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. 2025 Jun 7;25(1):2130.
doi: 10.1186/s12889-025-23323-w.

Positive association between cardiometabolic index and gallstones, with greater impact on women and those younger than 50 years: the NHANES 2017-2020 cross-sectional study

Jing Zheng #  1 , Huqiang Dong #  2 , Hongli Wan  3 , Qingye Yang  1 , Shujuan Xu  4 , Tingting Hu  1 , Chang Fu  5 , Keyun Cheng  6
Affiliations

Positive association between cardiometabolic index and gallstones, with greater impact on women and those younger than 50 years: the NHANES 2017-2020 cross-sectional study

Jing Zheng et al. BMC Public Health. .

Abstract

Background: Gallstones are a common hepatobiliary disorder. It is unclear whether cardiometabolic index (CMI) is associated with gallstones. The purpose of this study was to examine the association between CMI levels and gallstone prevalence among US adults.

Methods: We investigated data from 3711 participants aged 20 years or older in the 2017-2020 National Health and Nutrition Examination Survey (NHANES). Confounder adjustment, multivariate logistic regression modeling, and restricted cubic spline (RCS) analyses were used to assess the association between CMI and gallstone prevalence, and threshold effect analyses were performed. We conducted subgroup analyses to evaluate the impact of confounding variables, including age and gender. A sensitivity analysis was also performed to increase the robustness of the results.

Results: The weighted prevalence of gallstones in this study was 11.04%. The risk of gallstones increased significantly with higher CMI quartiles. Logistic regression analysis showed that there was a significant positive correlation between CMI and the risk of gallstones, with a 5% increase in the risk of gallstones for each one-unit increase in CMI (OR = 1.05). In the adjusted model, the positive correlation between CMI and the risk of gallstones remained significant. RCS analysis showed a nonlinear relationship between CMI and gallstones, with an inflection point of 0.69. Subgroup analyses showed that elevated CMI was significantly associated with the risk of gallstones in females and in the 20-50 year old population.

Conclusion: As the first study to show a significant association between CMI and the occurrence of gallstones in an adult population in the United States. However, further longitudinal studies are needed to verify this association.

Keywords: Cardiometabolic index; Cross-sectional study; Gallstones; HDL-C; NHANES.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The portions of this study involving human participants, human materials, or human data were conducted in accordance with the Declaration of Helsinki and were approved by the National Center for Health Statistics (NCHS) Ethics Review Board (#2018-01). The patients/participants provided their written informed consent to participate in this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
NHANES 2017–2020 participant selection flowchart
Fig. 2
Fig. 2
The RCS curve shows how each research participant’s CMI and odds ratio for gallstones relate to one another. RCS, restricted cubic spline; CMI, cardiometabolic index. 95% CI, 95% confidence interval
Fig. 3
Fig. 3
Subgroup analysis of the association between CMI and gallstones. Note 1: Age, gender, race, education level, marital status, PIR, smoking status, alcohol, diabetes, hypertension, HEI-2020, and physical activity were all taken into account while adjusting the aforementioned model. Note 2: The model does not account for the stratification variable in any of these situations
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