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. 2025 Jul 22;25(1):529.
doi: 10.1186/s12876-025-04099-0.

Sex-specific adverse effects of lipid accumulation products and cardiometabolic indices on the prevalence of gallstones: insights from the 2017-2020 national health and nutrition examination survey

Yangyang Zheng #  1 , Xiaoli Chen #  2   3 , Yunpeng Ge  1 , Haowei Shi  1 , Shiqi Guo  1 , Wendan Tan  4 , Jinghai Song  5
Affiliations

Sex-specific adverse effects of lipid accumulation products and cardiometabolic indices on the prevalence of gallstones: insights from the 2017-2020 national health and nutrition examination survey

Yangyang Zheng et al. BMC Gastroenterol. .

Abstract

Background: Anthropometric measurements and lipid profiles are associated with the onset of gallstone disease, with these associations exhibiting sex-specific variations. This study investigated the association between the prevalence of gallstones and two anthropometric-lipid markers, namely Lipid Accumulation Products (LAP) and Cardiometabolic Index (CMI), while also assessing the presence of sex disparities.

Methods: Data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) were analyzed, including 3,541 participants aged 20 years or older with complete information. Weighted logistic regression, restricted cubic spline modeling, and subgroup analyses were employed to assess the relationship between LAP and CMI and gallstone disease, as well as to investigate potential sex-specific differences. An analysis of the receiver operating characteristic (ROC) curve was performed to assess the prediction accuracy of indices and to determine appropriate cutoff values.

Results: Elevated LAP and CMI were significantly correlated with an increased prevalence of gallstone disease among women, whereas no significant association was found in men. For each unit increase in log2-LAP, the multivariable-adjusted odds ratio (OR) for gallstone disease was 1.375 (95% CI: 1.143-1.655). For each 1-point increase in CMI, the multivariable-adjusted OR was 1.408 (95% CI: 1.098-1.806). Quartile analysis demonstrated that higher levels of LAP and CMI were significantly associated with an increased prevalence of gallstones. The associations between CMI, LAP, and the prevalence of gallstones were consistent across all subgroups (p for interaction > 0.05). LAP exhibiting the largest AUC, demonstrating high accuracy in screening for high-risk individuals for gallstone disease, comparable to traditional indices.

Conclusions: The study revealed a positive association between LAP, CMI, and the prevalence of gallstones, observed exclusively among women. The findings suggest that prioritizing the reduction of LAP and CMI is crucial for preventing gallstone disease in women.

Keywords: Cardiometabolic indices; Gallstones; Lipid accumulation products; NHANES.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study used anonymous data from the National Health and Nutrition Examination Survey and complied with the ethical guidelines and regulations of the Declaration of Helsinki. The study was approved by the National Center for Health Statistics Ethics Review Board, and all participants provided written informed consent before the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Selection of participants in the study
Fig. 2
Fig. 2
Association between LAP, CMI and gallstone disease using a restricted cubic spline model stratified by gender. A Relationship between LAP and gallstone disease; (B) Relationship between CMI and gallstone disease. Multivariable adjusted odds ratios (solid line) with 95% confidence interval (shaded area) for the association of LAP with gallstone disease. Adjusted for age (continuous), race/ethnicity (Non-Hispanic White, Non-Hispanic Black, Mexican American, and Other Race), smoking status (Never, Ex-smoker, and Current-smoker), alcohol intake (no-drinking and drinking), hypertension, and Diabetes. LAP, Lipid Accumulation Products; CMI, Cardiometabolic Indices
Fig. 3
Fig. 3
Receiver operating characteristic curves of various anthropometric measures for distinguishing gallstone disease. AUC, area under the curve; LAP, Lipid Accumulation Products; CMI, Cardiometabolic Indices; VAI, Visceral adiposity index; BMI, Body Mass Index; BRI, Body Roundness Index; WHtR, Waist-to-Height Ratio; WC, waist circumference
Fig. 4
Fig. 4
Spearman's correlation heatmap of various anthropometric measures, displaying numerical values representing the correlation coefficients. Negative correlations are depicted in red, while positive correlations are shown in blue, with darker shades indicating stronger correlations. Significance levels are marked as follows: *** P < 0.001, ** P < 0.01, * P < 0.05. LAP, Lipid Accumulation Products; CMI, Cardiometabolic Indices; VAI, Visceral adiposity index; BMI, Body Mass Index; BRI, Body Roundness Index; WHtR, Waist-to-Height Ratio; WC, waist circumference
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