Abstract
BACKGROUND: Gallstone disease is one of the most prevalent digestive disorders globally, showing a trend toward increasing incidence and younger onset in Asian populations. Against this backdrop, this study aims to investigate the associations between 14 different obesity and lipid-related indices and gallstones, and to compare their predictive value for gallstone screening in the Chinese population. METHODS: This study included 44,030 adult participants from the Beijing MJ Health Screening Center (2009–2023). Individuals with a history of cholecystectomy or gallstones at baseline were excluded. Gallstones were diagnosed via abdominal B-mode ultrasonography. Fourteen indices were calculated and evaluated, including BMI, WHtR, BRI, ABSI, LAP, VAI, CMI, CVAI, RFM, AIP, TyG, TyG-BMI, TyG-WC, and TyG-WHtR. Cox proportional hazards regression models were employed to assess the associations between these indices and gallstone risk, with stratified analyses performed by age (< 45 and ≥ 45 years) and sex. Restricted cubic splines (RCS) were used to evaluate non-linear relationships, and the performance and accuracy of prediction models were assessed using the C-index, calibration curves, Integrated Discrimination Improvement (IDI), and Net Reclassification Improvement (NRI). RESULTS: During the follow-up period, a total of 933 (2.12%) participants were diagnosed with new-onset gallstones. Multivariate-adjusted analyses revealed that, with the exception of ABSI, the remaining 13 indices were significantly and positively associated with gallstone risk. Stratified analysis uncovered significant population heterogeneity: CVAI demonstrated the optimal predictive ability in the young male, young female, and middle-aged/elderly male subgroups (C-indices: 0.611, 0.673, and 0.603, respectively), significantly outperforming other indices. Conversely, WHtR exhibited the best predictive performance in the middle-aged/elderly female subgroup (C-index: 0.589). Further validation indicated that the prediction model based on CVAI (for adult males and young females) possessed favorable discrimination and calibration, whereas the WHtR-based model (for middle-aged/elderly females) performed suboptimally. CONCLUSION: This study confirms that 13 obesity and lipid-related indices, excluding ABSI, are independent risk factors for gallstones in the Chinese population. The results support the implementation of a stratified risk assessment strategy: CVAI is identified as the preferred risk indicator for adult males and young females; for middle-aged and elderly females, WHtR may serve as a preliminary risk assessment tool to identify individuals who warrant further diagnostic evaluation. This study provides a scientific, convenient, and non-invasive assessment basis for the risk stratification and personalized intervention of gallstones in clinical practice. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12944-026-02915-4.