successfully identified key references dealing with infliximab use on Crohn's disease patients, such as the original report that introduced the Crohn's Disease Activity Index (CDAI) in 1976, the first case series reporting a favourable outcome of infliximab infusion on 10 patients published in 1995, the first randomized controlled trial published in 1997, the ACCENT I and ACCENT II trials published in 1999 and 2002, and a couple of European consensus guidelines on the diagnosis and management of Crohn's disease. Conclusion: Cited reference analysis could reveal the historical origins of the use of infliximab in treating Crohn's disease. Highly cited references included CDAI, important early clinical studies, and European consensus guidelines. The important cited references identified by the analysis provided solid foundation to support subsequent research. [ABSTRACT FROM AUTHOR]

Antioxidant-rich diets serve as protective factors in preventing obesity. The composite dietary antioxidant index (CDAI) represents a novel, comprehensive metric for assessing the antioxidant capacity of diets. Our objective is to investigate the relationship between the CDAI and obesity prevalence among adults in the United States. Dietary and anthropometric information about adults aged 20 years and older were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007–2018. The CDAI was derived from six dietary antioxidants. Obesity is defined as a body mass index (BMI, kg/m2) ≥ 30 kg/m2, and abdominal obesity as a waist circumference (WC, cm) ≥ 102 cm for men and ≥ 88 cm for women. The relationship between CDAI and obesity, including abdominal obesity, was analyzed using logistic regression and subgroup analyses. A total of 25,553 participants were analyzed. With higher tertiles of the CDAI, both obesity (41.28% vs. 38.62 vs. 35.09%, P < 0.001) and abdominal obesity (63.75% vs. 59.54 vs. 52.09%, P < 0.001) prevalence notably declined. Adjusting for multiple confounders, the CDAI was found to be independently linked to obesity (OR = 0.980, 95%CI = 0.971–0.989, P < 0.001) and abdominal obesity (OR = 0.972, 95%CI = 0.963–0.982, P < 0.001) risks. Subgroup analyses revealed a stronger relationship between CDAI and obesity in non-hypertensive individuals and a more significant association with abdominal obesity in women and those without hypertension. Our findings reveal a negative relationship between CDAI levels and both general and abdominal obesity. Additional extensive research is necessary to investigate CDAI's contribution to obesity. [ABSTRACT FROM AUTHOR]

Purpose: The Composite Dietary Antioxidant Index (CDAI) is a novel, inclusive measure for evaluating the antioxidant potential of diets. We aim to explore the link between the CDAI and abdominal aortic calcification (AAC) in U.S. adults aged ≥ 40 years. Methods: This cross-sectional study collected dietary and AAC data for individuals aged ≥ 40 years from the 2013–2014 National Health and Nutrition Examination Survey (NHANES) database. The CDAI was calculated using six dietary antioxidants. AAC was evaluated using a semi-quantitative scoring system known as AAC-24, with an AAC score greater than 6 as severe AAC (SAAC). To examine the association between CDAI and AAC, including SAAC, liner/logistic regression analyses and smooth curve fitting were applied. Results: A total of 2,640 participants were included in this study, and significant decreases in AAC score and SAAC prevalence were observed with ascending CDAI levels (P < 0.01). After adjusting for confounding factors, a clear link was established between the CDAI and both AAC score (β = -0.083, 95% CI -0.144–0.022, P = 0.008) and SAAC (OR = 0.883, 95% CI 0.806–0.968, P = 0.008), respectively. Further smooth curve fitting indicated a negative correlation between CDAI and both AAC score and SAAC. Conclusions: Dietary antioxidant consumption, as quantified by the CDAI, shows an inverse relationship with AAC risk. Additional longitudinal and intervention studies are essential. [ABSTRACT FROM AUTHOR]

Background: The timing of food intake can affect the physiological and metabolic functions of the body. However, whether and how the timing of dietary antioxidant intake could influence non-alcoholic fatty liver disease (NAFLD) is largely unknown. The Composite Dietary Antioxidant Index (CDAI) serves as a comprehensive measure that encompasses various dietary antioxidants. This study aims to investigate the association between the meal timing of CDAI and NAFLD in American adults. Methods: We used data from the 2017–2020 National Health and Nutrition Examination Survey (NHANES). Dietary intake was assessed through the implementation of two non-concurrent 24-h dietary recalls. Vibration-controlled transient elastography was employed to assess the controlled attenuation as an indicator of NAFLD. CDAI across the day (total, breakfast, lunch, dinner) and Δ CDAI (Δ = dinner-breakfast) were categorized into quartiles. Weighted logistic regression models and restricted cubic splines were used to evaluate the association between the meal timing of CDAI and NAFLD. Results: Of the 6570 participants in this study, 1153 had NAFLD. Participants in the highest quartile of total CDAI levels had a lower risk of NAFLD compared with the lowest quartile (OR = 0.52; 95% CI, 0.38–0.71). More importantly, participants in the highest quartile of dinner CDAI, but not those in that of breakfast or lunch, had a lower risk of NAFLD (OR = 0.54; 95% CI, 0.40–0.73) compared with the lowest quartile. The restricted cubic splines indicated a linear relationship between total CDAI and NAFLD (Pfor nonlinearity = 0.70), as well as between dinner CDAI and NAFLD (Pfor nonlinearity = 0.19). Stratification analyses revealed that the effect of dinner CDAI on NAFLD varied between non-Hispanic Whites and individuals of other races (Pfor interaction = 0.032). Conclusions: these findings suggest the potential beneficial effects of an antioxidant-rich diet and strategic meal timing on NAFLD. [ABSTRACT FROM AUTHOR]

Abstract Background Individual antioxidants may not fully capture the comprehensive antioxidant intake from an individual’s diet. This study utilizes the Complex Dietary Antioxidant Index (CDAI) to evaluate the combined effects of various dietary antioxidants in the diet. The goal is to investigate the relationship between CDAI and the incidence of erectile dysfunction (ED), offering insights for dietary guidelines and intervention strategies aimed at mitigating the burden of ED. Methods This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) database in the years 2001–2004. We employed a weighted multivariate logistic regression model to validate the relationship between CDAI and ED. Subgroup analyses were conducted to explore the correlation between CDAI and ED across different subgroups. Additionally, we used propensity score matching (PSM) to adjust for several key confounding variables, enhancing the robustness of the results. Results In the fully adjusted multivariate logistic regression model for confounding variables, CDAI is negatively correlated with the risk of ED (OR = 0.95, 95% CI: 0.92–0.99, P = 0.005). When CDAI is transformed into a categorical variable based on quartiles, Q3 (OR = 0.73, 95% CI: 0.53–0.99, P = 0.040) and Q4 (OR = 0.70, 95% CI: 0.51–0.96, P = 0.026) show a negative correlation with the risk of ED. Subgroup analysis reveals no significant interaction. After adjusting for major confounding variables through PSM, the association between CDAI and reduced risk of ED remains significant. Conclusion In our study cohort, there is an association between CDAI and a reduced risk of ED, and further research is needed to validate and refine this conclusion.

Abstract Antioxidant-rich diets serve as protective factors in preventing obesity. The composite dietary antioxidant index (CDAI) represents a novel, comprehensive metric for assessing the antioxidant capacity of diets. Our objective is to investigate the relationship between the CDAI and obesity prevalence among adults in the United States. Dietary and anthropometric information about adults aged 20 years and older were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007–2018. The CDAI was derived from six dietary antioxidants. Obesity is defined as a body mass index (BMI, kg/m2) ≥ 30 kg/m2, and abdominal obesity as a waist circumference (WC, cm) ≥ 102 cm for men and ≥ 88 cm for women. The relationship between CDAI and obesity, including abdominal obesity, was analyzed using logistic regression and subgroup analyses. A total of 25,553 participants were analyzed. With higher tertiles of the CDAI, both obesity (41.28% vs. 38.62 vs. 35.09%, P

Abstract Purpose The Composite Dietary Antioxidant Index (CDAI) is a novel, inclusive measure for evaluating the antioxidant potential of diets. We aim to explore the link between the CDAI and abdominal aortic calcification (AAC) in U.S. adults aged ≥ 40 years. Methods This cross-sectional study collected dietary and AAC data for individuals aged ≥ 40 years from the 2013–2014 National Health and Nutrition Examination Survey (NHANES) database. The CDAI was calculated using six dietary antioxidants. AAC was evaluated using a semi-quantitative scoring system known as AAC-24, with an AAC score greater than 6 as severe AAC (SAAC). To examine the association between CDAI and AAC, including SAAC, liner/logistic regression analyses and smooth curve fitting were applied. Results A total of 2,640 participants were included in this study, and significant decreases in AAC score and SAAC prevalence were observed with ascending CDAI levels (P

Abstract Background The use of antioxidant-rich foods to treat female infertility has received significant attention in recent years. The aim of this study was to investigate the potential correlation between the composite dietary antioxidant index (CDAI) and female infertility. Methods The participants in the cross-sectional data were women between the ages of 20 and 45 who had complete CDAI-related data and infertility information, which were taken from the National Health and Nutrition Examination Survey (NHANES) conducted between 2013 and 2020. The independent association between CDAI and infertility was investigated using multivariate logistic regression analysis. Trends between the two variables were examined using smoothed curve fitting, and subgroup analysis and interaction tests were conducted. Results The prevalence of infertility was 12.57% of the 3,259 participants included in the study; individuals in higher CDAI quartiles tended to have a lower percentage of infertility. The risk of infertility was 44% lower among individuals in the highest quartile of the CDAI compared to those in the lowest quartile (OR = 0.56, 95%CI: 0.36–0.85, P = 0.0072), and the test for trend was also significant (P for trend = 0.0235). Smoothed curve fitting showed a negative non-linear relationship between CDAI and infertility. Subgroup analysis and interaction tests showed that there was an interaction of BMI in the relationship between CDAI and infertility risk (P for interaction = 0.0497) and that education, PIR, marital status, smoking status, hypertension, diabetes, age at menarche, ever having been treated for pelvic infection, ever having used female hormones, and ever been pregnant had no significant dependence on this negative association (all P for interaction > 0.05). Conclusion There was a negative non-linear correlation between CDAI and infertility among reproductive-aged women in the US. The risk of infertility may be reduced by increasing the intake of antioxidant-rich foods.

Abstract Background Although the relationship between oxidative stress and insulin resistance (IR) has been established, the associations of the composite dietary antioxidant index (CDAI) and its components with the surrogate index of insulin resistance (IR), triglyceride-glucose index (TyG), is still not clear. Methods This study analyzed the cross-sectional data of the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2018. Multivariate linear regression, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) were used to analyze the associations of the CDAI and its components with the TyG. In addition, subgroup analysis and several sensitivity analyses were conducted. Results A total of 14,673 participants with complete data were included, with a median age of 50 years and 7,257 women (49%). Multivariate linear regression showed that after full adjustment, the CDAI was significantly negatively associated with the TyG [β: -0.005, 95% CI: (-0.008, -0.002), p = 0.002]. The model in which six nutrients were mutually corrected showed that vitamin E (per-SD increase) was most strongly associated with the TyG [β: -0.062, 95% CI: (-0.074, -0.050), p

Background: The use of antioxidant-rich foods to treat female infertility has received significant attention in recent years. The aim of this study was to investigate the potential correlation between the composite dietary antioxidant index (CDAI) and female infertility. Methods: The participants in the cross-sectional data were women between the ages of 20 and 45 who had complete CDAI-related data and infertility information, which were taken from the National Health and Nutrition Examination Survey (NHANES) conducted between 2013 and 2020. The independent association between CDAI and infertility was investigated using multivariate logistic regression analysis. Trends between the two variables were examined using smoothed curve fitting, and subgroup analysis and interaction tests were conducted. Results: The prevalence of infertility was 12.57% of the 3,259 participants included in the study; individuals in higher CDAI quartiles tended to have a lower percentage of infertility. The risk of infertility was 44% lower among individuals in the highest quartile of the CDAI compared to those in the lowest quartile (OR = 0.56, 95%CI: 0.36–0.85, P = 0.0072), and the test for trend was also significant (P for trend = 0.0235). Smoothed curve fitting showed a negative non-linear relationship between CDAI and infertility. Subgroup analysis and interaction tests showed that there was an interaction of BMI in the relationship between CDAI and infertility risk (P for interaction = 0.0497) and that education, PIR, marital status, smoking status, hypertension, diabetes, age at menarche, ever having been treated for pelvic infection, ever having used female hormones, and ever been pregnant had no significant dependence on this negative association (all P for interaction > 0.05). Conclusion: There was a negative non-linear correlation between CDAI and infertility among reproductive-aged women in the US. The risk of infertility may be reduced by increasing the intake of antioxidant-rich foods. [ABSTRACT FROM AUTHOR]

Background: Although the relationship between oxidative stress and insulin resistance (IR) has been established, the associations of the composite dietary antioxidant index (CDAI) and its components with the surrogate index of insulin resistance (IR), triglyceride-glucose index (TyG), is still not clear. Methods: This study analyzed the cross-sectional data of the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2018. Multivariate linear regression, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) were used to analyze the associations of the CDAI and its components with the TyG. In addition, subgroup analysis and several sensitivity analyses were conducted. Results: A total of 14,673 participants with complete data were included, with a median age of 50 years and 7,257 women (49%). Multivariate linear regression showed that after full adjustment, the CDAI was significantly negatively associated with the TyG [β: -0.005, 95% CI: (-0.008, -0.002), p = 0.002]. The model in which six nutrients were mutually corrected showed that vitamin E (per-SD increase) was most strongly associated with the TyG [β: -0.062, 95% CI: (-0.074, -0.050), p < 0.0001]. In the WQS model, the WQS index of the antioxidant diet was negatively associated with the TyG (β: -0.060; P < 0.0001). Similar effects were observed in the BKMR analysis. Notably, in the WQS and BKMR models, vitamin E became the most influential component. In addition, in the subgroup analysis, the association between the CDAI and the TyG in overweight or obese and diabetic populations was significantly weaker. Conclusion: Antioxidant diets, especially vitamin E, are significantly negatively correlated with TyG. This study emphasizes the important value of supplementing vitamin E to improve IR. However, patients with poor weight management and diabetes seem to benefit less from antioxidant diets. [ABSTRACT FROM AUTHOR]

IntroductionThe use of infliximab to treat Crohn’s disease patients has been evaluated for decades. The current work aimed to identify the historical roots of this research topic.MethodsThe literature database Web of Science Core Collection was searched to identify relevant papers. Cited reference analysis on the identified literature set was performed using CRExplorer, a dedicated bibliometric software. The disruption index was computed with an automated routine described by Leydesdorff and Bornmann, which is freely available online. Based on data from citation count and reference list, the disruption index can range from −1 to +1, with −1 meaning a continuity from existing research and +1 meaning a disruption.ResultsThis analysis successfully identified key references dealing with infliximab use on Crohn’s disease patients, such as the original report that introduced the Crohn’s Disease Activity Index (CDAI) in 1976, the first case series reporting a favourable outcome of infliximab infusion on 10 patients published in 1995, the first randomized controlled trial published in 1997, the ACCENT I and ACCENT II trials published in 1999 and 2002, and a couple of European consensus guidelines on the diagnosis and management of Crohn’s disease.ConclusionCited reference analysis could reveal the historical origins of the use of infliximab in treating Crohn’s disease. Highly cited references included CDAI, important early clinical studies, and European consensus guidelines. The important cited references identified by the analysis provided solid foundation to support subsequent research.

BackgroundThe potential beneficial health effects of dietary antioxidants have been reported. However, the association of a composite dietary antioxidant index (CDAI) with fatty liver index (FLI) remains unclear. This study aims to assess whether CDAI (including its components) is associated with FLI among US adults.MethodsThis population-based cross-sectional study used data on US adults from the National Health and Nutrition Examination Survey (NHANES) 2007–2018 cycles. Weighted generalized linear regression models were used to analyze the association between CDAI (including vitamin A, C, E, zinc, selenium, and carotenoids) and FLI, which was calculated by using body mass index (BMI), waist circumference and levels of γ-glutamyl transferase and triglycerides.ResultsWeighted generalized linear regression models showed an inverse association between CDAI and FLI in the total population (β, −0.40; 95% CI, −0.59, −0.21), in women (β, −0.56; 95% CI, −0.94, −0.18), and in men (β, −0.32; 95% CI, −0.54, −0.10) after adjusting for various confounders. The restricted cubic splines showed the negative linear dose–response associations between CDAI and FLI (all P non_linear >0.05). The dietary selenium intake in women has an inverse U-shaped relationship with FLI, with an inflection point value of 110 μg. In model 3, intake of dietary antioxidants Vitamins A, C, E, and carotenoids were significantly negatively associated with FLI in female but only were vitamins A and E negatively associated with FLI in male. In subgroup analysis, CDAI showed a significantly negative relation to FLI among those aged 60 years or older (β, −0.57; 95% CI, −0.81, −0.33), among those who engaged in active physical activity (β, −0.46; 95% CI, −0.63, −0.29), among those without metabolic syndrome (β, −0.43; 95% CI, −0.62, −0.24), and those without hyperuricemia (β, −0.43; 95% CI, −0.60, −0.26). Additionally, CDAI was significantly negatively associated with male FLI, regardless of whether they had diabetes or not.ConclusionIn conclusion, our results indicate that higher CDAI may be associated with a lower FLI.

BackgroundThe relationship between CDAI and suicidal ideation is unclear. This study investigates the relationship between CDAI and suicidal ideation and examines the association between CDAI and all-cause mortality (ACM) or cardiovascular disease mortality (CVM) among participants with and without suicidal ideation.MethodsData from seven NHANES cycles (2005–2018) were analyzed using cross-sectional and prospective cohort studies. Weighted multivariable logistic regression models, restricted cubic spline (RCS) plots, and subgroup analyses explored the association between CDAI and suicidal ideation. Kaplan–Meier (KM) curves, weighted multivariable Cox proportional hazards models, and RCS assessed the relationship between CDAI and CVM or ACM.ResultsAmong 30,976 participants aged over 20, 1,154 (3.72%) had suicidal ideation. Higher CDAI levels (Quartile 4) were associated with a 28% reduction in suicidal ideation compared to lower levels (Quartile 1). Over an average follow-up of 89 months, 3,267 participants (7.6%) died, including 808 (1.8%) from cardiovascular causes. Higher CDAI levels were linked to a 30, 68, and 28% reduction in ACM in the total population, those with suicidal ideation, and those without, respectively. CVM was reduced by 40% in the total population and by 41% in those without suicidal ideation.ConclusionCDAI is negatively associated with suicidal ideation and correlated with reduced ACM and CVM among participants with and without suicidal ideation.

Abstract Current research has shown an increasing acceptance of interventions for depression through dietary modifications. However, whether composite dietary antioxidant index (CDAI) is associated with depression and all-cause mortality in middle-aged and elderly population remains unknown. This study aimed to explore those associations in American middle-aged and elderly population. Weighted logistic regression models and weighted Cox proportional hazard regression models were used to assess the association of CDAI, covariates, depression, and all-cause mortality, respectively. The stability of the results was also determined by a linear trend test based on CDAI quintiles. Restricted cubic spline curves were employed to test for non-linear relationships. In the model adjusted for all covariates, significant associations were found with the ORs (95% CI) for CDAI and depression [0.77 (0.67, 0.89)] and the HRs (95% CI) for CDAI with all-cause mortality[0.91 (0.83, 1.00)]. Upon conducting restricted cubic spline curves, we found that the association between CDAI and depression was linear, whereas the association between CDAI and all-cause mortality was non-linear with an inflection point of -0.19. Statistical significance was only found before the inflection point. In this study of middle-aged and elderly Americans, CDAI was linearly negatively associated with depression and non-linearly negatively associated with all-cause mortality.

Current research has shown an increasing acceptance of interventions for depression through dietary modifications. However, whether composite dietary antioxidant index (CDAI) is associated with depression and all-cause mortality in middle-aged and elderly population remains unknown. This study aimed to explore those associations in American middle-aged and elderly population. Weighted logistic regression models and weighted Cox proportional hazard regression models were used to assess the association of CDAI, covariates, depression, and all-cause mortality, respectively. The stability of the results was also determined by a linear trend test based on CDAI quintiles. Restricted cubic spline curves were employed to test for non-linear relationships. In the model adjusted for all covariates, significant associations were found with the ORs (95% CI) for CDAI and depression [0.77 (0.67, 0.89)] and the HRs (95% CI) for CDAI with all-cause mortality[0.91 (0.83, 1.00)]. Upon conducting restricted cubic spline curves, we found that the association between CDAI and depression was linear, whereas the association between CDAI and all-cause mortality was non-linear with an inflection point of -0.19. Statistical significance was only found before the inflection point. In this study of middle-aged and elderly Americans, CDAI was linearly negatively associated with depression and non-linearly negatively associated with all-cause mortality. [ABSTRACT FROM AUTHOR]

Yue Wu,1 Siqi Cheng,1 Shaoyuan Lei,2 Dongxiao Li,3 Zhongzhong Li,4 Yansu Guo1,2,5 1Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Department of Neurology, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, People’s Republic of China; 4Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China; 5Beijing Municipal Geriatric Medical Research Center, Beijing, People’s Republic of ChinaCorrespondence: Yansu Guo, Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Changchun Street 45, Beijing, People’s Republic of China, Email gys188@163.comBackground: There is growing evidence that an antioxidant diet is a protective factor against frailty. However, few studies have examined the effect of comprehensive dietary antioxidants on frailty symptoms. The aim of this study was to examine the relationships between the composite dietary antioxidant index (CDAI) and frailty and the underlying mechanisms involved.Methods: Based on the National Health and Nutrition Survey (NHANES) 2003– 2018, this study included 11,277 older persons aged ≥ 60 years. In this study, frailty was defined as having a total score > 0.21 on the 49-item frailty index. Six dietary antioxidants were selected for use in calculating the CDAI. A weighted multiple logistic regression model with subgroup analysis and restricted cubic splines (RCSs) were used to examine the association between the CDAI and frailty. To examine the role of oxidative stress, mediation analyses were also conducted.Results: The association between the CDAI score and frailty risk was significant according to the multivariate model. Compared with participants in tertile 1, participants in both tertile 2 and tertile 3 had lower odds of developing frailty symptoms (OR=0.86; 95% CI=0.75– 0.97; P=0.02; and OR=0.81; 95% CI=0.70– 0.93; P=0.003). According to the subgroup analyses, the differences in interactions were not statistically significant. There was also a potential nonlinear relationship between the CDAI score and frailty risk. The serum albumin concentration and uric acid concentration had significant mediating effects on the association between the CDAI score and frailty index, with 19.25% (P=0.002) and 21.26% (P < 0.001) of the total, respectively.Conclusion: Frailty is negatively associated with the CDAI score, which may be partially mediated by oxidative stress.Keywords: frailty, CDAI, NHANES, elderly adults

Background: There is a growing acknowledgment of the potential influence of antioxidative effects resulting from dietary decisions on the occurrence of stroke. The objective of this study was to elucidate the correlation between the composite dietary antioxidant index (CDAI) and the incidence of stroke in the general population of the United States. Methods: We gathered cross-sectional data encompassing 40,320 participants from the National Health and Nutrition Examination Survey (NHANES) spanning the years 1999 to 2018. Employing weighted multivariate logistic regression, we assessed the correlation between CDAI and stroke, while also investigating potential nonlinear relationships through restricted cubic spline (RCS) regression. Further, the intake of CDAI components were then incorporated into a predictive nomogram model, subsequently evaluated for its discriminatory prowess in stroke risk assessment using the receiver operating characteristic (ROC) curve. Results: Post-adjustment for confounding variables, we found that higher CDAI score were associated with a decreased risk of stroke, the odds ratio (OR) [95% CI] of CDAI associating with prevalence was 0.96 [0.94-0.98] (P< 0.001). Moreover, the adjusted OR [95% CI] for stroke across ascending CDAI quartiles stood at 0.90 [0.74-1.09], 0.74 [0.60-0.91], and 0.61 [0.50-0.76] compared to the reference quartile, respectively. The RCS analysis indicated a nonlinear yet negative correlation between CDAI and stroke. The nomogram model, constructed based the intake of antioxidants, exhibited a significant predictive capacity for stroke risk, boasting an area under the curve (AUC) of 77.4% (76.3%-78.5%). Conclusion: Our investigation ascertained a nonlinear negative relationship between CDAI and stroke within the broader American population. However, given the inherent limitations of the cross-sectional design, further comprehensive research is imperative to establish the causative nature of this association. [ABSTRACT FROM AUTHOR]

ObjectiveThe objective of this study is to assess the correlation between composite dietary antioxidant index (CDAI) with all-cause mortality and cause-specific mortality in adults with hypertension.MethodsThe cohort study comprised adult participants with hypertension from the NHANES database, spanning 9 cycles from 2001 to 2018. Follow-up was conducted until December 31, 2019. Multi-variable Cox regression analysis was utilized to ascertain hazard ratios (HR) and their corresponding 95% confidence intervals, evaluating the relationship between CDAI and the risks of all-cause and cause-specific mortality. To further investigate the association between CDAI and mortality rates in adults with hypertension, Kaplan–Meier survival curves, restricted cubic splines (RCS), subgroup analyses and sensitivity analyses were employed.ResultsThe analysis included 16,713 adults with hypertension (mean age 56.93 ± 0.23 years, 8,327 [49.61%] male). During the mean follow-up time 102.11 ± 1.22 months, with 3,908 (18.08%) all-cause mortality occurred, 1,082 (4.84%) cardiovascular mortality and 833 (3.80%) cancer mortality. Compared to the lowest quartile of CDAI, the weighted multivariate hazard ratios of participants in the highest quartile was 0.77 (95% CI, 0.68–0.87) for all-cause mortality, 0.83 (95% CI, 0.67–1.04) for cardiovascular mortality, and 0.64 (95% CI, 0.50–0.82) for cancer mortality. RCS analysis demonstrated a nonlinear association of CDAI with all-cause and cancer mortality, and a linear association between CDAI and cardiovascular mortality. The results were robust in subgroup analyses and sensitivity analyses.ConclusionHigher CDAI is associated with reduced all-cause mortality, cardiovascular mortality, and cancer mortality in hypertensive adults. Our findings highlight the importance of an antioxidant diet in improving outcomes in adults with hypertension.

BackgroundThe dietary inflammatory index (DII) and composite dietary antioxidant index (CDAI) were developed as tools for use when seeking to assess the potential inflammatory and antioxidant activity of a given diet, respectively. The associations between these indices and gallstone incidence remain largely unexplored.ObjectiveThe present study sought to clarify how both the DII and the CDAI are related to gallstone incidence and age at first gallbladder surgery among adults in the USA.MethodsCross-sectional data from the 2017–2020 cycles of the National Health and Nutrition Examination Survey (NHANES) pertaining to 12,426 individuals were used to conduct the present study. Data from 2 days with 24-h dietary recall were employed when calculating DII and CDAI scores. Relationships between dietary indices and the incidence of gallstones were assessed through logistic regression analyses, while linear regression analyses were employed to characterize how these indices are associated with the age at first gallbladder surgery.ResultsHigher DII scores and lower CDAI scores, which, respectively, denote diets with greater inflammatory potential and reduced antioxidant potential, were found to be associated with higher gallstone incidence even following adjustment for potential confounding factors. Smooth curve fitting suggested that the association between DII and gallstones was nearly linear, whereas that between CDAI and gallstone incidence was nonlinear. Higher DII values were also related to first gallbladder surgery at an earlier age (β = −0.64, 95% CI: −1.26, −0.02).ConclusionThese results emphasize the benefits of anti-inflammatory diets rich in antioxidants, which may help reduce gallstone incidence among adults in the USA. Higher DII scores may also predict the need for gallbladder surgery at a younger age.

Abstract Background The Composite Dietary Antioxidant Index (CDAI) is a dietary antioxidant score that plays a protective role in many diseases, including depression, osteoporosis, papillomavirus infection, etc. However, the association between CDAI and coronary heart disease (CHD) is currently unclear. We aim to explore the correlations between CDAI and the risk of CHD. Methods Eligible participants were obtained from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. All participants in this cross-sectional study are required to undergo two separate 24-h dietary recall interviews. Average daily intakes of dietary antioxidants were used to calculate CDAI. CHD status was determined through a questionnaire. Weighted multiple logistic regression models were used to evaluate the relationship between CDAI and CHD. Moreover, we also used restricted cubic spline to explore Non-linear correlations. Sensitivity analysis using unweighted logistic analysis and subgroup analysis were used to demonstrate the stability of the results. Results A total of 34,699 participants were eligible for analysis.Compared to the participants without CHD, the participants with CHD showed lower levels of CDAI. After adjusting confounding factors in the multivariate weighted logistic regression model, CDAI was inversely associated with CHD (Q4 vs. Q1, OR = 0.65 (0.51–0.82, P

Background. Regular assessment of rheumatoid arthritis (RA) activity is a key factor in therapy effectiveness improving. Aim. To prove that timely RA treatment control recommended by modern guidelines improves outcomes and reduce disability in real clinical practice. Materials and methods. Fourty patients with RA hospitalized at the University Clinical Hospital from January 2021 to January 2023 were included into a retrospective single-center study and divided into 2 groups. In the first group, RA activity was monitored after 3, 6, and 12 months, with therapy adjusted if necessary. In the second group, monitoring of RA activity was carried out after 12 months. The patients underwent clinical, laboratory and instrumental examinations (Tender Joint Count (TJC) and Swollen Joint Count (SJC), common blood test with differential white blood cell count, ESR, biochemical blood test, CRP, RF, ACCP, hands, feet and chest X-ray, ECG). RA activity was assessed using DAS28, CDAI, SDAI indices in both groups. Results. RA activity control after 12 months in patients of the first group regularly observed by a rheumatologist was better than in patients of the second group, who visited rheumatologist again only in 12 months. DAS28 decreased significantly, from 4.71±0.80 to 3.08±0.70 in the group with regular monitoring during the observation period. Remission or low activity was achieved by 75% of patients (5% remission and 70% low activity). Less dynamics was registered in patients of the second group: the initial DAS28 was 4.50±0.74, DAS28 after 12 months was 4.36±0.64, which corresponds to moderate activity. Low activity was achieved in 15% of patients, remission was not achieved in any patient. Conclusion. Strict adherence to the recommended terms for disease activity monitoring is necessary for successful RA treatment in real clinical practice.

Abstract Background Mucosal healing has become the primary treatment target for patients with Crohn’s disease (CD). We aimed to develop a noninvasive and convenient tool to evaluate the endoscopic activity in patients with ileocolic CD. Methods A retrospective multicenter study including 300 CD patients (training, 210 patients; test, 90 patients) was conducted at two tertiary referral centers. Independent risk factors associated with endoscopic activity were explored, which were then combined into a comprehensive index. The predictive performance was evaluated with the area under receiver operating characteristic curve (ROC). Cohen’s Kappa was adopted to examine the consistency between each indicator and endoscopic activity. Results A total of 210 CD patients were recruited in the training cohort. We found that Crohn’s Disease Activity Index (CDAI), C-reactive protein (CRP) and platelet-to-lymphocyte percentage ratio (PLpR) were independently associated with endoscopic activity. Additionally, the comprehensive index generated from the above three indices achieved good discrimination and performed better than CDAI in AUC (0.849 vs. 0.769, P

BackgroundThere is growing evidence that antioxidant-rich diets may prevent hyperlipidemia. However, the relationship between the Composite Dietary Antioxidant Index (CDAI) and hyperlipidemia is unclear. The CDAI is a composite score reflecting the antioxidant content of an individual’s diet, and this study aimed to investigate the relationship between CDAI and hyperlipidemia.MethodsThe study used the 2003–2018 National Health and Nutrition Examination Survey (NHANES) database for cross-sectional analyses and included 27,626 participants aged 20 years and older. The CDAI, which includes vitamins A, C, and E, zinc, selenium, and carotenoids, was calculated based on dietary intake reported in a 24-h recall interview. Hyperlipidemia was defined by the National Cholesterol Education Program (NCEP). Covariates included age, sex, race, education, marriage, household poverty-to-income ratio (PIR), glomerular filtration rate (eGFR), body mass index (BMI), energy, carbohydrates, total fat, cholesterol, smoking, alcohol consumption, hypertension, diabetes mellitus, coronary heart disease, and lipid-lowering medications. The association between CDAI and hyperlipidemia was explored through multiple logistic regression analyses and smoothed curve fitting. We also performed subgroup analyses and interaction tests to verify the relationship’s stability.ResultsAfter adjusting for potential confounders, CDAI was negatively associated with the risk of developing hyperlipidemia (OR 0.98, 95% CI 0.96–0.99, p

ObjectiveAtherosclerosis is a significant cause of cardiovascular and cerebrovascular diseases, with a greater impact on men than women. Dietary antioxidant intake is inversely related to the risk of atherosclerosis development. We aimed to investigate the association between dietary composite antioxidant intake and the ankle brachial pressure index (ABPI). The ABPI is not only used for assessing the progression of arterial lesions but also for stratifying the risk of atherosclerotic disease.MethodsWe conducted a cross-sectional analysis involving 1,049 participants from the National Health and Nutrition Examination Survey (NHANES). We examined six antioxidants (zinc, selenium, carotenoids, and vitamins A, C, and E) and a composite dietary antioxidant index (CDAI) derived from these antioxidants as exposure variables. The primary outcomes encompassed cardio-metabolic parameters, including body mass index (BMI), body fat mass (BFM), systolic and diastolic blood pressure, triglycerides, HDL and LDL cholesterol, C-reactive protein, and the Ankle-Brachial Pressure Index (ABPI). Associations and interactions between variables were assessed using linear regression analyses. Moreover, mediation and moderation analysis is employed.ResultsHierarchical multiple regression analysis revealed that among men, dietary intake of zinc, selenium, and vitamin A remained positively associated with a higher ABPI even after adjusting for covariates. Conversely, in the stratified regression analysis based on CDAI quartiles, a U-shaped association between CDAI and ABPI was suggested. Notably, no significant association between dietary antioxidant intake and ABPI was observed among women. CDAI, intake of Vitamin A, Vitamin C, and Vitamin E do not influence all-cause death through mediation by abpi, but rather have a direct effect on all-cause death. Moreover, there is a significant interaction between the intake of Vitamin A and gender, where a daily intake of Vitamin A more than 776 ug is especially beneficial for women.ConclusionThe combined intake of nutrients with antioxidant properties may prevent the initiation and progression of atherosclerosis and influence the outcome in a sex-specific manner.

Background: The Composite Dietary Antioxidant Index (CDAI) is a dietary antioxidant score that plays a protective role in many diseases, including depression, osteoporosis, papillomavirus infection, etc. However, the association between CDAI and coronary heart disease (CHD) is currently unclear. We aim to explore the correlations between CDAI and the risk of CHD. Methods: Eligible participants were obtained from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. All participants in this cross-sectional study are required to undergo two separate 24-h dietary recall interviews. Average daily intakes of dietary antioxidants were used to calculate CDAI. CHD status was determined through a questionnaire. Weighted multiple logistic regression models were used to evaluate the relationship between CDAI and CHD. Moreover, we also used restricted cubic spline to explore Non-linear correlations. Sensitivity analysis using unweighted logistic analysis and subgroup analysis were used to demonstrate the stability of the results. Results: A total of 34,699 participants were eligible for analysis.Compared to the participants without CHD, the participants with CHD showed lower levels of CDAI. After adjusting confounding factors in the multivariate weighted logistic regression model, CDAI was inversely associated with CHD (Q4 vs. Q1, OR = 0.65 (0.51–0.82, P < 0.001). Restricted cubic spline showed that there was a negative non-linear correlation (L-shaped) between CDAI and CHD, suggesting a potential saturation effect at higher CDAI levels, with the inflection point of 0.16. Sensitivity analysis showed that the results were stable. No significant statistically interaction was showed in subgroup analysis. Conclusions: There was a negative non-linear correlation between CDAI and CHD in US adults. However, further prospective studies are still needed to reveal their relationship. [ABSTRACT FROM AUTHOR]

Abstract To investigate the associations of composite dietary antioxidant index (CDAI) with risk of cardiovascular disease (CVD) mortality among individuals with type 2 diabetes (T2D). This prospective cohort study included 7551 patients with T2D who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 through 2018. Death statistics were gathered by connecting the cohort database to the National Death Index through December 31, 2019. Multivariable Cox proportional hazards regression models were utilized to calculate hazard ratios and 95% CIs for the relationship of CDAI with risks of CVD and all-cause mortality. Three multivariable models were built. Restricted cubic spline analyses were utilized to explore the nonlinear association of CDAI with CVD mortality, and nonlinearity was tested by the likelihood ratio test. This cohort study included data from 7551 participants with T2D (mean [SE] age, 61.4 (0.2) years; 3811 male [weighted, 50.5%] and 3740 female [weighted, 49.5%]; median CDAI level, − 2.19 [IQR, − 2.19 ~ − 0.22]). A total of 2227 all-cause deaths and 746 CVD deaths were identified during an average of 98 months of follow-up. Nonlinear associations were observed for CDAI (P

Abstract Introduction Clinical trial findings may not be generalizable to routine practice. This study evaluated sarilumab effectiveness in patients with rheumatoid arthritis (RA) and tested the real-world applicability of a response prediction rule, derived from trial data using machine learning (based on C-reactive protein [CRP] > 12.3 mg/l and seropositivity [anticyclic citrullinated peptide antibodies, ACPA +]). Methods Sarilumab initiators from the ACR-RISE Registry, with ≥ 1 prescription on/after its FDA approval (2017–2020), were divided into three cohorts based on progressively restrictive criteria: Cohort A (had active disease), Cohort B (met eligibility criteria of a phase 3 trial in RA patients with inadequate response/intolerance to tumor necrosis factor inhibitors [TNFi]), and Cohort C (characteristics matched to the phase 3 trial baseline). Mean changes in Clinical Disease Activity Index (CDAI) and Routine Assessment of Patient Index Data 3 (RAPID3) were evaluated at 6 and 12 months. In a separate cohort, predictive rule was tested based on CRP levels and seropositive status (ACPA and/or rheumatoid factor); patients were categorized into rule-positive (seropositive with CRP > 12.3 mg/l) and rule-negative groups to compare the odds of achieving CDAI low disease activity (LDA)/remission and minimal clinically important difference (MCID) over 24 weeks. Results Among sarilumab initiators (N = 2949), treatment effectiveness was noted across cohorts, with greater improvement noted for Cohort C at 6 and 12 months. Among the predictive rule cohort (N = 205), rule-positive (vs. rule-negative) patients were more likely to reach LDA (odds ratio: 1.5 [0.7, 3.2]) and MCID (1.1 [0.5, 2.4]). Sensitivity analyses (CRP > 5 mg/l) showed better response to sarilumab in rule-positive patients. Conclusions In real-world setting, sarilumab demonstrated treatment effectiveness, with greater improvements in the most selective population, mirroring phase 3 TNFi-refractory and rule-positive RA patients. Seropositivity appeared a stronger driver for treatment response than CRP, although optimization of the rule in routine practice requires further data.

Background: Mucosal healing has become the primary treatment target for patients with Crohn's disease (CD). We aimed to develop a noninvasive and convenient tool to evaluate the endoscopic activity in patients with ileocolic CD. Methods: A retrospective multicenter study including 300 CD patients (training, 210 patients; test, 90 patients) was conducted at two tertiary referral centers. Independent risk factors associated with endoscopic activity were explored, which were then combined into a comprehensive index. The predictive performance was evaluated with the area under receiver operating characteristic curve (ROC). Cohen's Kappa was adopted to examine the consistency between each indicator and endoscopic activity. Results: A total of 210 CD patients were recruited in the training cohort. We found that Crohn's Disease Activity Index (CDAI), C-reactive protein (CRP) and platelet-to-lymphocyte percentage ratio (PLpR) were independently associated with endoscopic activity. Additionally, the comprehensive index generated from the above three indices achieved good discrimination and performed better than CDAI in AUC (0.849 vs. 0.769, P < 0.05). This was further well demonstrated by the external test cohort, which showed good discrimination (AUC: 0.84, 95% CI: 0.744–0.936). Intra-individual comparison revealed the comprehensive index to be superior in the prediction of endoscopic activity. In the subgroup analysis, the AUC of comprehensive index was significantly higher than CDAI especially in inflammatory phenotype (0.824 vs. 0.751, P < 0.05). Conclusion: Combining CDAI, CRP and PLpR significantly improved the accuracy for predicting endoscopic activity in ileocolic CD, which can help better monitor an endoscopic flare. [ABSTRACT FROM AUTHOR]

Introduction: Clinical trial findings may not be generalizable to routine practice. This study evaluated sarilumab effectiveness in patients with rheumatoid arthritis (RA) and tested the real-world applicability of a response prediction rule, derived from trial data using machine learning (based on C-reactive protein [CRP] > 12.3 mg/l and seropositivity [anticyclic citrullinated peptide antibodies, ACPA +]). Methods: Sarilumab initiators from the ACR-RISE Registry, with ≥ 1 prescription on/after its FDA approval (2017–2020), were divided into three cohorts based on progressively restrictive criteria: Cohort A (had active disease), Cohort B (met eligibility criteria of a phase 3 trial in RA patients with inadequate response/intolerance to tumor necrosis factor inhibitors [TNFi]), and Cohort C (characteristics matched to the phase 3 trial baseline). Mean changes in Clinical Disease Activity Index (CDAI) and Routine Assessment of Patient Index Data 3 (RAPID3) were evaluated at 6 and 12 months. In a separate cohort, predictive rule was tested based on CRP levels and seropositive status (ACPA and/or rheumatoid factor); patients were categorized into rule-positive (seropositive with CRP > 12.3 mg/l) and rule-negative groups to compare the odds of achieving CDAI low disease activity (LDA)/remission and minimal clinically important difference (MCID) over 24 weeks. Results: Among sarilumab initiators (N = 2949), treatment effectiveness was noted across cohorts, with greater improvement noted for Cohort C at 6 and 12 months. Among the predictive rule cohort (N = 205), rule-positive (vs. rule-negative) patients were more likely to reach LDA (odds ratio: 1.5 [0.7, 3.2]) and MCID (1.1 [0.5, 2.4]). Sensitivity analyses (CRP > 5 mg/l) showed better response to sarilumab in rule-positive patients. Conclusions: In real-world setting, sarilumab demonstrated treatment effectiveness, with greater improvements in the most selective population, mirroring phase 3 TNFi-refractory and rule-positive RA patients. Seropositivity appeared a stronger driver for treatment response than CRP, although optimization of the rule in routine practice requires further data. Plain Language Summary: Rheumatoid arthritis (RA) is a condition that may cause joint damage, if untreated. Sarilumab is an advanced medication, approved for treating moderate-to-severe RA in patients not responding to initial standard medicines. Clinical trials have shown that sarilumab improves RA symptoms; however, some people do not respond. This is a common problem in RA treatment. Physicians measure proteins in people's blood (called biomarkers; e.g., anticyclic citrullinated peptide antibodies [ACPA], C-reactive protein [CRP], and rheumatoid factor [RF]) to predict a medicine's response. A previous study showed that people with positive blood tests for ACPA and CRP (> 12.3 mg/l) responded well to sarilumab; this study was based on machine learning (a branch of science using computers) and identified factors that could be linked to treatment benefits. The present study analyzed routine data of 2949 people from the ACR-RISE Registry and showed an improvement in RA symptoms after 6 and 12 months of sarilumab, with a greater improvement noted in patients previously treated with other medicines. Biomarkers were tested in 205 people to check whether they could predict treatment response in day-to-day life. People were called rule-positive if they tested positive for RF and/or ACPA with CRP > 12.3 mg/l, and otherwise rule-negative. After 24 weeks of treatment, rule-positive people had a greater chance of disease improvement than rule-negative people. These results showed the benefits of sarilumab in RA in routine care and suggested the usefulness of machine learning in identifying biomarkers that physicians can use to make treatment decisions. [ABSTRACT FROM AUTHOR]

Abstract Background The effects and their magnitudes of sex on disease activity indices for rheumatoid arthritis are not clear. We aimed to comprehensively evaluate the influence of sex on disease activity indices in the real-world setting using a large observational database. Methods We analyzed 14,958 patients registered in the National Database of Rheumatic Diseases in Japan (NinJa) in 2017. We evaluated the sex differences in the 28-joint disease activity score (DAS28) using erythrocyte sedimentation rate (ESR), DAS28 using C-reactive protein (DAS28-CRP), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index by disease activity category using Cliff’s delta and regression analysis. Differences in the share of components of indices were evaluated using permutational multivariate analysis of variance. Correction equations were constructed to estimate the number of misclassification in male patients who achieve DAS28-ESR remission. Results DAS28-ESR showed higher values in female patients than male patients in remission despite no obvious difference in other indices or disease activity categories. Among the components of DAS28-ESR, only ESR was higher in female patients than male patients in remission. In DAS28-CRP and SDAI, 28-tender joint count was higher and CRP was lower in female patients than male patients. In addition, the profiles in the components were different between female and male patients, especially among those with high disease activity. Using correction equations, almost 12% of male patients with DAS28-ESR remission were estimated to be misclassified, mainly due to differences in ESR. Conclusion Among the disease activity indices, significant sex difference was observed only in DAS28-ESR remission. The degree of misclassification in DAS28-ESR remission would be unignorable.

Abstract Background Some composite measures for determining the treatment effects of disease-modifying antirheumatic drugs on remission and low disease activity (LDA) in rheumatoid arthritis (RA) may produce misleading results if they include an acute phase reactant (APR). To inform the choice of appropriate measure, we performed a systematic comparison of treatment effects using different composite measures. Methods We used data generated for a systematic review of biologics in RA conducted by the Institute for Quality and Efficiency in Health Care and data from systematic reviews of newer biologics and Janus kinase (JAK) inhibitors provided by sponsors. The studies included had been conducted up to 2020 and investigated comparisons of biologics with placebo and head-to-head comparisons of biologics. Treatment effects on LDA and remission in studies investigating biologics or JAK inhibitors in RA were compared among 4 composite measures: the disease activity score 28 (DAS 28), the simplified disease activity index (SDAI), the Boolean approach (remission only), and the clinical disease activity index (CDAI)—only the latter does not include an APR. Results 49 placebo-controlled studies included 9 different biologics; 48 studies (16,233 patients) investigated LDA and 49 (16,338 patients) investigated remission. 11 active-controlled studies (5996 patients) investigated both LDA and remission and included 5 different head-to-head comparisons of biologics and 5 different comparisons (6 studies) of biologics with JAK inhibitors. Statistically significantly larger treatment effects were found for biologics or JAK inhibitors versus placebo or active control in 16% of pairwise comparisons of composite measures (27 of 168). Most of these larger effects were observed for composite measures with an APR, i.e. the DAS 28 (19 comparisons) followed by the SDAI (n = 7). Larger effects were most frequently detected in favour of interleukin (IL)-6 inhibitors and to a lesser extent for JAK inhibitors versus treatments with different modes of action. Conclusions The use of the DAS 28 and SDAI in clinical studies may generate results favouring certain treatments based on their mode of action (e.g. IL-6 inhibitors versus other biologics). To enable unbiased comparative effectiveness research, a composite measure without an APR (i.e. the CDAI) should thus be the measure of choice.

To investigate the associations of composite dietary antioxidant index (CDAI) with risk of cardiovascular disease (CVD) mortality among individuals with type 2 diabetes (T2D). This prospective cohort study included 7551 patients with T2D who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 through 2018. Death statistics were gathered by connecting the cohort database to the National Death Index through December 31, 2019. Multivariable Cox proportional hazards regression models were utilized to calculate hazard ratios and 95% CIs for the relationship of CDAI with risks of CVD and all-cause mortality. Three multivariable models were built. Restricted cubic spline analyses were utilized to explore the nonlinear association of CDAI with CVD mortality, and nonlinearity was tested by the likelihood ratio test. This cohort study included data from 7551 participants with T2D (mean [SE] age, 61.4 (0.2) years; 3811 male [weighted, 50.5%] and 3740 female [weighted, 49.5%]; median CDAI level, − 2.19 [IQR, − 2.19 ~ − 0.22]). A total of 2227 all-cause deaths and 746 CVD deaths were identified during an average of 98 months of follow-up. Nonlinear associations were observed for CDAI (P < 0.05 for nonlinearity) with risk of CVD mortality among patients with T2D. Compared with participants in the first quartile of CDAI levels (< − 2.19), the hazard ratios for CVD mortality were 0.47 (95% CI 0.30–0.75) for participants in the highest CDAI level quartile. This cohort study found that higher CDAI levels were significantly associated with lower risk of CVD mortality among individuals with T2D. Highlights: This prospective cohort study shows that a higher CDAI, including vitamins A, C and E, manganese, selenium and zinc, is associated with a decreased risk of developing CVD mortality among T2D adults overall. A high-antioxidant dietary play a protective role in CVD mortality especially with T2D patients. Based on these findings, food-based antioxidants appear to be beneficial and may be a potential strategy for preventing CVD mortality among T2D patients. [ABSTRACT FROM AUTHOR]

Background: The potential beneficial health effects of dietary antioxidants have been reported. However, the association of a composite dietary antioxidant index (CDAI) with fatty liver index (FLI) remains unclear. This study aims to assess whether CDAI (including its components) is associated with FLI among US adults., Methods: This population-based cross-sectional study used data on US adults from the National Health and Nutrition Examination Survey (NHANES) 2007-2018 cycles. Weighted generalized linear regression models were used to analyze the association between CDAI (including vitamin A, C, E, zinc, selenium, and carotenoids) and FLI, which was calculated by using body mass index (BMI), waist circumference and levels of γ -glutamyl transferase and triglycerides., Results: Weighted generalized linear regression models showed an inverse association between CDAI and FLI in the total population ( β , -0.40; 95% CI, -0.59, -0.21), in women (β, -0.56; 95% CI, -0.94, -0.18), and in men (β, -0.32; 95% CI, -0.54, -0.10) after adjusting for various confounders. The restricted cubic splines showed the negative linear dose-response associations between CDAI and FLI (all P non&#95;linear >0.05). The dietary selenium intake in women has an inverse U-shaped relationship with FLI, with an inflection point value of 110 μg. In model 3, intake of dietary antioxidants Vitamins A, C, E, and carotenoids were significantly negatively associated with FLI in female but only were vitamins A and E negatively associated with FLI in male. In subgroup analysis, CDAI showed a significantly negative relation to FLI among those aged 60 years or older ( β , -0.57; 95% CI, -0.81, -0.33), among those who engaged in active physical activity ( β , -0.46; 95% CI, -0.63, -0.29), among those without metabolic syndrome (β, -0.43; 95% CI, -0.62, -0.24), and those without hyperuricemia (β, -0.43; 95% CI, -0.60, -0.26). Additionally, CDAI was significantly negatively associated with male FLI, regardless of whether they had diabetes or not., Conclusion: In conclusion, our results indicate that higher CDAI may be associated with a lower FLI., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zheng, Li, Fu, Bai and Dong.)

Background: The relationship between CDAI and suicidal ideation is unclear. This study investigates the relationship between CDAI and suicidal ideation and examines the association between CDAI and all-cause mortality (ACM) or cardiovascular disease mortality (CVM) among participants with and without suicidal ideation., Methods: Data from seven NHANES cycles (2005-2018) were analyzed using cross-sectional and prospective cohort studies. Weighted multivariable logistic regression models, restricted cubic spline (RCS) plots, and subgroup analyses explored the association between CDAI and suicidal ideation. Kaplan-Meier (KM) curves, weighted multivariable Cox proportional hazards models, and RCS assessed the relationship between CDAI and CVM or ACM., Results: Among 30,976 participants aged over 20, 1,154 (3.72%) had suicidal ideation. Higher CDAI levels (Quartile 4) were associated with a 28% reduction in suicidal ideation compared to lower levels (Quartile 1). Over an average follow-up of 89 months, 3,267 participants (7.6%) died, including 808 (1.8%) from cardiovascular causes. Higher CDAI levels were linked to a 30, 68, and 28% reduction in ACM in the total population, those with suicidal ideation, and those without, respectively. CVM was reduced by 40% in the total population and by 41% in those without suicidal ideation., Conclusion: CDAI is negatively associated with suicidal ideation and correlated with reduced ACM and CVM among participants with and without suicidal ideation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Huang, Zhao, Choi and Gong.)

BackgroundGrowing evidence has shown that the antioxidant diet is a protective factor against depression. However, the relationship between the Composite Dietary Antioxidant Index (CDAI), an important measure of antioxidant diet, and depression has received little attention. Therefore, we investigated the relationship between CDAI and depression through a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018.MethodsThe association between CDAI and depression was investigated using a weighted multiple logistic regression model with subgroup analysis. Non-linear correlations were explored using fitted smoothing curves. And we used a recursive method to figure out the turning point and build a weighted two-piece linear regression model.ResultsIn the multivariate logistic regression model with full adjustment for confounding variables, the ORs (95% CI) for the association between CDAI and depression were 0.83 (0.78, 0.88). Moreover, a non-linear association was found, with 0.16 being the inflection point. Before the inflection point, each unit increase in CDAI was associated with a 30% decrease in the risk of depression. After the inflection point, the risk of depression was found to be reduced by 11% for each unit increase. None of the interactions in all subgroup analyses were statistically significant.ConclusionsOur study highlighted a negative non-linear association between CDAI and depression in a nationally representative sample of US adults. Further clinical and basic research is needed to explore their association better.

Objectives: The Simplified Disease Activity Index (SDAI) is a recommended composite score for assessing the remission status in patients with rheumatoid arthritis (RA). However, determination of C-reactive protein (CRP) levels takes several hours and sometimes days and limits the use of the SDAI in the clinical setting. The aim of this study was to validate the SDAI using a quick quantitative C-reactive protein (qCRP) assay (as SDAI-Q) in RA patients. Design: This is a multicenter, prospective, cross-sectional pilot study in RA patients. Methods: Adult patients (⩾18 years) with a clinical diagnosis of RA were recruited between January 2020 and September 2020 from five rheumatologic centers located in Berlin, Germany. SDAI, SDAI-Q, Clinical Disease Activity Index (CDAI), and DAS28 scores comprising CRP, qCRP, or erythrocyte sedimentation rate (ESR) were calculated. The agreement of disease activity categories was analyzed using cross tabulations and weighted Cohen's kappa. The agreement of numerical values was analyzed with Bland–Altman plots and intraclass correlation coefficients (ICCs). Results: Overall, 100 RA patients were included in the statistical analysis. The mean value of qCRP (7.89 ± 16.98 mg/l) was slightly higher than that of routine laboratory CRP (6.97 ± 15.02 mg/l). Comparing SDAI and SDAI-Q, all patients were assigned to identical disease activity categories. Agreement of disease activity categories by CDAI and SDAI/SDAI-Q was observed in 93% with a weighted Cohen's kappa of 0.929 (95% confidence interval (CI) = 0.878; 0.981). Conclusion: The SDAI-Q showed an absolute agreement regarding the assignment of disease activity categories in comparison with the conventional SDAI. Therefore, the SDAI-Q may facilitate the application of a treat-to-target concept in clinical trials and clinical routine as a quickly available disease activity score incorporating CRP as an objective parameter. [ABSTRACT FROM AUTHOR]

Mohammed AlOmair,&ast; Hanan AlMalki,&ast; Nouf AlShamrani, Ghadah Habtar, Maram AlAsmari, Wejdan Mobasher, Hanan AlQahtani, Aydah Rahman, Alhussain Asiri Division of Rheumatology, Department of Medicine, Aseer Central Hospital, Abha, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Mohammed AlOmairDivision of Rheumatology, Department of Medicine, Aseer Central Hospital, P.O. Box 34, Abha, Saudi ArabiaTel +966 507735466Fax +966 172243595Email alomair.mohd@gmail.com; MAL-OMAIR@moh.gov.saPurpose: To study the pattern of response to different treatment strategies in seropositive rheumatoid arthritis (RA) patients and to describe our clinical practice in RA management.Patients and Methods: Over a period of two years from April 2018 to April 2020, we conducted a retrospective analysis of data for 288 consecutive seropositive RA patients attending rheumatology clinics and the daycare unit at Aseer Central Hospital. Data were collected on patient demographics, disease duration, extraarticular manifestations, comorbidities and treatment. Disease activity was assessed using the clinical disease activity index (CDAI).Results: Out of the total 288 patients, 42% (120) are on csDMRADs, while 54% (162) are on bDMRADs and 4% (6) are on tsDMARDs. Of the patients on csDMARDS, 51%, 43% and 7% of them were on remission, low and moderate disease activity, respectively. However, of the patients on non-csDMARDS, 36.3%, 49.4% and 14.3% of them were on remission, low and moderate disease activity, respectively. Failure of csDMARDs was affected by the presence of high disease activity at baseline, extraarticular lung manifestations and coexistent fibromyalgia, with a significant effect of the latter on remission rate. Among patients on non-csDMARDs, 42 (25%) showed one or more therapy changes. Tumor necrosis factor inhibitors were the predominant first-line agents in biologically naive patients (65%) followed by abatacept (18%). Abatacept was the most frequently prescribed second biologic in 52% of cases followed by tocilizumab in 19%.Conclusion: The current clinical practice in our hospital is consistent with the latest American College of Rheumatology (ACR)/The European League Against Rheumatism (EULAR) guidelines. Treat-to-target strategy was achieved in the vast majority of our patients, while remission was observed in almost half of the patients.Keywords: rheumatoid arthritis, DMARDs, biologics, remission, CDAI

Objective: Aim of the present study is to find out the level of vitamin D in patients of early rheumatoid arthritis and investigate association of vitamin D deficiency with the disease activity in rheumatoid arthritis. Methods: A case control study comprising 90 case of early rheumatoid arthritis and 80 age and sex matched control carried out at tertiary care hospital in western province of Uttar Pradesh India between January 2017 and June 2021. Baseline data along with vitamin D level was recorded in both the group. Disease activity was recorded using clinical disease activity index (CDAI) in all patients of rheumatoid arthritis. Results: Vitamin D deficiency was significantly higher in rheumatoid arthritis patients compared to healthy control from same geographic region (56.7% vs 32.5%, p value = 0.002%). Disease activity assessed by clinical disease severity index (CDAI) was inversely correlated with vitamin D level(r= -0.23, p-value 0.028) and. Joint pain was also inversely correlated with vitamin d level(r= -0.37, p value <0.0001). However, there was no significant association of vitamin D level with joint swelling, tenderness and erythrocyte sedimentation rate. Conclusions: In our study vitamin D deficiency was more common in patients of rheumatoid arthritis. Disease activity and joint pain were inversely correlated with vitamin D level. However, there was no significant association of vitamin D level with joint swelling and tenderness. [ABSTRACT FROM AUTHOR]

Abstract Background A previous analysis of the Veterans Affairs Rheumatoid Arthritis (VARA) registry showed that more than half of the patients with rheumatoid arthritis (RA) did not receive a major therapeutic change (MTC) despite moderate or severe disease activity. We aimed to empirically determine disease activity thresholds associated with a decision by rheumatologists and nurse practitioners to institute a MTC in patients with RA and to report the impact of that change on RA disease activity. Methods We analyzed data from the VARA registry between January 1, 2006, and September 30, 2017. Eligible patients had a visit with 3 disease activity measures (DAMs) recorded: Disease Activity Score for 28 joints (DAS28), Clinical Disease Activity Index (CDAI), and Routine Assessment of Patient Index Data 3 (RAPID3). The Youden Index was used to identify disease activity thresholds that best discriminated rheumatologist/nurse practitioner decision to initiate MTC. Clinical outcome was 20% improvement in the American College of Rheumatology criteria (ACR20 response). The effect of MTC on ACR20 response was presented as crude descriptive statistics and evaluated using G-computation for marginal and conditional effects with established disease activity level combined with an empirical threshold from Youden analysis. Results The study population comprised 1776 patients (12,094 visits: 3077 with MTC, 9017 without MTC). Empirical thresholds (95% bootstrap confidence interval with 1000 replications) for MTC were 4.03 (3.70–4.36) for DAS28, 12.9 (10.4–15.4) for CDAI, and 3.81 (3.32–4.30) for RAPID3. Visits with MTC had increased likelihood of ACR20 response: risk ratios for ACR20 response for visits with MTC vs without MTC ranged 1.2–2.6 across DAMs; risk differences ranged 0.2–14.5%. Conclusions MTC was associated with clinical improvement across all DAMs with the greatest change in patients with RA disease activity above the Youden threshold identified in this work. Trial registration VARA Registry, https://www.hsrd.research.va.gov/research/abstracts.cfm?Project_ID=2141698764

Objectives RA patients are often not in remission due to patient global assessment of disease activity (PtGA) included in disease activity indices. The aim was to assess the lag of patient-reported outcomes (PROs) after remission measured by clinical disease activity index (CDAI) or swollen joint count (SJC28). Methods RA patients enrolled in the Ontario Best Practices Research Initiative registry not in low disease state at baseline with at ≥6 months of follow-up, were included. Low disease state was defined as CDAI ≤ 10, SJC28 ≤ 2, PtGA ≤ 2cm, pain score ≤ 2cm, or fatigue ≤ 2cm. Remission included CDAI ≤ 2.8, SJC28 ≤ 1, PtGA ≤ 1cm, pain score ≤ 1cm, or fatigue ≤ 1cm. Time to first low disease state/remission based on each definition was calculated overall and stratified by early vs established RA. Results A total of 986 patients were included (age 57.4 (12.9), disease duration 8.3 (9.9) years, 80% women). The median (95% CI) time in months to CDAI ≤ 10 was 12.4 (11.4, 13.6), SJC28 ≤ 2 was 9 (8.2, 10), PtGA ≤ 2cm was 18.9 (16.1, 22), pain ≤ 2cm was 24.5 (19.4, 30.5), and fatigue ≤ 2cm was 30.4 (24.8, 31.7). For remission, the median (95% CI) time in months to CDAI ≤ 2.8 was 46.5 (42, 54.1), SJC28 ≤ 1 was 12.5 (11.4, 13.4), PtGA ≤ 1cm was 39.6 (34.6, 44.8), pain ≤ 1cm was 54.7 (43.6, 57.5) and fatigue ≤ 1cm was 42.6 (36.8, 48). Time to achieving low disease state and remission was generally significantly shorter in early RA compared with established RA with the exception of fatigue. Conclusion Time to achieving low disease state or remission based on PROs was considerably longer compared with swollen joint count. Treating to a composite target in RA could lead to inappropriate changes in DMARDs. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to assess the correlation between composite dietary antioxidant index (CDAI) with all-cause mortality and cause-specific mortality in adults with hypertension., Methods: The cohort study comprised adult participants with hypertension from the NHANES database, spanning 9 cycles from 2001 to 2018. Follow-up was conducted until December 31, 2019. Multi-variable Cox regression analysis was utilized to ascertain hazard ratios (HR) and their corresponding 95% confidence intervals, evaluating the relationship between CDAI and the risks of all-cause and cause-specific mortality. To further investigate the association between CDAI and mortality rates in adults with hypertension, Kaplan-Meier survival curves, restricted cubic splines (RCS), subgroup analyses and sensitivity analyses were employed., Results: The analysis included 16,713 adults with hypertension (mean age 56.93 ± 0.23 years, 8,327 [49.61%] male). During the mean follow-up time 102.11 ± 1.22 months, with 3,908 (18.08%) all-cause mortality occurred, 1,082 (4.84%) cardiovascular mortality and 833 (3.80%) cancer mortality. Compared to the lowest quartile of CDAI, the weighted multivariate hazard ratios of participants in the highest quartile was 0.77 (95% CI, 0.68-0.87) for all-cause mortality, 0.83 (95% CI, 0.67-1.04) for cardiovascular mortality, and 0.64 (95% CI, 0.50-0.82) for cancer mortality. RCS analysis demonstrated a nonlinear association of CDAI with all-cause and cancer mortality, and a linear association between CDAI and cardiovascular mortality. The results were robust in subgroup analyses and sensitivity analyses., Conclusion: Higher CDAI is associated with reduced all-cause mortality, cardiovascular mortality, and cancer mortality in hypertensive adults. Our findings highlight the importance of an antioxidant diet in improving outcomes in adults with hypertension., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Qin, Shen and Xu.)

Background: The dietary inflammatory index (DII) and composite dietary antioxidant index (CDAI) were developed as tools for use when seeking to assess the potential inflammatory and antioxidant activity of a given diet, respectively. The associations between these indices and gallstone incidence remain largely unexplored., Objective: The present study sought to clarify how both the DII and the CDAI are related to gallstone incidence and age at first gallbladder surgery among adults in the USA., Methods: Cross-sectional data from the 2017-2020 cycles of the National Health and Nutrition Examination Survey (NHANES) pertaining to 12,426 individuals were used to conduct the present study. Data from 2 days with 24-h dietary recall were employed when calculating DII and CDAI scores. Relationships between dietary indices and the incidence of gallstones were assessed through logistic regression analyses, while linear regression analyses were employed to characterize how these indices are associated with the age at first gallbladder surgery., Results: Higher DII scores and lower CDAI scores, which, respectively, denote diets with greater inflammatory potential and reduced antioxidant potential, were found to be associated with higher gallstone incidence even following adjustment for potential confounding factors. Smooth curve fitting suggested that the association between DII and gallstones was nearly linear, whereas that between CDAI and gallstone incidence was nonlinear. Higher DII values were also related to first gallbladder surgery at an earlier age ( β  = -0.64, 95% CI: -1.26, -0.02)., Conclusion: These results emphasize the benefits of anti-inflammatory diets rich in antioxidants, which may help reduce gallstone incidence among adults in the USA. Higher DII scores may also predict the need for gallbladder surgery at a younger age., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Jiang and Shao.)

Choosing between the different disease activity indices used for rheumatoid arthritis RA evaluation in clinical practice and research is often difficult. The aim of the current study was to compare clinical disease activity index (CDAI) to simplified disease activity index (SDAI), and disease activity score 28 (DAS28) regarding inter-observer reliability and correlation to the modified health assessment questionnaire (MHAQ) in a cohort of Egyptian RA patients. This study included one hundred RA patients. Every patient had an independent clinical evaluation made by two rheumatologists (professor and candidate) to evaluate disease activity using DAS28 with its 4 types, CDAI and SDAI. We used Cohen’s weighted kappa coefficient to measure the inter-observer agreement between the professor and candidate in different disease activity measures. Correlation between MHAQ and disease activity measures was made with Spearman’s rho test. Inter-observer agreement in CDAI and DAS28 values was almost perfect. A strong positive correlation was found between professor and candidate regarding the tested activity indices (p

Objective Data from two double-blind, randomized, Phase III studies were analysed to investigate the ability of Routine Assessment of Patient Index Data 3, DAS28 (CRP), modified (M)-DAS28 (CRP) and Simplified or Clinical Disease Activity Indices to predict structural damage progression in RA. Methods This post hoc analysis included data from the 2-year Abatacept vs adaliMumab comParison in bioLogic-naïvE RA subjects with background MTX (AMPLE) trial in biologic-naïve patients with active RA (<5 years) and an inadequate response to MTX, and the 12-month treatment period of the Assessing Very Early Rheumatoid arthritis Treatment (AVERT) trial in MTX-naïve patients with early RA (⩽2 years) and poor prognostic indicators. Adjusted logistic regression analysis assessed the relationship between baseline disease activity and structural damage progression (defined as change from baseline greater than the smallest detectable change) at 12 and 24 months in AMPLE and 6 and 12 months in AVERT. Areas under the receiver operating characteristic curves for the impact of baseline disease activity on structural damage progression were calculated. Results Adjusted logistic regression analyses included all randomized and treated patients in AMPLE (N = 646) and those who received abatacept plus MTX or MTX monotherapy in AVERT (N = 235). Baseline Routine Assessment of Patient Index Data 3, DAS28 (CRP) and M-DAS28 (CRP) scores significantly predicted structural progression at months 12 and 24 in AMPLE (P < 0.05) and months 6 and 12 in AVERT (P < 0.01), and were stronger predictors than Simplified or Clinical Disease Activity Indices. Conclusion In this post hoc analysis of two patient populations with RA, Routine Assessment of Patient Index Data 3, DAS28 (CRP) and M-DAS28 (CRP) were good at predicting structural damage. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov : NCT00929864 (AMPLE); NCT01142726 (AVERT). [ABSTRACT FROM AUTHOR]

Background and objective: Rheumatoid arthritis (RA) is an autoimmune disease of unknown etiology. Vitamin D3 plays an important role in bone metabolism and may also have immunomodulatory effects. This study was designed to estimate the prevalence of vitamin D3 deficiency in patients with rheumatoid arthritis as compared to healthy controls and to analyze the association between vitamin D3 with disease activity. Methods: This case-control study included 50 consecutive rheumatoid arthritis patients, who fulfilled EULAR-ACR-2010 and ACR 1987 criteria for Rheumatoid Arthritis, and 50 age matched controls. Their mean age and standard deviation (SD) was 46.42±10.86 years. They were not on vitamin D3 supplements. They were selected from the Rheumatology and Medical Rehabilitation Department of Rizgary Teaching Hospital in Erbil City. The activity of disease was assessed by disease activity score and clinical disease activity index parameters. The vitamin D3 was measured for all patients and controls. Results: A total of 100 participants were enrolled in the study. The vast majority of them were female, and 70% of cases had deficient vitamin D3 levels, while 46% of control group suffered from vitamin D3 deficiency (P