Factors associated with gallbladder polyps among adults with metabolic dysfunction-associated fatty liver disease: a cross-sectional study with subgroup analyses

Objective This study aims to explore factors associated with gallbladder polyps among patients with metabolic dysfunction-associated fatty liver disease (MAFLD) and its different subgroups. Methods Utilizing health promotion center data, this cross-sectional observational study categorized participants into gallbladder polyp and control groups based on ultrasound. MAFLD patients were stratified into subgroups using consensus criteria. Gallbladder polyp and control characteristics were compared. Gallbladder polyp associated factors were identified via multivariable logistic regression in the entire cohort and separately within each MAFLD subgroup. Results In total, 51 420 participants were enrolled, among whom 9 341 (18.17%) had gallbladder polyps. Although MAFLD was more frequent among participants with gallbladder polyps in crude unadjusted comparisons, MAFLD showed no independent association with gallbladder polyps after multivariable adjustment. In multivariable-adjusted analyses among MAFLD participants, male gender 1.743 (1.605-1.893) and smoking 1.069 (1.014-1.127) showed statistically significant associations with gallbladder polyps. Diastolic blood pressure 1.004 (1.002-1.006) and 25(OH)D 1.005 (1.002-1.009) also reached adjusted statistical significance; however, their OR values were very close to 1.0, and these associations are likely driven by the large sample size with limited clinical relevance. In the MAFLD with type 2 diabetes subgroup, male gender 2.433 (1.478-4.003) showed an adjusted statistical association. In the overweight/obese MAFLD subgroup, male gender 1.834 (1.604-2.098) and smoking 1.142 (1.065-1.224) showed adjusted statistical associations. In the lean MAFLD subgroup, male gender 1.875 (1.345-2.615) and elevated diastolic blood pressure 1.019 (1.007-1.031) showed adjusted statistical association, with a small effect size for diastolic blood pressure. Conclusion Although a higher proportion of MAFLD was observed among participants with gallbladder polyps in crude comparisons, MAFLD was not an independently associated factor for gallbladder polyps after multivariable adjustment. Factors associated with gallbladder polyps differ across MAFLD subgroups. BMI showed no association with gallbladder polyps in the health-check population and the overall MAFLD cohort; however, a weak statistically significant association of BMI with gallbladder polyps was observed within the overweight/obese MAFLD subgroup.