Abstract
BACKGROUND/OBJECTIVE: Gallstone disease (GSD) is a common hepatobiliary condition closely associated with metabolic disturbances. The triglyceride-glucose index (TyG index), a widely used surrogate marker of insulin resistance, has gained attention as a potential indicator of gallstone risk. This systematic review and meta-analysis aimed to synthesize observational evidence evaluating the association between TyG index and GSD in adults. METHODS: Web of Science, Embase, and PubMed were searched from inception to December 2025 for relevant observational studies. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Adjusted odds ratios (aORs), standardized mean differences (SMDs), adjusted hazard ratios (aHRs), and prevalence estimates were pooled using a random-effects model (REM). Sensitivity analyses, subgroup analyses, and assessment of publication bias were conducted. RESULTS: Nine studies including more than 430 000 participants were included. For each one-unit increase in the TyG index, the pooled odds ratio for GSD was 1.332 (95% CI: 1.213-1.462; I (2) = 0%). When comparing the highest versus lowest TyG categories, the summary OR was 1.678 (95% CI: 1.150-2.448). Participants with GSD had higher TyG values than those without GSD (pooled SMD: 0.29; 95% CI: 0.26-0.32). The pooled prevalence of GSD was 10.51% (95% CI: 5.40-19.44), with heterogeneity (I (2) = 99.8%). Subgroup analyses were performed according to body mass index (BMI), sex, diabetes, and race. CONCLUSION: Higher TyG index values are consistently linked to elevated risk of GSD. Given that TyG is inexpensive and routinely available, it may be useful for identifying individuals at a heightened risk of GSD. More longitudinal studies are needed to determine causation and to assess whether TyG-based screening can improve GSD risk prediction or prevention.