不同代谢肥胖表型与人群患胆结石风险的关联性

谢林君; 徐逸婷; 王欣; 何梦琳; 江奕; 李光灿; 单雪峰; 娄彦梅; 王新

doi:10.16462/j.cnki.zhjbkz.2025.06.011

不同代谢肥胖表型与人群患胆结石风险的关联性

doi: 10.16462/j.cnki.zhjbkz.2025.06.011

1.
四川大学华西公共卫生学院/华西第四医院流行病与卫生统计学系，成都 610041
2.
重庆市开州区人民医院药学部，重庆 405400
3.
重庆医科大学附属璧山医院药学部，重庆 400016
4.
北京小汤山医院健康风险评估部，北京 102211

基金项目:

国家自然科学基金 81903398

四川省科学技术厅杰出青年科学基金 2023NSFSC1927

四川省科学技术厅中央引导地方科技发展专项项目 2023ZYD0097

四川省保健科研项目 Chuanjian Research 2025-2401

四川大学“从0到1”创新项目 2023SCUH0026

四川大学2025年度大学生创新创业训练计划项目 S202510610537

详细信息

通讯作者:
王新；E-mail: wangxinmarine@126.com

中图分类号: R181.3;R575.6
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出版历程
- 收稿日期: 2024-12-23
- 修回日期: 2025-02-24
- 网络出版日期: 2025-07-07
- 刊出日期: 2025-06-10

The association between different metabolic obesity phenotypes and gallstone disease risk

1.
Department of Epidemiology and Biostatistics, West China School of Public Health / West China Fourth Hospital, Sichuan University, Chengdu 610041, China
2.
Department of Pharmacy, Kaizhou District People′s Hospital, Chongqing 405400, China
3.
Department of Pharmacy, Bishan Hospital of Chongqing Medical University, Chongqing 400016, China
4.
Health Risk Assessment Department, Beijing Xiaotangshan Hospital, Beijing 102211, China

Funds:

National Natural Science Foundation of China 81903398

Sichuan Provincial Science and Technology Department Outstanding Youth Science Fund 2023NSFSC1927

Sichuan Provincial Science and Technology Department Central Guide Local Science and Technology Development Special Project 2023ZYD0097

Health Research Project of Sichuan Province Chuanjian Research 2025-2401

Sichuan University "From 0 to 1" Innovation Projec 2023SCUH0026

Sichuan University 2025 Undergraduate Innovation and Entrepreneurship Training Program S202510610537

More Information

Corresponding author: WANG Xin, E-mail: wangxinmarine@126.com

摘要

摘要: 目的通过开展全国多中心横断面研究，探讨不同代谢肥胖表型与人群患胆结石风险的关联性。方法连续纳入2015―2020年在重庆市和北京市4所三级甲等医院健康体检的研究对象，采用多因素logistic回归分析，比较代谢健康非肥胖(metabolically healthy non-obese, MHNO)、代谢健康型肥胖(metabolically healthy obesity, MHO)、代谢异常型非肥胖(metabolically unhealthy non-obese, MUNO)、代谢异常型肥胖(metabolically unhealthy obesity, MUO)与人群患胆结石风险的关联性，再采用随机效应模型对4个中心的结果进行Meta分析合并。结果共招募522 958名研究对象，胆结石总患病率为7.5%。MUO、MUNO、MHO和MHNO组胆结石患病率分别为9.4%、8.3%、6.5%和4.2%，组间差异均有统计学意义(均P < 0.05)。与MHNO组相比，MHO组患胆结石的风险增加了35.8%(合并OR=1.358, 95% CI: 1.213~1.520, P < 0.001)；MUNO组患胆结石的风险增加了34.3%(合并OR=1.343, 95% CI: 1.211~1.489, P < 0.001)；MUO组患胆结石的风险增加了48.9%(合并OR=1.489, 95% CI: 1.221~1.817, P < 0.001)。亚组分析显示，在不同性别和年龄组中，代谢肥胖表型与人群患胆结石风险的关联性差异均无统计学意义(均P>0.05)。结论无论是否伴随代谢异常，肥胖群体均会增加患胆结石的风险。未来应对肥胖群体，尤其是伴有代谢异常者，进行早期筛查与干预，以减少胆结石的疾病负担。
- 胆结石 /
- 代谢综合征 /
- 肥胖
Abstract: Objective This study aimed to investigate the association between different metabolic obesity phenotypes and the risk of gallstone disease through a nationwide multicenter cross-sectional study. Methods Participants who underwent health check-ups in four tertiary hospitals in Chongqing and Beijing from 2015 to 2020 were consecutively enrolled. A multivariate logistic regression analysis was used to compare the risk of gallstone disease among metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO) groups. Finally, a random-effects model was employed to pool the Results from the four centers through meta-analysis. Results A total of 522 958 participants were recruited in this study, with an overall prevalence of gallstone disease of 7.5%. The prevalence of gallstone disease in the MUO, MUNO, MHO, and MHNO groups was 9.4%, 8.3%, 6.5%, and 4.2%, respectively, with statistically significant differences among the groups(all P < 0.05). Compared with the MHNO group, the risk of gallstone disease in the MHO group increased significantly by 35.8%(pooled OR=1.358; 95% CI: 1.213-1.520; P < 0.001); in the MUNO group, it increased by 34.3% (pooled OR=1.343; 95% CI: 1.211-1.489; P < 0.001); and in the MUO group, it increased by 48.9% (pooled OR=1.489; 95% CI: 1.221-1.817; P < 0.001). Subgroup analysis showed no significant differences in the association between metabolic obesity phenotypes and the risk of gallstone disease across different genders and age groups (all P>0.05). Conclusions Obesity, whether accompanied by metabolic abnormalities or not, significantly increases the risk of gallstone disease. Future efforts should focus on early screening and intervention for obese individuals, especially those with metabolic abnormalities, to reduce the burden of gallstone disease.
- Gallstones /
- Metabolic syndrome /
- Obesity

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图 1 不同代谢肥胖表型人群胆结石患病率森林图

MHNO：代谢健康非肥胖；MHO：代谢健康型肥胖；MUNO：代谢异常型非肥胖；MUO：代谢异常型肥胖；I²: 异质性指数。

Figure 1. Forest plot of gallstone prevalence for different metabolic obesity phenotypes

MHNO: metabolically healthy non-obese; MHO: metabolically healthy obesity; MUNO: metabolically unhealthy non-obese; MUO: metabolically unhealthy obesity; I²: I-squared statistic.

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图 2 多因素回归结果合并森林图

MHNO：代谢健康非肥胖；MHO：代谢健康型肥胖；MUNO：代谢异常型非肥胖；MUO：代谢异常型肥胖。

Figure 2. Combined forest plot of multivariate regression results

MHNO: metabolically healthy non-obese; MHO: metabolically healthy obesity; MUNO: metabolically unhealthy non-obese; MUO: metabolically unhealthy obesity.

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表 1 各中心研究对象基线特征

Table 1. Baseline characteristics of study population by centre

变量Variable	重庆市璧山区B医院B hospital in Bishan District, Chongqing (n= 131 478)				重庆开州区K医院K hospital in Kaizhou District, Chongqing (n= 250 947)
变量Variable	胆结石Gallstone^①	非胆结石Non-gallstone^①	χ²/Z值value	P值value	胆结石Gallstone^①	非胆结石Non-gallstone^①	χ²/Z值value	P值value
总人群Total	10 267	121 211			22 828		228 119
年龄/岁Age /years	52.0(43.0, 61.0)	39.0(31.0, 51.0)	-73.585	< 0.001	52.0(45.0, 60.0)	44.0(35.0, 52.0)	-86.981	< 0.001
性别Gender			107.681	< 0.001			896.076	< 0.001
男性Male	5 481(53.4)	71 084(58.6)			10 201(44.7)	125 560(55.0)
女性Female	4 786(46.6)	50 127(41.4)			12 627(55.3)	102 559(45.0)
BMI /(kg·m^-2)	24.4(22.4, 26.5)	23.2(21.0, 25.4)	-37.636	< 0.001	25.1(23.0, 27.2)	23.8(21.6, 26.1)	-54.202	< 0.001
DBP /mmHg	77.0(70.0, 86.0)	73.0(67.0, 82.0)	-35.807	< 0.001	79.0(71.0, 88.0)	76.0(69.0, 85.0)	-45.536	< 0.001
SBP /mmHg	128.0(116.0, 141.0)	121.0(111.0, 133.0)	-29.929	< 0.001	127.0(115.0, 141.0)	121.0(111.0, 134.0)	-28.810	< 0.001
FBG /(mmol·L^-1)	5.4(5.1, 6.0)	5.2(4.9, 5.6)	-36.962	< 0.001	5.5(5.2, 6.1)	5.3(5.0, 5.7)	-51.989	< 0.001
TC /(mmol·L^-1)	5.0(4.4, 5.6)	4.8(4.2, 5.6)	-14.222	< 0.001	5.1(4.5, 5.8)	5.0(4.4, 5.6)	-12.518	< 0.001
TG /(mmol·L^-1)	1.5(1.0, 2.2)	1.2(0.9, 1.9)	-30.658	< 0.001	1.6(1.1, 2.3)	1.3(0.9, 2.0)	-39.606	< 0.001
LDL-C /(mmol·L^-1)	3.0(2.5, 3.6)	2.9(2.4, 3.4)	-14.683	< 0.001	2.6(2.2, 3.1)	2.5(2.2, 3.0)	-17.499	< 0.001
HDL-C /(mmol·L^-1)	1.3(1.1, 1.6)	1.4(1.2, 1.6)	-12.517	< 0.001	1.3(1.1, 1.5)	1.4(1.2, 1.6)	-16.994	< 0.001
AST /(U·L^-1)	22.0(18.0, 27.0)	21.0(17.0, 26.0)	-10.330	< 0.001	24.0(20.0, 30.0)	23.0(19.0, 29.0)	-11.624	< 0.001
ALT /(U·L^-1)	22.0(16.0, 33.0)	21.0(14.0, 32.0)	-11.678	< 0.001	23.0(16.5, 34.0)	21.0(15.0, 32.0)	-17.114	< 0.001
GGT /(U·L^-1)	27.0(18.0, 45.0)	24.0(16.0, 40.0)	-22.105	< 0.001	26.0(17.0, 42.0)	22.0(15.0, 37.0)	-13.370	< 0.001
TBIL /(μmol·L^-1)	12.8(10.3, 16.2)	12.7(10.1, 16.1)	-3.252	0.001	―	―	―	―
SUA /(μmol·L^-1)	341.0(281.0, 407.0)	339.0(275.0, 408.0)	-2.802	< 0.001	333.8(277.7, 397.79)	333.6(274.3, 399.5)	-1.358	0.174
BUN /(mmol/L^-1)	5.1(4.3, 6.1)	5.0(4.2, 5.9)	-13.265	< 0.001	5.2(4.3, 6.2)	5.1(4.3, 6.1)	-11.138	< 0.001
脂肪肝Fatty liver	4 262(41.5)	31 551(26.0)	1 144.693	< 0.001	9 518(41.7)	61 563(27.0)	1 144.693	< 0.001
肾结石Kidney stone	559(5.4)	5 205(4.3)	29.887	< 0.001	854(3.7)	7 585(3.3)	11.051	0.001
胆囊息肉Gallbladder polyp	264(2.6)	10 504(8.7)	467.565	< 0.001	493(2.2)	21 920(9.6)	1 415.801	< 0.001
代谢肥胖表型Metabolic obesity phenotype			1 897.543	< 0.001			3 338.360	< 0.001
MHNO	3 589(35.0)	67 338(55.6)			6 703(29.4)	108 631(47.6)
MHO	1 377(13.4)	14 930(12.3)			3 636(15.9)	33 394(14.6)
MUNO	2 294(22.3)	18 878(15.6)			4 351(19.1)	35 951(15.8)
MUO	3 007(29.3)	20 065(16.6)			8 138(35.6)	50 143(22.0)

变量Variable	重庆黔江区Q医院Q hospital in Qianjiang District, Chongqing (n=70 156)				北京市昌平区T医院T hospital in Changping District, Beijing (n=70 377)
变量Variable	胆结石Gallstone^①	非胆结石Non-gallstone^①	χ²/Z值value	P值value	胆结石Gallstone^①	非胆结石Non-gallstone^①	χ²/Z值value	P值value
总人群Total	2 398	67 758			3 844	66 533
年龄/岁Age /years	52.0(44.0, 61.0)	33.0(22.0, 46.0)	-48.577	< 0.001	55.0(45.0, 68.0)	42.0(33.0, 52.0)	-50.202	< 0.001
性别Gender			73.134	< 0.001			2.266	0.132
男性Male	1 102(46.0)	37 134(54.8)			2 275(59.2)	40 189(60.4)
女性Female	1 296(54.0)	30 624(45.2)			1 569(40.8)	26 344(39.6)
BMI /(kg·m^-2)	24.6(22.5, 26.8)	23.7(21.5, 26.0)	-13.539	< 0.001	26.0(23.9, 28.2)	25.0(22.5, 27.4)	-17.302	< 0.001
DBP /mmHg	79.0(71.0, 86.5)	76.1(69.0, 84.0)	-14.680	< 0.001	76.0(70.0, 82.0)	74.0(67.0, 80.0)	-10.392	< 0.001
SBP /mmHg	129.0(117.0, 141.0)	124.0(113.0, 135.0)	-10.120	< 0.001	125.0(115.0, 137.0)	119.0(110.0, 130.0)	-22.282	< 0.001
FBG /(mmol·L^-1)	5.3(4.9, 5.9)	5.2(4.7, 5.7)	-12.720	< 0.001	5.5(5.1, 6.1)	5.2(4.9, 5.6)	-23.046	< 0.001
TC /(mmol·L^-1)	5.0(4.4, 5.6)	4.9(4.3, 5.5)	-4.784	< 0.001	4.9(4.2, 5.5)	4.7(4.2, 5.4)	-7.696	< 0.001
TG /(mmol·L^-1)	1.8(1.2, 2.5)	1.7(1.1, 2.6)	-4.878	< 0.001	1.4(1.0, 2.0)	1.2(0.8, 1.9)	-11.356	< 0.001
LDL-C /(mmol·L^-1)	2.7(2.2, 3.2)	2.6(2.1, 3.1)	-4.662	< 0.001	3.0(2.5, 3.6)	2.9(2.4, 3.5)	-6.902	< 0.001
HDL-C /(mmol·L^-1)	1.3(1.1, 1.5)	1.4(1.1, 1.6)	-6.588	< 0.001	1.3(1.1, 1.5)	1.3(1.1, 1.5)	-5.345	< 0.001
AST /(U·L^-1)	23.0(16.2, 33.9)	19.4(13.0, 32.0)	-12.036	< 0.001	20.5(17.1, 24.9)	20.0(17.0, 24.2)	-5.070	< 0.001
ALT /(U·L^-1)	23.0(19.0, 28.5)	22.1(18.0, 28.2)	-5.374	< 0.001	19.6(14.5, 27.8)	19.0(13.5, 28.0)	-4.055	< 0.001
TBIL /(μmol·L^-1)	13.3(10.6, 16.9)	13.6(10.4, 17.7)	-1.730	0.084	―	―	―	―
SUA /(μmol·L^-1)	―	―	―	―	337.4(281.4, 397.0)	326.0(267.0, 389.0)	-7.803	< 0.001
脂肪肝Fatty liver	1 056(44.0)	8 003(11.8)	2 138.824	< 0.001	9 518(41.7)	61 563(27.0)	186.847	< 0.001
肾结石Kidney stone	61(2.5)	659(1.0)	56.289	< 0.001	279(7.3)	2 152(3.2)	176.412	< 0.001
高血压Hypertension	―	―	―	―	1 773(46.1)	17 108(25.7)	771.170	< 0.001
糖尿病Diabetes	―	―	―	―	755(19.6)	5 847(8.8)	503.518	< 0.001
代谢肥胖表型Metabolic obesity phenotype			151.281	< 0.001			510.085	< 0.001
MHNO	738(30.8)	28 426(42.0)			1 124(29.7)	30 251(45.5)
MHO	338(14.1)	8 402(12.4)			444(11.6)	9 055(13.6)
MUNO	581(24.2)	15 811(23.3)			317(8.2)	3 078(4.6)
MUO	741(30.9)	15 119(22.3)			1 941(50.5)	24 149(36.3)
注：DBP，舒张压；SBP，收缩压；FBG，空腹血糖；TC，总胆固醇；LDL-C，低密度脂蛋白胆固醇；HDL-C，高密度脂蛋白胆固醇；TG，三酰甘油；AST，天冬氨酸氨基转移酶；ALT，γ-谷氨酰转移酶；GGT，丙氨酸氨基转移酶；TBIL，总胆红素；SUA，血清尿酸；BUN，尿素氮；MHNO，代谢健康非肥胖；MHO，代谢健康型肥胖；MUNO，代谢异常型非肥胖；MUO，代谢异常型肥胖；“―”表示该中心缺乏该数据。 ①以人数(占比/%)或M(P₂₅, P₇₅)表示。 Note: DBP, diastolic blood pressure; SBP, systolic blood pressure; FBG, fasting blood glucose; TC, total cholesterol; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; TG, triglycerides; AST, aspartate aminotransferase; ALT, alanine aminotransferase; GGT, gamma-glutamyl transferase; TBIL, total bilirubin; SUA, serum uric acid; BUN, blood urea nitrogen; MHNO, metabolically healthy non-obese; MHO, metabolically healthy obesity; MUNO, metabolically unhealthy non-obese; MUO, metabolically unhealthy obesity; "―" indicates that the center lacks the data. ① Number of people(proportion/%) or M(P₂₅, P₇₅).

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表 2 胆结石与代谢肥胖表型的相关性多因素logistic回归分析

Table 2. Multifactorial logistic regression analysis of the correlation between gallstones and metabolic obesity phenotype

变量Variable	重庆市璧山区B医院B hospital in Bishan District, Chongqing		重庆市开州区K医院K hospital in Kaizhou District, Chongqing		重庆市黔江区Q医院Q hospital in Qianjiang District, Chongqing		北京市昌平区T医院T hospital in Changping District, Beijing
变量Variable	OR值value (95% CI)	P值value	OR值value (95% CI)	P值value	OR值value (95% CI)	P值value	OR值value (95% CI)	P值value
总计Total
MHNO	1.000		1.000		1.000		1.000
MHO	1.469(1.370~1.576)	< 0.001	1.526(1.458~1.596)	< 0.001	1.169(1.018~1.343)	0.027	1.222(1.086~1.376)	0.001
MUNO	1.454(1.369~1.545)	< 0.001	1.435(1.375~1.498)	< 0.001	1.082(0.963~1.215)	0.187	1.385(1.208~1.587)	< 0.001
MUO	1.781(1.670~1.899)	< 0.001	1.828(1.752~1.907)	< 0.001	1.063(0.946~1.195)	0.306	1.388(1.268~1.519)	< 0.001
性别Gender
男性Male
MHNO	1.000		1.000		1.000		1.000
MHO	1.488(1.356~1.632)	< 0.001	1.553(1.450~1.664)	< 0.001	1.146(0.934~1.407)	0.191	1.266(1.089~1.471)	0.002
MUNO	1.402(1.287~1.527)	< 0.001	1.370(1.280~1.466)	< 0.001	1.186(0.987~1.425)	0.069	1.374(1.146~1.648)	0.001
MUO	1.831(1.683~1.992)	< 0.001	1.797(1.686~1.915)	< 0.001	1.267(1.068~1.504)	0.007	1.455(1.307~1.619)	< 0.001
性别Gender
女性Female
MHNO	1.000		1.000		1.000		1.000
MHO	1.465(1.313~1.634)	< 0.001	1.498(1.410~1.592)	< 0.001	1.241(1.025~1.502)	0.027	1.395(1.162~1.674)	< 0.001
MUNO	1.488(1.365~1.623)	< 0.001	1.474(1.394~1.559)	< 0.001	1.007(0.864~1.173)	0.931	1.533(1.251~1.880)	< 0.001
MUO	1.676(1.512~1.858)	< 0.001	1.853(1.747~1.964)	< 0.001	0.874(0.740~1.033)	0.114	1.773(1.569~2.004)	< 0.001
年龄组/岁Age group/years
≤40
MHNO	1.000		1.000		1.000		1.000
MHO	1.919(1.664~2.212)	< 0.001	1.885(1.695~2.097)	< 0.001	1.121(0.838~1.500)	0.442	1.740(1.347~2.248)	< 0.001
MUNO	1.645(1.417~1.910)	< 0.001	1.606(1.424~1.810)	< 0.001	0.789(0.603~1.031)	0.083	1.904(1.135~3.194)	0.015
MUO	2.317(1.986~2.704)	< 0.001	2.011(1.787~2.264)	< 0.001	0.951(0.726~1.245)	0.715	1.551(1.204~1.998)	0.001
＞40~＜60
MHNO	1.000		1.000		1.000		1.000
MHO	1.317(1.194~1.452)	< 0.001	1.460(1.380~1.544)	< 0.001	1.118(0.927~1.349)	0.243	1.118(0.944~1.324)	0.198
MUNO	1.367(1.257~1.488)	< 0.001	1.405(1.331~1.483)	< 0.001	1.174(1.005~1.371)	0.043	1.481(1.196 ~1.835)	< 0.001
MUO	1.688(1.544~1.846)	< 0.001	1.768(1.677~1.865)	< 0.001	1.049(0.897~1.226)	0.552	1.557(1.369~1.772)	< 0.001
≥60
MHNO	1.000		1.000		1.000		1.000
MHO	1.510(1.307~1.746)	< 0.001	1.465(1.313~1.634)	< 0.001	1.334(0.997~1.784)	0.052	1.189(0.946~1.494)	0.138
MUNO	1.486(1.333~1.656)	< 0.001	1.395(1.277~1.525)	< 0.001	1.166(0.913~1.489)	0.220	1.153(0.952~1.396)	0.146
MUO	1.676(1.491~1.885)	< 0.001	1.831(1.672~2.006)	< 0.001	1.212(0.954~1.540)	0.115	1.119(0.967~1.295)	0.130
注：MHNO，代谢健康非肥胖；MHO，代谢健康型肥胖；MUNO，代谢异常型非肥胖；MUO，代谢异常型肥胖。 Note: MHNO, metabolically healthy non-obese; MHO, metabolically healthy obesity; MUNO, metabolically unhealthy non-obese; MUO, metabolically unhealthy obesity.

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参考文献(25)

[1]	Wang X, Yu WQ, Jiang GH, et al. Global epidemiology of gallstones in the 21st century: a systematic review and Meta-analysis [J]. Clin Gastroenterol Hepatol, 2024, 22(8): 1586-1595. DOI: 10.1016/j.cgh.2024.01.051.
[2]	Lammert F, Wittenburg H. Gallstones: prevention, diagnosis, and treatment [J]. Semin Liver Dis, 2024, 44(3): 394-404. DOI: 10.1055/a-2378-9025.
[3]	Ratheesh R, Ulrich MT, Ghozy S, et al. The association between diabetes and gallstones: a nationwide population-based cohort study [J]. Prz Gastroenterol, 2023, 18(3): 292-299. DOI: 10.5114/pg.2023.131395.
[4]	Luo X, Yang WS, Joshi AD, et al. Gallstones and risk of cancers of the liver, biliary tract and pancreas: a prospective study within two U.S. cohorts [J]. Br J Cancer, 2022, 127(6): 1069-1075. DOI: 10.1038/s41416-022-01877-5.
[5]	Yuan S, Gill D, Giovannucci EL, et al. Obesity, type 2 diabetes, lifestyle factors, and risk of gallstone disease: a Mendelian randomization investigation [J]. Clin Gastroenterol Hepatol, 2022, 20(3): e529-e537. DOI: 10.1016/j.cgh.2020.12.034.
[6]	BLüHER M. Metabolically Healthy Obesity [J]. Endocrine reviews, 2020, 41(3). DOI: 10.1210/endrev/bnaa004.
[7]	Janota O, Mantovani M, Kwiendacz H, et al. Metabolically "extremely unhealthy" obese and non-obese people with diabetes and the risk of cardiovascular adverse events: the Silesia diabetes - heart project [J]. Cardiovasc Diabetol, 2024, 23(1): 326. DOI: 10.1186/s12933-024-02420-x.
[8]	Stefan N. Causes, consequences, and treatment of metabolically unhealthy fat distribution [J]. Lancet Diabetes Endocrinol, 2020, 8(7): 616-627. DOI: 10.1016/S2213-8587(20)30110-8.
[9]	Dvo r ˇ ák K. Diagnostic methods of fatty liver diseases [J]. Cas Lek Cesk, 2022, 161(2): 57-60.
[10]	Thongprayoon C, Krambeck AE, Rule AD. Determining the true burden of kidney stone disease [J]. Nat Rev Nephrol, 2020, 16(12): 736-746. DOI: 10.1038/s41581-020-0320-7.
[11]	Kamaya A, Fung C, Szpakowski JL, et al. Management of incidentally detected gallbladder polyps: society of radiologists in ultrasound consensus conference recommendations [J]. Radiology, 2022, 305(2): 277-289. DOI: 10.1148/radiol.213079.
[12]	WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies [J]. Lancet, 2004, 363(9403): 157-163. DOI: 10.1016/S0140-6736(03)15268-3.
[13]	Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel Ⅲ) [J]. JAMA, 2001, 285(19): 2486-2497. DOI: 10.1001/jama.285.19.2486.
[14]	Lin L, Zhang J, Jiang L, et al. Transition of metabolic phenotypes and risk of subclinical atherosclerosis according to BMI: a prospective study [J]. Diabetologia, 2020, 63(7): 1312-1323. DOI: 10.1007/s00125-020-05116-5.
[15]	Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group [J]. JAMA, 2000, 283(15): 2008-2012. DOI: 10.1001/jama.283.15.2008.
[16]	Zhang JL, Chen LL, Shen KQ, et al. Association between metabolically healthy overweight/obesity and gallstones in Chinese adults [J]. Nutr Metab, 2023, 20(1): 20. DOI: 10.1186/s12986-023-00741-4.
[17]	Man S, Gao YX, Lyu J, et al. Metabolically healthy obesity was significantly associated with increased risk of gallstones [J]. Eur J Endocrinol, 2022, 186(2): 275-283. DOI: 10.1530/EJE-21-0802.
[18]	Su PY, Hsu YC, Cheng YF, et al. Strong association between metabolically-abnormal obesity and gallstone disease in adults under 50 years [J]. BMC Gastroenterol, 2019, 19(1): 117. DOI: 10.1186/s12876-019-1032-y.
[19]	Unalp-Arida A, Ruhl CE. Increasing gallstone disease prevalence and associations with gallbladder and biliary tract mortality in the US [J]. Hepatology, 2023, 77(6): 1882-1895. DOI: 10.1097/HEP.0000000000000264.
[20]	Lee KX, Quek KF, Ramadas A. Dietary and lifestyle risk factors of obesity among young adults: a scoping review of observational studies [J]. Curr Nutr Rep, 2023, 12(4): 733-743. DOI: 10.1007/s13668-023-00513-9.
[21]	Takei A, Nagashima S, Takei S, et al. Myeloid HMG-CoA reductase determines adipose tissue inflammation, insulin resistance, and hepatic steatosis in diet-induced obese mice [J]. Diabetes, 2020, 69(2): 158-164. DOI: 10.2337/db19-0076.
[22]	DeForest N, Wang YQ, Zhu ZY, et al. Genome-wide discovery and integrative genomic characterization of insulin resistance loci using serum triglycerides to HDL-cholesterol ratio as a proxy [J]. Nat Commun, 2024, 15(1): 8068. DOI: 10.1038/s41467-024-52105-y.
[23]	Kubica K, Balbus J. A computer study of the risk of cholesterol gallstone associated with obesity and normal weight [J]. Sci Rep, 2021, 11(1): 8868. DOI: 10.1038/s41598-021-88249-w.
[24]	Li Y, Onodera T, Scherer PE. Adiponectin [J]. Trends Endocrinol Metab, 2024, 35(7): 674-675. DOI: 10.1016/j.tem.2024.05.004.
[25]	Yu JJ, Meng ZA, Liu XX, et al. Lipopolysaccharide in bile promotes the neutrophil extracellular traps-induced gallstone formation by activating the gallbladder immune barrier [J]. Immunotargets Ther, 2024, 13: 789-803. DOI: 10.2147/ITT.S495095.