The potential of 8 insulin resistance indicators as biomarkers for predicting gallstone risk in American adults: A cross-sectional NHANES study

Insulin resistance (IR) serves as a key mechanism underlying both obesity and metabolic syndrome, exerting significant impacts on the onset and progression of gallstones. This study systematically explores the associations between 8 IR indicators and the risk of gallstones in American adults, while evaluating the diagnostic value of these indicators in predicting gallstones. This cross-sectional study analyzed data from the 2017 to 2020 National Health and Nutrition Examination Survey (NHANES) to explore the association between 8 IR indicators and gallstone risk. The included indicators were: triglyceride-glucose (TyG)-relative fat mass (TyG-RFM), TyG-body roundness index (TyG-BRI), TyG-lipid accumulation product (TyG-LAP), TyG-A body shape index (TyG-ABSI), TyG-waist-to-height ratio (TyG-WHtR), TyG-weight-adjusted waist index (TyG-WWI), TyG-body mass index (TyG-BMI), and TyG-waist circumference (TyG-WC). Weighted logistic regression analysis, restricted cubic spline curves, inflection point analysis, subgroup analysis, and receiver operating characteristic curves were employed to investigate the association between these indicators and gallstones, as well as their diagnostic accuracy. A total of 3644 participants were included, of whom 384 (10.54%) had gallstones. The results showed that TyG-RFM, TyG-BRI, TyG-WHtR, TyG-WWI, TyG-BMI, and TyG-WC were significantly positively associated with the risk of gallstones. Specifically, the risk of gallstones increased linearly with elevated levels of TyG-RFM, TyG-WHtR, TyG-BMI, and TyG-WC, whereas TyG-WWI and TyG-BRI exhibited a nonlinear positive correlation with gallstones. No significant correlation was observed between TyG-LAP or TyG-ABSI and gallstones. Subgroup analysis indicated that the positive correlation was more pronounced in the 20 to 40 years age group, but relatively weaker in those over 40 years of age ( P for interaction < .05). Receiver operating characteristic curve analysis demonstrated that TyG-RFM outperformed the other 7 IR indicators in predicting gallstone risk, showing particularly prominent performance in the 20 to 40 years age group (area under the curve = 0.790). The DeLong test confirmed that the difference in area under the curve between TyG-RFM and the other indicators was statistically significant ( P < .05). TyG-RFM, TyG-BRI, TyG-WHtR, TyG-WWI, TyG-BMI, and TyG-WC were significantly associated with the risk of gallstones among US adults. Notably, TyG-RFM demonstrated the highest predictive ability, particularly in individuals aged 20 to 40 years.