Lipid accumulation product and gallstone risk in US adults: A cross-sectional analysis of NHANES 2017–2020 data

Background Abdominal obesity and insulin resistance are key risk factors for gallstones. The Lipid Accumulation Product (LAP), which combines waist circumference and triglyceride levels, may be a superior marker for visceral fat accumulation. However, its association with gallstone risk is unclear. Methods Data from 3294 participants in the National Health and Nutrition Examination Survey (NHANES) 2017–2020 cycle were analyzed. Weighted logistic regression, subgroup analyses, and restricted cubic spline (RCS) analysis explored the relationship between LAP and gallstone risk. ROC analysis, along with Random Forest and CatBoost models, compared the predictive abilities of LAP with BMI. Results Weighted logistic regression analysis showed that each unit increase in Ln-LAP was associated with a 52% higher risk of gallstones (OR: 1.52; 95% CI: 1.24–1.86; P = 0.009). Compared to the lowest tertile (T1), the second tertile (T2) had a higher risk of gallstones (OR: 1.76; 95% CI: 1.09–2.84; P = 0.082), and the third tertile (T3) had an even higher risk (OR: 2.27; 95% CI: 1.47–3.49; P = 0.021). RCS analysis showed a nonlinear positive relationship between Ln-LAP and gallstone risk (non-linear P < 0.001). Subgroup analyses indicated that Ln-LAP was significantly positively associated with the risk of gallstones in most subgroups, with no significant interactions observed among the subgroups. Weighted logistic regression analysis revealed a significant positive association between BMI ≥ 30 kg/m 2 (obesity) and the risk of gallstones. ROC analysis indicated that Ln-BMI is a better predictor of gallstone risk than Ln-LAP. However, in Random Forest and CatBoost models, LAP exhibited predictive value similar to BMI for gallstone risk. Conclusion While LAP is significantly and positively associated with an increased risk of gallstones, BMI generally appears to be a stronger predictor. However, LAP may still serve as a comparable marker under specific modeling conditions. Further research is needed to explore the relationship between LAP and gallstone risk.