Zhen Xu, Yisen Hou, Weirong Jiang, Zhiwen Li, Rui Li, Wenhao Chen, Yong Meng, Jianli Han
Department of Oncology Surgery, Xi'an No.3 Hospital, the Affiliated Hospital of Northwest Universit, Xi'an, Shanxi, 710018, People's Republic of China.
School of Medicine, Northwest University, No. 229 Taibai North Road, Xi'an, 710069, Shaanxi, People's Republic of China.
Eur J Med Res. 2025 Jul 21;30(1):650. doi: 10.1186/s40001-025-02915-7.
Obesity is a well-known risk factor for gallstone disease, but the underlying mechanisms remain unclear. Recent studies suggest that inflammation may mediate the relationship between obesity and gallstones. This study, based on the 2017-2020 NHANES dataset, aims to explore this association and assess the mediating role of inflammatory markers.
We analyzed data from 7,978 adults aged 20 years and older. Gallstones were self-reported, and obesity was defined as a BMI ≥ 30. Inflammatory markers included white blood cell count (WBC), neutrophil count (NEU), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), and the systemic immune inflammation index (SII). Multivariable logistic regression and causal mediation analysis were used to examine direct associations and mediation effects, adjusting for potential confounders. Subgroup analyses by age and sex were also performed.
Obesity was significantly associated with an increased incidence of gallstones (OR = 2.29; 95% CI, 1.98-2.65). After adjusting for confounders, including age, sex, smoking, and alcohol consumption, the relationship remained significant (OR = 1.86; 95% CI, 1.57-2.22). Inflammatory markers, such as WBC (OR = 1.61; 95% CI, 1.22-2.11), NEU (OR = 1.46; 95% CI, 1.17-1.81), and CRP (OR = 1.18; 95% CI, 1.10-1.28), were also significantly associated with gallstones. Causal mediation analysis indicated that inflammatory markers, particularly WBC, NEU, and CRP, mediated the relationship between obesity and gallstones. Subgroup analysis showed the association was consistent across age groups, but mediating effects varied by age and sex. In the 41-60 years group, WBC and NEU had significant mediating effects, while in those over 60, PLR showed a negative association. In females, the mediating effect of inflammatory markers was not significant after adjustments.
This study demonstrates a significant association between obesity and gallstones, with inflammatory markers playing a partial mediating role in this relationship. Modulating levels of inflammation may help reduce the risk of gallstone formation associated with obesity.
肥胖是胆结石疾病的一个众所周知的危险因素，但其潜在机制仍不清楚。最近的研究表明，炎症可能介导肥胖与胆结石之间的关系。本研究基于2017 - 2020年美国国家健康与营养检查调查（NHANES）数据集，旨在探讨这种关联并评估炎症标志物的中介作用。
我们分析了7978名20岁及以上成年人的数据。胆结石通过自我报告获取，肥胖定义为体重指数（BMI）≥30。炎症标志物包括白细胞计数（WBC）、中性粒细胞计数（NEU）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、C反应蛋白（CRP）以及全身免疫炎症指数（SII）。采用多变量逻辑回归和因果中介分析来检验直接关联和中介效应，并对潜在混杂因素进行调整。还按年龄和性别进行了亚组分析。
肥胖与胆结石发病率增加显著相关（比值比[OR]=2.29；95%置信区间[CI]，1.98 - 2.65）。在调整了包括年龄、性别、吸烟和饮酒等混杂因素后，这种关系仍然显著（OR = 1.86；95% CI，1.57 - 2.22）。炎症标志物，如白细胞计数（OR = 1.61；95% CI，1.22 - 2.11）、中性粒细胞计数（OR = 1.46；95% CI，1.17 - 1.81）和C反应蛋白（OR = 1.18；95% CI，1.10 - 1.28），也与胆结石显著相关。因果中介分析表明，炎症标志物，特别是白细胞计数、中性粒细胞计数和C反应蛋白，介导了肥胖与胆结石之间的关系。亚组分析显示，各年龄组之间的关联是一致的，但中介效应因年龄和性别而异。在41 - 60岁组中，白细胞计数和中性粒细胞计数具有显著的中介作用，而在60岁以上人群中，血小板与淋巴细胞比值呈负相关。在女性中，调整后炎症标志物中介效应不显著。
本研究表明肥胖与胆结石之间存在显著关联，炎症标志物在这种关系中起部分中介作用。调节炎症水平可能有助于降低与肥胖相关的胆结石形成风险。
