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. 2025 Apr 15;20(4):e0321733.
doi: 10.1371/journal.pone.0321733. eCollection 2025.

Association between advanced lung cancer inflammation index and gallstone prevalence among U.S. adults: A population-based study

Chaofeng Gao  1 , Miaoyan Liu  2 , Yuan Sun  1 , Zekun Zhao  3 , Fengxian Wei  1 , Xiaodong Xu  1
Affiliations

Association between advanced lung cancer inflammation index and gallstone prevalence among U.S. adults: A population-based study

Chaofeng Gao et al. PLoS One. .

Abstract

Introduction: Gallstones are a common digestive disorder, with a global prevalence of 10%-15%, posing a significant economic burden on public health. The formation of gallstones is closely associated with inflammation and nutritional status. The Advanced Lung Cancer Inflammation Index (ALI) is a composite measure for assessing inflammation and nutritional status; however, its relationship with gallstone risk remains unclear. This study aims to investigate the association between ALI and gallstone prevalence among U.S. adults.

Methods: This study is based on data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) and includes 5,826 adults aged 20 years and older. The Advanced Lung Cancer Inflammation Index (ALI) was calculated using body mass index (BMI), serum albumin levels, and the neutrophil-to-lymphocyte ratio (NLR). The prevalence of gallstones was determined through questionnaire surveys. Multivariable logistic regression models were employed to analyze the relationship between ALI and the risk of gallstones. Additionally, trend analysis, smooth curve fitting, and subgroup analyses were conducted.

Results: The study results showed a significant positive correlation between ALI levels and the risk of gallstone disease. After fully adjusting for covariates, each unit increase in lnALI was associated with a 42% increase in the risk of gallstone disease (OR = 1.42, 95% CI: 1.12-1.80). Trend analysis indicated a significant dose-response relationship between ALI and gallstone risk (P for trend < 0.01). Subgroup analysis further revealed that the correlation between ALI and gallstone risk was more pronounced in females, non-diabetic patients, individuals with higher education levels, those with insufficient physical activity, and non-drinkers, with gender showing a significant interaction effect (interaction P < 0.05). Smooth curve fitting further validated the linear relationship between ALI and gallstone risk, and this association was particularly prominent in the female population.

Conclusions: This study demonstrates that ALI is significantly associated with the risk of gallstones, particularly among women. As a simple and readily accessible indicator, ALI may help identify high-risk populations and provide a new clinical tool for the prevention and management of gallstones. Future longitudinal studies should further validate these findings and evaluate the predictive value of ALI across different populations.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of study cohort selection process.
Fig 2
Fig 2. The association between ALI and gallstone.
The solid red line represents the smooth curve fit between variables. Blue bands represent the 95% confidence interval from the fit.
Fig 3
Fig 3. The association between ALI and gallstone stratified by sex.
See this image and copyright information in PMC

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