ArticleBMC pulmonary medicine2026
The red cell distribution width-to-albumin ratio mediates the association between the dietary index for gut microbiota and chronic obstructive pulmonary disease.
Article in BMC pulmonary medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundChronic obstructive pulmonary disease (COPD) is a major global health burden, with emerging evidence implicating gut microbiota dysbiosis via the gut-lung axis. The Dietary Index for Gut Microbiota (DI-GM) quantifies dietary impact on microbial health, but the mechanisms linking DI-GM to COPD risk remain unclear. This study aimed to investigate whether systemic inflammatory-nutritional biomarkers might explain the association between DI-GM and COPD, with a focus on the red cell distribution width-to-albumin ratio (RAR).
methodsThis cross-sectional analysis included 20,487 U.S. adults aged ≥ 40 years from the National Health and Nutrition Examination Survey (2005–2018). DI-GM was derived from 24-hour dietary recalls, and COPD was defined by self-reported physician diagnosis. Survey-weighted multivariable logistic regression and mediation analysis were used to assess associations and statistically decompose the potential mediating effects of 11 inflammatory-nutritional biomarkers.
resultsEach one-unit increase in DI-GM was associated with an 8% reduction in COPD prevalence (odds ratio 0.92, 95% confidence interval 0.88–0.97). In the mediation analysis, RAR was the most robust factor, accounting for 10.3% of the observed total association. Other biomarkers, including the neutrophil percentage-to-albumin ratio and monocyte-to-albumin ratio, showed significant but weaker contributions. These findings were consistent in sensitivity analyses.
conclusionsAdherence to a gut microbiota-beneficial diet is associated with reduced COPD risk, and this association may be partially explained by systemic inflammatory-nutritional status. RAR emerged as a significant intermediary factor in this observed association, providing epidemiological clues for the gut-lung axis and suggesting its potential as a biomarker for further investigation in targeted prevention strategies.
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