The etiology of rheumatoid arthritis (RA), remains incompletely understood. It is considered to be a multifactorial disease, resulting from the interaction of both genetic and environmental factors. Epidemiologic research has produced convincing data for associations between environmental risk factors, including cigarette smoking, exogenous hormone use and female reproductive factors and RA susceptibility. Dietary studies suggest that high intake of certain antioxidants, fish, olive oil and cooked vegetables confer a protective effect against the development of RA, whereas red meat, fat, dairy and cereals may increase the risk of RA, although evidence for dietary etiology is inconclusive. However, the effect of individual food groups and nutrients may be too small to detect with limited sample sizes in previous studies. Overall dietary pattern and dietary quality analysis examines the cumulative effects of multiple nutrients, and may thus be more predictive of disease risk than individual foods or nutrients. To date, no studies have assessed the association between overall dietary patterns / dietary quality and RA risk, especially in the setting of a well-controlled large prospective cohort study. The goal of the proposed investigation is to address whether overall dietary patterns / dietary quality are associated with risk of RA in women using data from the largest rheumatic disease environmental epidemiology study in the world, the two Nurses'Health Study Cohorts (NHS I and NHS II). We will also examine the causal pathways between dietary patterns / dietary quality, biochemical measurements including plasma antioxidants and markers of inflammation, and risk of developing RA in a matched case-control subsample nested in NHS I and II cohorts. In addition, we will investigate possible interactions between dietary patterns / dietary quality and genetic factors in RA susceptibility. With recent advances in genetic epidemiology and high throughput genotying, the study of gene-diet interactions has become an exciting direction in the field of nutritional epidemiology. Overall, the large size of these cohorts, the prospective design, the repeated and detailed measurements of diet and covariates, the high follow-up rates, and the availability of biochemical measurements provide a unique opportunity to study the relationship between overall dietary patterns /dietary quality and risk of RA in an extremely cost-efficient manner. We believe that this project presents a novel approach to study diet-RA relationships and will have important public health implications.

Public Health Relevance

The evidence for dietary etiology of RA is inconclusive. To date, no studies have assessed the association between overall dietary patterns / dietary quality, gene by dietary pattern interaction, and risk of RA. Findings from this large cohort study will furnish novel information about diet and etiology of RA, and have large potential public health implications for RA prevention.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Research Project (R01)
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Neurological, Aging and Musculoskeletal Epidemiology Study Section (NAME)
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Serrate-Sztein, Susana
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Brigham and Women's Hospital
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Lu, Bing; Driban, Jeffrey B; Xu, Chang et al. (2016) Dietary Fat and Progression of Knee Osteoarthritis Dietary Fat Intake and Radiographic Progression of Knee Osteoarthritis: Data from the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) :
Tedeschi, Sara K; Costenbader, Karen H (2016) Is There a Role for Diet in the Therapy of Rheumatoid Arthritis? Curr Rheumatol Rep 18:23
Tedeschi, Sara K; Cui, Jing; Arkema, Elizabeth V et al. (2016) Elevated BMI and antibodies to citrullinated proteins interact to increase rheumatoid arthritis risk and shorten time to diagnosis: A nested case-control study of women in the Nurses' Health Studies. Semin Arthritis Rheum :
Barbhaiya, Medha; Lu, Bing; Sparks, Jeffrey A et al. (2016) Influence of Alcohol Consumption on the Risk of Systemic Lupus Erythematosus among Women in the Nurses' Health Study Cohorts. Arthritis Care Res (Hoboken) :
Hu, Yang; Costenbader, Karen H; Gao, Xiang et al. (2015) Mediterranean diet and incidence of rheumatoid arthritis in women. Arthritis Care Res (Hoboken) 67:597-606
Lu, Bing; Rho, Young Hee; Cui, Jing et al. (2014) Associations of smoking and alcohol consumption with disease activity and functional status in rheumatoid arthritis. J Rheumatol 41:24-30
Lu, Bing; Driban, Jeffrey B; Duryea, Jeffrey et al. (2014) Milk consumption and progression of medial tibiofemoral knee osteoarthritis: data from the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 66:802-9
Hu, Yang; Costenbader, Karen H; Gao, Xiang et al. (2014) Sugar-sweetened soda consumption and risk of developing rheumatoid arthritis in women. Am J Clin Nutr 100:959-67
Lu, Bing; Hiraki, Linda T; Sparks, Jeffrey A et al. (2014) Being overweight or obese and risk of developing rheumatoid arthritis among women: a prospective cohort study. Ann Rheum Dis 73:1914-22
Solomon, Daniel H; Tonner, Chris; Lu, Bing et al. (2014) Predictors of stopping and starting disease-modifying antirheumatic drugs for rheumatoid arthritis. Arthritis Care Res (Hoboken) 66:1152-8

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