Risk factors for cholesterol polyps in the gallbladder: a multicenter retrospective case-control study

Risk factors for cholesterol polyps in the gallbladder: a multicenter retrospective case-control study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Risk factors for cholesterol polyps in the gallbladder: a multicenter retrospective case-control study Wenqing Bao, Anan Xu, Jing Yang, Shubin Ni, Guanglong Hu, Tianyu Tang, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1902351/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: Gallbladder polyps are often found in clinical examination, of which cholesterol polyps (CPs) account for the vast majority. However, there is limited evidence-based guidance on the management of CPs patients. This study aimed to determine the risk factors for CPs formation and provide bases for optimizing treatment and prevention strategies. Methods: In this multicenter retrospective case-control study, patients with pathologically-proven CPs between September 2018 to June 2022 were included in the CPs group. The control group included age- and gender-matched subjects sonographically diagnosed without GPs or other gallbladder lesions, randomly selected from the health checkup center in a 1:1 (CPs: control) ratio. Clinical characteristics, ultrasound findings, and laboratory examination results were reviewed and compared between the two groups to determine the risk factors for CPs. Results: In total, 3110 patients who met the inclusion criteria were equally enrolled in CPs and the control groups. The mean age of CPs patients was 41.66±13.18 years, with the highest proportion in the 30-39 years group. On multivariate analysis, triacylglycerol ≥ 2.3mmol/L, decreased high-density lipoprotein (HDL), and fatty liver were significantly associated with CPs ( P < 0.001, P < 0.001 and P = 0.001, respectively). There was no strong correlation between CPs and other parameters, such as body mass index, blood pressure, total cholesterol, and liver function. Conclusion: The morbidity of CPs displayed a younger trend and was closely associated with two types of dyslipidemia: decreased HDL and increased triacylglycerol. Moreover, fatty liver was found to be an independent risk factor for CPs. Gallbladder polyps Cholesterol polyps Dyslipidemia Fatty liver Risk factors Figures Figure 1 Figure 2 Introduction Gallbladder polyps (GPs) have become one of the most prevalent biliary tract lesions with the widespread use of better medical imaging in routine health checkups, and the prevalence of GPs assessed by ultrasonography in global adults is approximately 3 to 12% [1-4]. GPs are broadly categorized as non-neoplastic lesions and neoplastic lesions. Cholesterol polyps (CPs) are the most common type of non-neoplastic lesions, while neoplastic lesions consist of adenomas and adenocarcinomas, treated as premalignant neoplasms or cancerous [5]. In past decades, a considerable number of patients underwent surgical treatments in line with GPs management guidelines due to concerns about malignant transformation [6]. Actually, not a few studies have shown that over 80% of GPs confirmed by pathology were harmless CPs [7,8]. Since cholecystectomies are unnecessary for most CPs patients, excessive surgeries will undoubtedly result in the patients suffering from surgical trauma, related complications, and financial burden. Hence, knowledge of factors associated with CPs can help improve treatment or early intervention strategies. Previous studies have profoundly investigated the risk factors for GPs formation, including middle age, male gender, obesity, fatty liver, abnormal body fat distribution, and dyslipidemia, but most of them were based on ultrasound results rather than specifying the exact histological classification [9-11]. Given that risk factors and the mechanisms of pathophysiologic mechanisms are quite different in various GPs, pathology-oriented analysis is undoubtedly more convincing [12]. However, so far, there is a paucity of data from high-level studies lucubrating CPs [13,14]. Therefore, it is of great value to explore CPs from the perspective of postoperative pathology based on a large sample size. This study aimed to determine the risk factors for CPs formation through a multicenter database to provide meaningful bases for the management and preclinical prevention of CPs. Material And Methods Study subjects This study included and analyzed data of postoperative patients pathologically diagnosed with CPs from September 2018 to June 2022 at six Chinese hospitals. (Gallbladder Diseases Center, Tongji University Affiliated Shanghai East Hospital; Department of General Surgery, Shanghai University of Traditional Chinese Medicine Affiliated Shanghai Seventh People's Hospital; Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Wannan Medical College; Department of Gallbladder Diseases, Zhengzhou People's Hospital; Department of Hepatobiliary Surgery, Xuzhou Medical University Affiliated Changshu Hospital; The Fourth Department of Hepatic Surgery, The Third Affiliated Hospital of Naval Military Medical University). Considering that age and gender are physiologic factors strongly influencing plasma lipid levels, we enrolled age- and gender-matched subjects randomly selected among subjects without GPs, recruited from the health checkup center of Shanghai Seventh People's Hospital, in a 1:1 (CPs: control) ratio as the control group to avoid related confounders [15]. The exclusion criteria for the CPs patients were as follows: (1) patients who were taking lipid-lowering drugs and (2) comorbid with other gallbladder lesions such as cholelithiasis or mixed polyps. Subjects in the control group meeting the following criteria were excluded: (1) those who were diagnosed with any gallbladder lesions; (2) those who have already undergone cholecystectomy; and (3) those who lacked necessary data. The study protocol was approved by the ethics committee of the above hospitals, and all procedures were conducted following the Declaration of Helsinki. Clinical and laboratory evaluations The baseline characteristics of recruited patients included general information and laboratory tests of age, gender, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), fasting blood glucose (FBG), alanine aminotransferase (ALT), aspartate aminotransferase (AST). Serum chemical tests of all participants were performed after overnight fasting. Fatty liver was confirmed by ultrasound or other imaging reports. Body mass index (BMI) was calculated by dividing weight (kg) by height squared (m 2 ), and obese status was identified by BMI ≥ 25kg/m 2 according to the WHO BMI criteria for Asian populations. Dyslipidemia was characterized when any of the following criteria: (1) hypercholesterolemia: ≥ 6.2 mmol/L; (2) hypertriglyceridemia: ≥ 2.3 mmol/L; and (3) decreased HDL: < 1.03 mmol/L in men or < 1.29 mmol/L in women. Statistical analysis Categorical variables, expressed as frequencies and percentages, were analyzed using the Chi-square test or Fisher’s exact test. Continuous variables, expressed as mean ± standard deviation or as median (25 th percentile, 75 th percentile), were compared using independent Student T-test or Mann-Whitney U test depending on skewed or normally distributed variables. Variables showing significance on univariate analysis were further analyzed using multivariate binary logistic regression analysis to determine the significant predictors associated with CPs. Statistical analyses were performed using SPSS version 26.0 (IBM). P values < 0.05 was considered statistically significant. Results General information We identified 2139 postoperative patients with pathologically diagnosed GPs and 7624 health checkups subjects (Figure 1). After excluding patients with other types of GPs or cholelithiasis, 1555 CPs patients who met the inclusion criteria were enrolled in the CPs group. Figure 2 showed the age and gender proportional distribution of the CPs groups. The proportion of CPs patients by age peaked in the 30-39 year group, and the proportion of female patients over 50 years was higher than that of male patients. According to exclusion criteria, the study excluded 281 and 827 subjects who had undergone cholecystectomy or ultrasound-diagnosed gallbladder lesions, and 1555 age- and gender-matched subjects without GPs were included in the control group. Clinical and laboratory tests characteristics The demographic and clinical characteristics of the CPs group and the control group were summarized in Table 1. The mean age of subjects was 41.66 ± 13.18 years, and the females accounted for 53.38%. In terms of dyslipidemia, the HDL level in the CPs group was significantly lower than that in the controls (1.36±0.37vs.1.48±0.32 mmol/L), and the median TG level (25 th percentile, 75 th percentile) was higher in the CPs group [1.06 (0.74,1.6) mmol/L] compared to the control group [0.93 (0.66,1.25) mmol/L]. Nearly 33% of patients in the CPs group showed high LDL levels, significantly higher than 29.52% in the control group. The proportion of patients with fatty liver in the CPs group (44.12%) was significantly higher than that in the control group (38.39%). There was no significant difference between the two groups in BMI, SBP, DBP, TC, FBG, AST, and ALT. Risk factors for CPs On univariate analysis, several clinical and laboratory variables showed significant associations with CPs, including fatty liver ( P = 0.001), LDL > 3.12mmol/L ( P = 0.044), TG ≥ 2.3mmol/L ( P < 0.001), and decreased HDL ( P < 0.001). On multivariate analysis, fatty liver, TG ≥ 2.3mmol/L, and decreased HDL were independent risk factors for CPs formation (OR = 1.285, P = 0.001; OR = 1.9, P < 0.001; and OR = 1.632, P < 0.001, respectively) (Table 2) Discussion GPs have become a global public health problem, and the management of GPs has been extensively investigated [16,17]. However, CPs, the most common type of GPs, have not received much attention due to their benign nature. Moreover, even if surgical treatment is unnecessary for CPs patients in most cases, we still have to face the following dilemmas in clinical practice. Firstly, CPs can develop typical biliary colic symptoms caused by obstructing the gallbladder outflow, similar to cholelithiasis [18]. Secondly, a considerable proportion of resected GPs that showed rapid growth or obvious size progression proved to be CPs [19,20]. According to the latest management guidelines, cholecystectomy is advised for patients when they encounter the above status, and it would be a great pity to lose gallbladder functions because of CPs [21]. Hence, we conducted this study from 6 centers in 4 Chinese cities to investigate the risk factors for CPs with a view to early prevention and targeted therapy. This study indicated that decreased HDL, increased TG, and fatty liver were significantly related to the development of CPs. Several previous studies have reported that GPs are the most common in middle-aged subjects, peaking in 40-59 years [22,23]. However, our findings indicated that the onset age of CPs appeared to be earlier. In this study, the mean age of the CPs group was 41.66±13.18 years, with the highest proportion in the 30–39 age group. This inconsistency may result from the histological type of GPs being not determined in prior studies, and the mean age of patients with neoplastic polyps was generally higher than that of CPs patients [24]. The other explanation is the younger trend of dyslipidemia. A recent study among the large Chinese population reported that dyslipidemia was closely correlated with GPs formation [25]. Meanwhile, evidence showed that the prevalence of dyslipidemia in young adults has increased during the past decade with the lifestyle change, and decreased HDL and hypertriglyceridemia were the two main types of dyslipidemia, which was consistent with the results in our study [26,27]. This study identified decreased HDL significantly related to CPs formation, consistent with the survey of Zheng et al., whereas our findings showed no direct association between CPs and LDL on multivariate analysis despite LDL being associated with CPs on univariate analysis [14]. HDL plays a vital role in accepting cholesterol from cells and promotes reverse cholesterol transportation (RCT), which is essential for maintaining cholesterol metabolism balance in gallbladders [28]. Decreased HDL can inhibit the process of RCT and cholesterol elimination in the gallbladder mucous membrane, which may lead to the development of CPs [29]. In addition, a recent cohort study found that the non-HDL/HDL ratio, a superior marker for coronary heart disease, was an independent risk factor for GPs formation [30]. The non-HDL/HDL ratio may contain more information on cholesterol transport than non-HDL or other lipoprotein levels, and it would be meaningful for exploring the relationship between the non-HDL/HDL ratio and CPs. It has not been fully discovered whether there is a relationship between TC or TG levels and CPs. Some studies have demonstrated that elevated TG level is a risk factor for GPs, while others have discrepant results [31,32]. We found that the TG level in the CPs group was significantly higher than that in the controls. Abnormal TG levels were reported to impair gallbladder motility by reducing gallbladder sensitivity to cholecystokinin and be associated with some gallbladder cholesterol diseases such as cholelithiasis and cholesterolosis, which might share similar pathological processes with CPs formation [33,34]. Fatty liver is currently viewed as a hepatic manifestation of metabolic syndrome [35]. Lim et al. demonstrated that GPs formation was independently correlated with fatty liver and suggested that hepatic fat might play a vital role in developing GPs due to anatomically close to gallbladders fossa, with the presumption that GPs were most likely CPs based on the typical distribution of various types of GPs [10]. Consistent with the previous report, fatty liver in the CPs group was significantly more common than in the control group. Notably, a Korean study found that fatty liver showed a significant dose-dependent relationship with GPs, especially in the larger GPs group ( ≥ 5mm) [36]. Regrettably, we could not investigate the relationship because the degree of fatty liver was not included in the databases of some medical centers, and further studies are needed to elucidate this issue. Concerning increased body weight, several studies which set non-polyp subjects as the control group found this to be associated with GPs [14,37,38]. Interestingly, the positive relationship was hardly reported in other studies which compared CPs with neoplastic polyps as controls [12,19,39]. Indeed, it is well known that CPs and neoplasms progress in entirely different pathological processes, and this inconsistency needs more research to confirm. Our findings showed that there was no direct association between CPs and obesity. Abnormal liver function is now discovered as a factor correlated to the development of CPs [14]. Although the specific mechanisms were unknown, the elevation of AST was supposed as a representation of liver damage due to lipid disorder or high metabolism and may indirectly or directly contribute to CPs formation [32]. In our study, no significant relationship was observed between abnormal liver function and CPs. Several limitations of this study need to be acknowledged. First, as with most published studies in this field, the quality of evidence is restricted by retrospective observational nature. Thus, variables including insulin resistance, family history, and lifestyles were not included in the analysis, especially the absence of waist circumference, which prevented us from investigating the association between metabolic syndrome, whose role with GPs has been endorsed, and CPs formation [40]. Third, the background uses of the lipid-lowering drug were not collected in the control group, which might influence the evaluation of laboratory tests. Despite these limitations, we believed that the strengths of the current study, such as age and gender matching of the control subjects and a large sample based on multicenter databases, could provide valuable references. Conclusion To sum up, understanding and actively controlling risk factors for CPs may help decrease the incidence of CPs, thereby reducing the number of patients undergoing unnecessary surgery at this stage. Our findings identified that decreased HDL, increased TG, and fatty liver are highly associated with CPs. These findings related to metabolic disorders could provide preventive strategies and individual treatment advice for CPs patients. Declarations The authors report no conflict of interest. Authors’ Contributions Wenqing Bao, Anan Xu, and Jing Yang contributed equally to the writing of this article and are co-first authors. Study conception and design: W. Bao and A. Xu; acquisition of data: J. Yang, S. Ni, G. Hu, T. Tang, Q. Liu, Z. Xu, and K. Zhang; analysis and interpretation of data: B. Zhang and B. Wang; drafting of the manuscript; W. Bao, J. Yang and B. Zhao; critical revision of the manuscript: H. Hu, A. Xu and W. Bao; all the authors read and approved the final manuscript. Acknowledgments Funding This work was supported by the [Pudong New Area Health Commission clinical characteristic discipline] under Grant [number PWYTS2021-06]. Data availability Not applicable. References Walsh AJ, Bingham DB, Kamaya A. (2022). Longitudinal Ultrasound Assessment of Changes in Size and Number of Incidentally Detected Gallbladder Polyps. AJR Am J Roentgenol 218(3):472-483. Yin SN, Shen GH, Liu L, Chi J, Ding N, Ji YD, Yuan JM. (2021). Triphasic dynamic enhanced computed tomography for differentiating cholesterol and adenomatous gallbladder polyps. Abdom Radiol (NY) 46(10):4701-4708. Lee YJ, Park B, Hong KW, Jung DH. (2021). Gallbladder Polyps Increase the Risk of Ischaemic Heart Disease Among Korean Adults. 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Tables Table 1 Clinical and laboratory features of subjects with CPs and without GPs CPs group (n=1555) Control group (n=1555) P value Age (years) 41.66±13.18 41.66±13.18 > 0.999 Gender (female) 832 (53.38%) 832 (53.38%) > 0.999 BMI (kg/m 2 ) 23.51 ± 3.38 23.33 ± 3.37 0.145 Obesity 449 (28.87%) 422 (27.14%) 0.299 Systolic BP ≥ 140mmHg 210 (13.50%) 248 (15.95%) 0.061 Diastolic BP ≥ 90mmHg 177 (11.38%) 201 (12.92%) 0.207 Fatty liver 686 (44.12%) 597 (38.39%) 0.001 FBG (mmol/L) 5.10 ± 0.95 5.15 ± 0.82 0.79 TC (mmol/L) 4.48 ± 0.94 4.47 ± 0.78 0.65 TG (mmol/L) 1.06 (0.74,1.6) 0.93 (0.66,1.25) < 0.001 HDL (mmol/L) 1.36 ± 0.37 1.48 ± 0.32 3.12 mmol/L 512 (32.93%) 459 (29.52%) 0.044 ALT > 40 IU/L 132 (8.49%) 146 (9.39%) 0.414 AST > 40 IU/L 58 (3.73%) 50 (3.22%) 0.493 Dyslipidemia TC ≥ 6.2mmol/L 52 (3.34%) 34 (2.19%) 0.062 TG ≥ 2.3mmol/L 172 (11.06%) 78 (5.02%) < 0.001 Decreased HDL 473 (30.42%) 307 (19.74%) < 0.001 Data expressed as mean ± SD or number (%) except median (25th percentile, 75th percentile) for TG GPs gallbladder polyps, CPs cholesterol polyps, BMI body mass index, BP blood pressure, FBG fasting blood glucose, TC total cholesterol, TG triglyceride, HDL high-density lipoprotein, LDL low-density lipoprotein, ALT alanine aminotransferase, AST aspartate aminotransferase Table 2 Results of multivariate logistic regression analysis OR 95% CI P value Fatty liver (%) 1.285 1.111–1.485 0.001 LDL > 3.12 mmol/L 1.138 0.974–1.329 0.104 TG ≥ 2.3mmol/L 1.9 1.423–2.537 <.001 Decreased HDL 1.632 1.375–1.937 <.001 OR odds ratio, CI confidence interval LDL low-density lipoprotein, TG triglyceride, HDL high-density lipoprotein Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1902351","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":124536720,"identity":"a5f57cd2-d443-43ef-8feb-7defa4c4a22c","order_by":0,"name":"Wenqing Bao","email":"","orcid":"","institution":"Gallbladder Diseases Center, Tongji University Affiliated Shanghai East Hospital, Shanghai 200120","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wenqing","middleName":"","lastName":"Bao","suffix":""},{"id":124536721,"identity":"539c61de-e1e7-490d-9a0d-8627c6e511ed","order_by":1,"name":"Anan 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200137","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shubin","middleName":"","lastName":"Ni","suffix":""},{"id":124536724,"identity":"0b0114bb-6998-41bc-87b9-afc1d50d0158","order_by":4,"name":"Guanglong Hu","email":"","orcid":"","institution":"Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Wannan Medical College, Wuhu 241000","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Guanglong","middleName":"","lastName":"Hu","suffix":""},{"id":124536725,"identity":"bf3adeac-5c9b-40e3-8f59-d9283e28395d","order_by":5,"name":"Tianyu Tang","email":"","orcid":"","institution":"Department of Hepatobiliary Surgery, The Second People's Hospital of Changshu, Xuzhou Medical University Affiliated Changshu Hospital, Changshu 215500","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tianyu","middleName":"","lastName":"Tang","suffix":""},{"id":124536726,"identity":"11b3c98b-88e2-4b61-a840-04cefcfe800f","order_by":6,"name":"Qi Liu","email":"","orcid":"","institution":"Department of Gallbladder Diseases, Zhengzhou People's Hospital, Zhengzhou 450003","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Qi","middleName":"","lastName":"Liu","suffix":""},{"id":124536727,"identity":"b2e939b9-842e-4270-9cd5-1a321e43ec0d","order_by":7,"name":"Zhiying Xu","email":"","orcid":"","institution":"The Fourth Department of Hepatic Surgery, The Third Affiliated Hospital of Naval Military Medical University, Shanghai 201805","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhiying","middleName":"","lastName":"Xu","suffix":""},{"id":124536728,"identity":"82cffcfd-8908-43f7-af76-9ea4fe04f08f","order_by":8,"name":"Bo Wang","email":"","orcid":"","institution":"Gallbladder Diseases Center, Tongji University Affiliated Shanghai East Hospital, Shanghai 200120","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bo","middleName":"","lastName":"Wang","suffix":""},{"id":124536729,"identity":"6b9856c2-0a0e-40a4-8244-09a38d9a321a","order_by":9,"name":"Kai Zhang","email":"","orcid":"","institution":"Gallbladder Diseases Center, Tongji University Affiliated Shanghai East Hospital, Shanghai 200120","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kai","middleName":"","lastName":"Zhang","suffix":""},{"id":124536730,"identity":"efd6a4f7-22cf-432b-b154-95fec6cdadbd","order_by":10,"name":"Bosen Zhang","email":"","orcid":"","institution":"Gallbladder Diseases Center, Tongji University Affiliated Shanghai East Hospital, Shanghai 200120","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bosen","middleName":"","lastName":"Zhang","suffix":""},{"id":124536731,"identity":"27507675-564f-435e-90c9-787fd63fe432","order_by":11,"name":"Bin Zhao","email":"","orcid":"","institution":"Department of General Surgery, Shanghai University of Traditional Chinese Medicine Affiliated Shanghai Seventh People's Hospital, Shanghai 200137","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bin","middleName":"","lastName":"Zhao","suffix":""},{"id":124536732,"identity":"aeed32c5-ae5d-45c8-8429-19877b0f635d","order_by":12,"name":"Hai Hu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAArUlEQVRIiWNgGAWjYBACAwYeBoaEAgY5BmbStBgwGJOoBUgmNhDtMHOJ3IMfHhjYpc9v5z34gaHGJpqgFssZeckSCQbJuRsO8yVLMBxLyyVoncGNHAOglgO5G5h5DCQYGw4TpcX4B1BLunwzj/EPYrWYgWxJYDjMY0akLWfemFkA/WK4AajFIoEovxzPMb75o8JOXr7/jPGNDzU2hLWgggTSlI+CUTAKRsEowAUABXA6LH/grm8AAAAASUVORK5CYII=","orcid":"","institution":"Gallbladder Diseases Center, Tongji University Affiliated Shanghai East Hospital, Shanghai 200120","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Hai","middleName":"","lastName":"Hu","suffix":""}],"badges":[],"createdAt":"2022-07-27 15:59:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1902351/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1902351/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":24606631,"identity":"bf493e06-2e8b-4b8f-a90a-19c76cbeabaa","added_by":"auto","created_at":"2022-08-01 16:14:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":133988,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic enrollment of the cholesterol polyp and the control group. \u003cem\u003eGPs\u003c/em\u003e\u0026nbsp;gallbladder polyps, \u003cem\u003eCPs \u003c/em\u003echolesterol polyps, \u003cem\u003eGB \u003c/em\u003egallbladder\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-1902351/v1/bb3973e0af0abcf5782ae8d9.png"},{"id":24606629,"identity":"20af6152-7276-4868-80b1-35c23e1b686e","added_by":"auto","created_at":"2022-08-01 16:14:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":117993,"visible":true,"origin":"","legend":"\u003cp\u003eThe proportional distribution of patients with cholesterol polyps according to age groups and gender.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-1902351/v1/146332b112b970dbfddc1996.png"},{"id":26802485,"identity":"6d353f2e-695a-494b-b8e0-ecdcb7681468","added_by":"auto","created_at":"2022-09-22 05:29:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":509527,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1902351/v1/cb156cfa-bbe8-4459-b8d9-d3c47741d940.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Risk factors for cholesterol polyps in the gallbladder: a multicenter retrospective case-control study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGallbladder polyps (GPs) have become one of the most prevalent biliary tract lesions with the widespread use of better medical imaging in routine health checkups, and the prevalence of GPs assessed by ultrasonography in global adults is approximately 3 to 12% [1-4]. GPs are broadly categorized as non-neoplastic lesions and neoplastic lesions. Cholesterol polyps (CPs) are the most common type of non-neoplastic lesions, while neoplastic lesions consist of adenomas and adenocarcinomas, treated as premalignant neoplasms or cancerous [5].\u003c/p\u003e\n\u003cp\u003eIn past decades, a considerable number of patients underwent surgical treatments in line with GPs management guidelines due to concerns about malignant transformation [6]. Actually, not a few studies have shown that over 80% of GPs confirmed by pathology were harmless CPs [7,8]. Since cholecystectomies are unnecessary for most CPs patients, excessive surgeries will undoubtedly result in the patients suffering from surgical trauma, related complications, and financial burden. Hence, knowledge of factors associated with CPs can help improve treatment or early intervention strategies. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePrevious studies have profoundly investigated the risk factors for GPs formation, including middle age, male gender, obesity, fatty liver, abnormal body fat distribution, and dyslipidemia, but most of them were based on ultrasound results rather than specifying the exact histological classification [9-11]. Given that risk factors and the mechanisms of pathophysiologic mechanisms are quite different in various GPs, pathology-oriented analysis is undoubtedly more convincing [12]. However, so far, there is a paucity of data from high-level studies lucubrating CPs [13,14]. Therefore, it is of great value to explore CPs from the perspective of postoperative pathology based on a large sample size.\u003c/p\u003e\n\u003cp\u003eThis study aimed to determine the risk factors for CPs formation through a multicenter database to provide meaningful bases for the management and preclinical prevention of CPs.\u003c/p\u003e"},{"header":"Material And Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy subjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study included and analyzed data of postoperative patients pathologically diagnosed with CPs from September 2018 to June 2022 at six Chinese hospitals. (Gallbladder Diseases Center, Tongji University Affiliated Shanghai East Hospital; Department of General Surgery, Shanghai University of Traditional Chinese Medicine Affiliated Shanghai Seventh People\u0026apos;s Hospital; Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Wannan Medical College; Department of Gallbladder Diseases, Zhengzhou People\u0026apos;s Hospital; Department of Hepatobiliary Surgery, Xuzhou Medical University Affiliated Changshu Hospital; The Fourth Department of Hepatic Surgery, The Third Affiliated Hospital of Naval Military Medical University). Considering that age and gender are physiologic factors strongly influencing plasma lipid levels, we enrolled age- and gender-matched subjects randomly selected among subjects without GPs, recruited from the health checkup center of Shanghai Seventh People\u0026apos;s Hospital, in a 1:1 (CPs: control) ratio as the control group to avoid related confounders [15]. The exclusion criteria for the CPs patients were as follows: (1) patients who were taking lipid-lowering drugs and (2) comorbid with other gallbladder lesions such as cholelithiasis or mixed polyps. Subjects in the control group meeting the following criteria were excluded: (1) those who were diagnosed with any gallbladder lesions; (2) those who have already undergone cholecystectomy; and (3) those who lacked necessary data.\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the ethics committee of the above hospitals, and all procedures were conducted following the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical and laboratory evaluations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe baseline characteristics of recruited patients included general information and laboratory tests of age, gender, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), fasting blood glucose (FBG), alanine aminotransferase (ALT), aspartate aminotransferase (AST). Serum chemical tests of all participants were performed after overnight fasting. Fatty liver was confirmed by ultrasound or other imaging reports. Body mass index (BMI) was calculated by dividing weight (kg) by height squared (m\u003csup\u003e2\u003c/sup\u003e), and obese status was identified by BMI \u0026ge; 25kg/m\u003csup\u003e2\u003c/sup\u003e according to the WHO BMI criteria for Asian populations. Dyslipidemia was characterized when any of the following criteria: (1) hypercholesterolemia: \u0026ge; 6.2 mmol/L; (2) hypertriglyceridemia: \u0026ge; 2.3 mmol/L; and (3) decreased HDL: \u0026lt; 1.03 mmol/L in men or \u0026lt; 1.29 mmol/L in women.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCategorical variables, expressed as frequencies and percentages, were analyzed using the Chi-square test or Fisher\u0026rsquo;s exact test. Continuous variables, expressed as mean \u0026plusmn; standard deviation or as median (25\u003csup\u003eth\u003c/sup\u003e percentile, 75\u003csup\u003eth\u003c/sup\u003e percentile), were compared using independent Student T-test or Mann-Whitney U test depending on skewed or normally distributed variables.\u003c/p\u003e\n\u003cp\u003eVariables showing significance on univariate analysis were further analyzed using multivariate binary logistic regression analysis to determine the significant predictors associated with CPs. Statistical analyses were performed using SPSS version 26.0 (IBM). P values \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eGeneral information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe identified 2139 postoperative patients with pathologically diagnosed GPs and 7624 health checkups subjects (Figure 1). After excluding patients with other types of GPs or cholelithiasis, 1555 CPs patients who met the inclusion criteria were enrolled in the CPs group. Figure 2 showed the age and gender proportional distribution of the CPs groups. The proportion of CPs patients by age peaked in the 30-39 year group, and the proportion of female patients over 50 years was higher than that of male patients. According to exclusion criteria, the study excluded 281 and 827 subjects who had undergone cholecystectomy or ultrasound-diagnosed gallbladder lesions, and 1555 age- and gender-matched subjects without GPs were included in the control group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical and laboratory tests characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe demographic and clinical characteristics of the CPs group and the control group were summarized in Table 1. The mean age of subjects was 41.66 \u0026plusmn; 13.18 years, and the females accounted for 53.38%. In terms of dyslipidemia, the HDL level in the CPs group was significantly lower than that in the controls (1.36\u0026plusmn;0.37vs.1.48\u0026plusmn;0.32 mmol/L), and the median TG level (25\u003csup\u003eth\u003c/sup\u003e percentile, 75\u003csup\u003eth\u003c/sup\u003e percentile) was higher in the CPs group [1.06 (0.74,1.6) mmol/L] compared to the control group [0.93 (0.66,1.25) mmol/L]. Nearly 33% of patients in the CPs group showed high LDL levels, significantly higher than 29.52% in the control group. The proportion of patients with fatty liver in the CPs group (44.12%) was significantly higher than that in the control group (38.39%). There was no significant difference between the two groups in BMI, SBP, DBP, TC, FBG, AST, and ALT.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRisk factors for CPs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOn univariate analysis, several clinical and laboratory variables showed significant associations with CPs, including fatty liver (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.001), LDL \u0026gt; 3.12mmol/L (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.044), TG \u0026ge; 2.3mmol/L (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001), and decreased HDL (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001). On multivariate analysis, fatty liver, TG \u0026ge; 2.3mmol/L, and decreased HDL were independent risk factors for CPs formation (OR = 1.285, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.001; OR = 1.9, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001; and OR = 1.632,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001, respectively) (Table 2)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eGPs have become a global public health problem, and the management of GPs has been extensively investigated\u0026nbsp;[16,17].\u0026nbsp;However, CPs, the most common type of GPs, have not received much attention due to their benign nature. Moreover, even if surgical treatment is unnecessary for CPs patients in most cases, we still have to face the following dilemmas in clinical practice. Firstly, CPs can develop typical biliary colic symptoms caused by obstructing the gallbladder outflow, similar to cholelithiasis\u0026nbsp;[18]. Secondly, a considerable proportion of resected GPs that showed rapid growth or obvious size progression proved to be CPs\u0026nbsp;[19,20].\u0026nbsp;According to the latest management guidelines, cholecystectomy is advised for patients when they encounter the above status, and it would be a great pity to lose gallbladder functions because of CPs\u0026nbsp;[21]. Hence, we conducted this study from 6 centers in 4 Chinese cities to investigate the risk factors for CPs with a view to early prevention and targeted therapy. This study indicated that decreased HDL, increased TG, and fatty liver were significantly related to the development of CPs.\u003c/p\u003e\n\u003cp\u003eSeveral previous studies have reported that GPs are the most common in middle-aged subjects, peaking in 40-59 years\u0026nbsp;[22,23]. However, our findings indicated that the onset age of CPs appeared to be earlier. In this study, the mean age of the CPs group was 41.66\u0026plusmn;13.18 years, with the highest proportion in the 30\u0026ndash;39 age group.\u0026nbsp;This inconsistency may result from the histological type of GPs being not determined in prior studies, and the mean age of patients with neoplastic polyps was generally higher than that of CPs patients\u0026nbsp;[24].\u0026nbsp;The other explanation is the younger trend of dyslipidemia. A recent study among the large Chinese population reported that dyslipidemia was closely correlated with GPs formation\u0026nbsp;[25].\u0026nbsp;Meanwhile, evidence showed that the prevalence of dyslipidemia in young adults has increased during the past decade with the lifestyle change, and decreased HDL and hypertriglyceridemia were the two main types of dyslipidemia, which was consistent with the results in our study\u0026nbsp;[26,27].\u003c/p\u003e\n\u003cp\u003eThis study identified decreased HDL significantly related to CPs formation, consistent with the survey of Zheng et al., whereas our findings showed no direct association between CPs and LDL on multivariate analysis despite LDL being associated with CPs on univariate analysis\u0026nbsp;[14]. HDL plays a vital role in accepting cholesterol from cells and promotes reverse cholesterol transportation (RCT), which is essential for maintaining cholesterol metabolism balance in gallbladders\u0026nbsp;[28]. Decreased HDL can inhibit the process of RCT and cholesterol elimination in the gallbladder mucous membrane, which may lead to the development of CPs\u0026nbsp;[29]. In addition, a recent cohort study found that the non-HDL/HDL ratio, a superior marker for coronary heart disease, was an independent risk factor for GPs formation\u0026nbsp;[30]. The non-HDL/HDL ratio may contain more information on cholesterol transport than non-HDL or other lipoprotein levels, and it would be meaningful for exploring the relationship between the non-HDL/HDL ratio and CPs.\u003c/p\u003e\n\u003cp\u003eIt has not been fully discovered whether there is a relationship between TC or TG levels and CPs. Some studies have demonstrated that elevated TG level is a risk factor for GPs, while others have discrepant results\u0026nbsp;[31,32]. We found that the TG level in the CPs group was significantly higher than that in the controls. Abnormal TG levels were reported to impair gallbladder motility by reducing gallbladder sensitivity to cholecystokinin and be associated with some gallbladder cholesterol diseases such as cholelithiasis and cholesterolosis, which might share similar pathological processes with CPs formation\u0026nbsp;[33,34].\u003c/p\u003e\n\u003cp\u003eFatty liver is currently viewed as a hepatic manifestation of metabolic syndrome\u0026nbsp;[35]. Lim et al. demonstrated that GPs formation was independently correlated with fatty liver and suggested that hepatic fat might play a vital role in developing GPs due to anatomically close to gallbladders fossa, with the presumption that GPs were most likely CPs based on the typical distribution of various types of GPs\u0026nbsp;[10]. Consistent with the previous report, fatty liver in the CPs group was significantly more common than in the control group. Notably, a Korean study found that fatty liver showed a significant dose-dependent relationship with GPs, especially in the larger GPs group ( \u0026ge; 5mm)\u0026nbsp;[36]. Regrettably, we could not investigate the relationship because the degree of fatty liver was not included in the databases of some medical centers, and further studies are needed to elucidate this issue.\u003c/p\u003e\n\u003cp\u003eConcerning increased body weight, several studies which set non-polyp subjects as the control group found this to be associated with GPs\u0026nbsp;[14,37,38]. Interestingly, the positive relationship was hardly reported in other studies which compared CPs with neoplastic polyps as controls\u0026nbsp;[12,19,39]. Indeed, it is well known that CPs and neoplasms progress in entirely different pathological processes, and this inconsistency needs more research to confirm. Our findings showed that there was no direct association between CPs and obesity. Abnormal liver function is now discovered as a factor correlated to the development of CPs\u0026nbsp;[14]. Although the specific mechanisms were unknown, the elevation of AST was supposed as a representation of liver damage due to lipid disorder or high metabolism and may indirectly or directly contribute to CPs formation\u0026nbsp;[32]. In our study, no significant relationship was observed between abnormal liver function and CPs.\u003c/p\u003e\n\u003cp\u003eSeveral limitations of this study need to be acknowledged. First, as with most published studies in this field, the quality of evidence is restricted by retrospective observational nature. Thus, variables including insulin resistance, family history, and lifestyles were not included in the analysis, especially the absence of waist circumference, which prevented us from investigating the association between metabolic syndrome, whose role with GPs has been endorsed, and CPs formation [40]. Third, the background uses of the lipid-lowering drug were not collected in the control group, which might influence the evaluation of laboratory tests. Despite these limitations, we believed that the strengths of the current study, such as age and gender matching of the control subjects and a large sample based on multicenter databases, could provide valuable references.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTo sum up, understanding and actively controlling risk factors for CPs may help decrease the incidence of CPs, thereby reducing the number of patients undergoing unnecessary surgery at this stage. Our findings identified that decreased HDL, increased TG, and fatty liver are highly associated with CPs. These findings related to metabolic disorders could provide preventive strategies and individual treatment advice for CPs patients.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003eThe authors report no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWenqing Bao, Anan Xu, and Jing Yang contributed equally to the writing of this article and are co-first authors.\u003c/p\u003e\n\u003cp\u003eStudy conception and design: W. Bao and A. Xu; acquisition of data: J. Yang, S. Ni, G. Hu, T. Tang, Q. Liu, Z. Xu, and K. Zhang; analysis and interpretation of data: B. Zhang and B. Wang; drafting of the manuscript; W. Bao, J. Yang and B. Zhao; critical revision of the manuscript: H. Hu, A. Xu and W. Bao; all the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the\u0026nbsp;[Pudong New Area Health Commission clinical characteristic discipline] under Grant [number PWYTS2021-06].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWalsh AJ, Bingham DB, Kamaya A. (2022). Longitudinal Ultrasound Assessment of Changes in Size and Number of Incidentally Detected Gallbladder Polyps. AJR Am J Roentgenol 218(3):472-483.\u003c/li\u003e\n \u003cli\u003eYin SN, Shen GH, Liu L, Chi J, Ding N, Ji YD, Yuan JM. (2021). 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A Nomogram-based Model to Predict Neoplastic Risk for Patients with Gallbladder Polyps. J Clin Transl Hepatol 10(2):263-272.\u003c/li\u003e\n \u003cli\u003eBhatt NR, Gillis A, Smoothey CO, Awan FN, Ridgway PF. (2016). Evidence based management of polyps of the gall bladder: A systematic review of the risk factors of malignancy. Surgeon 14(5):278-286.\u003c/li\u003e\n \u003cli\u003eWennmacker SZ, Lamberts MP, Di Martino M, Drenth JP, Gurusamy KS, van Laarhoven CJ. (2018). Transabdominal ultrasound and endoscopic ultrasound for diagnosis of gallbladder polyps. Cochrane Database Syst Rev 8(8):Cd012233.\u003c/li\u003e\n \u003cli\u003eLee JK, Hahn SJ, Kang HW, Jung JG, Choi HS, Lee JH, Han IW, Jung JH, Kwon JH. (2016). Visceral Obesity Is Associated with Gallbladder Polyps. Gut Liver 10(1):133-139.\u003c/li\u003e\n \u003cli\u003eLim SH, Kim D, Kang JH, Song JH, Yang SY, Yim JY, Chung SJ, Kim JS, Cho SH. (2015). Hepatic fat, not visceral fat, is associated with gallbladder polyps: a study of 2643 healthy subjects. J Gastroenterol Hepatol 30(4):767-774.\u003c/li\u003e\n \u003cli\u003eXu Q, Tao LY, Wu Q, Gao F, Zhang FL, Yuan L, He XD. (2012). Prevalences of and risk factors for biliary stones and gallbladder polyps in a large Chinese population. HPB (Oxford) 14(6):373-381.\u003c/li\u003e\n \u003cli\u003eKim EY, Hong TH. (2020). Bile cholesterol and viscosity, the keys to discriminating adenomatous polyps from cholesterol polyps by a novel predictive scoring model. BMC Gastroenterol 20(1):268.\u003c/li\u003e\n \u003cli\u003eChoi JH, Yun JW, Kim YS, Lee EA, Hwang ST, Cho YK, Kim HJ, Park JH, Park DI, Sohn CI, Jeon WK, Kim BI, Kim HO, Shin JH. (2008). Pre-operative predictive factors for gallbladder cholesterol polyps using conventional diagnostic imaging. World J Gastroenterol 14(44):6831-6834.\u003c/li\u003e\n \u003cli\u003eYu Z, Yang C, Bai X, Yao G, Qian X, Gao W, Huang Y, Tian X, Cheng S, Zheng Y. (2021). Risk factors for cholesterol polyp formation in the gallbladder are closely related to lipid metabolism. Lipids Health Dis 20(1):26.\u003c/li\u003e\n \u003cli\u003eCho SMJ, Lee HJ, Shim JS, Song BM, Kim HC. (2020). Associations between age and dyslipidemia are differed by education level: The Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) cohort. Lipids Health Dis 19(1):12.\u003c/li\u003e\n \u003cli\u003eChou SC, Chen SC, Shyr YM, Wang SE. (2017). Polypoid lesions of the gallbladder: analysis of 1204 patients with long-term follow-up. Surg Endosc 31(7):2776-2782.\u003c/li\u003e\n \u003cli\u003eFei X, Li N, Zhu L, Han P, Jiang B, Tang W, Sang M, Zhang X, Luo Y. (2021). Value of high frame rate contrast-enhanced ultrasound in distinguishing gallbladder adenoma from cholesterol polyp lesion. Eur Radiol 31(9):6717-6725.\u003c/li\u003e\n \u003cli\u003eLam R, Zakko A, Petrov JC, Kumar P, Duffy AJ, Muniraj T. (2021). Gallbladder Disorders: A Comprehensive Review. Dis Mon 67(7):101130.\u003c/li\u003e\n \u003cli\u003eBao W, Xu A, Ni S, Wang B, Urmi H, Zhao B, You Y, Hu H. (2021). Is there a role for growth status in distinguishing gallbladder adenomas from cholesterol polyps? - A retrospective study based on 520 cholecystectomy patients. Scand J Gastroenterol 56(12):1450-1455.\u003c/li\u003e\n \u003cli\u003eFujiwara K, Abe A, Masatsugu T, Hirano T, Sada M. (2021). Effect of gallbladder polyp size on the prediction and detection of gallbladder cancer. Surg Endosc 35(9):5179-5185.\u003c/li\u003e\n \u003cli\u003eFoley KG, Lahaye MJ, Thoeni RF, Soltes M, Dewhurst C, Barbu ST, Vashist YK, Rafaelsen SR, Arvanitakis M, Perinel J, Wiles R, Roberts SA. (2022). Management and follow-up of gallbladder polyps: updated joint guidelines between the ESGAR, EAES, EFISDS and ESGE. Eur Radiol 32(5):3358-3368.\u003c/li\u003e\n \u003cli\u003eKwon OS, Kim YK. (2021). Are there modifiable risk factors affecting the prevalence of gallbladder polyps or those 5 mm or larger? A retrospective cross-sectional study. Medicine (Baltimore) 100(35):e27115.\u003c/li\u003e\n \u003cli\u003eMao YS, Mai YF, Li FJ, Zhang YM, Hu KM, Hong ZL, Zhu ZW. (2013). Prevalence and risk factors of gallbladder polypoid lesions in Chinese petrochemical employees. World J Gastroenterol 19(27):4393-4399.\u003c/li\u003e\n \u003cli\u003eSun Y, Yang Z, Lan X, Tan H. (2019). Neoplastic polyps in gallbladder: a retrospective study to determine risk factors and treatment strategy for gallbladder polyps. Hepatobiliary Surg Nutr 8(3):219-227.\u003c/li\u003e\n \u003cli\u003eYamin Z, Xuesong B, Zhen Z, Yue H, Liwei L, Fei L. (2020). Correlation of dyslipidemias and gallbladder polyps-A large retrospective study among Chinese population. Asian J Surg 43(1):181-185.\u003c/li\u003e\n \u003cli\u003ePan L, Yang Z, Wu Y, Yin RX, Liao Y, Wang J, Gao B, Zhang L. (2016). The prevalence, awareness, treatment and control of dyslipidemia among adults in China. Atherosclerosis 248:2-9.\u003c/li\u003e\n \u003cli\u003eZhang H, Kwapong WR, Shao MM, Yan JY, Lin XD, Chen BB, Chen KY. (2020). Predictors of the Prevalence of Dyslipidemia and Influencing Factors for Young Health Examination Cohort: A Cross-Sectional Survey. Front Public Health 8:400.\u003c/li\u003e\n \u003cli\u003eLing-wei M. (2011). Reserve cholesterol transport and gallbladder cholesterol polyp formation. JOURNAL OF SURGERY CONCEPTS \u0026amp; PRACTICE 16(1):100-103. (in Chinese).\u003c/li\u003e\n \u003cli\u003eLee J, Choi HS. (2004). [Reverse cholesterol transport in cultured gallbladder epithelial cells]. Korean J Gastroenterol 43(3):145-152.\u003c/li\u003e\n \u003cli\u003eZhao X, Zheng H, Shan S, Wang K, Zhang M, Xie S, Liu C. (2020). Association between the non-HDL-cholesterol-to-HDL-cholesterol ratio and the risk of gallbladder polyp formation among men: a retrospective cohort study. Lipids Health Dis 19(1):146.\u003c/li\u003e\n \u003cli\u003eLeng S, Zhao A, Li Q, Pei L, Zheng W, Liang R, Yan H. (2018). Metabolic status and lifestyle factors associated with gallbladder polyps: a covariance structure analysis. BMC Gastroenterol 18(1):159.\u003c/li\u003e\n \u003cli\u003eYao G, Bai X, Yang C, Liu L, Zhou Z, Huang Y, Zheng Y. (2020). Analysis of risk factors for gallbladder polyp formation - A retrospective study based on serial ultrasounds. Eur J Gastroenterol Hepatol 32(9):1154-1159.\u003c/li\u003e\n \u003cli\u003eGoodloe R, Brown-Gentry K, Gillani NB, Jin H, Mayo P, Allen M, McClellan B, Jr., Boston J, Sutcliffe C, Schnetz-Boutaud N, Dilks HH, Crawford DC. (2013). Lipid trait-associated genetic variation is associated with gallstone disease in the diverse Third National Health and Nutrition Examination Survey (NHANES III). BMC Med Genet 14:120.\u003c/li\u003e\n \u003cli\u003eJacyna MR, Bouchier IA. (1987). Cholesterolosis: a physical cause of \u0026quot;functional\u0026quot; disorder. Br Med J (Clin Res Ed) 295(6599):619-620.\u003c/li\u003e\n \u003cli\u003eVernon G, Baranova A, Younossi ZM. (2011). Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther 34(3):274-285.\u003c/li\u003e\n \u003cli\u003eAhn DW, Jeong JB, Kang J, Kim SH, Kim JW, Kim BG, Lee KL, Oh S, Yoon SH, Park SJ, Lee DH. (2020). Fatty liver is an independent risk factor for gallbladder polyps. World J Gastroenterol 26(44):6979-6992.\u003c/li\u003e\n \u003cli\u003eKim HS, Cho SK, Kim CS, Park JS. (2019). Big data and analysis of risk factors for gallbladder disease in the young generation of Korea. PLoS One 14(2):e0211480.\u003c/li\u003e\n \u003cli\u003eYoon JH, Kim YJ, Baik GH, Kim YS, Suk KT, Kim JB, Kim DL. (2014). The Impact of Body Mass Index as a Predictive Factor of Steatocholecystitis. Hepatogastroenterology 61(132):902-907.\u003c/li\u003e\n \u003cli\u003eWu T, Sun Z, Jiang Y, Yu J, Chang C, Dong X, Yan S. (2019). Strategy for discriminating cholesterol and premalignancy in polypoid lesions of the gallbladder: a single-centre, retrospective cohort study. ANZ J Surg 89(4):388-392.\u003c/li\u003e\n \u003cli\u003eLim SH, Kim DH, Park MJ, Kim YS, Kim CH, Yim JY, Cho KR, Kim SS, Choi SH, Kim N, Cho SH, Oh BH. (2007). Is Metabolic Syndrome One of the Risk Factors for Gallbladder Polyps Found by Ultrasonography during Health Screening? Gut Liver 1(2):138-144.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e Clinical and laboratory features of subjects with CPs and without GPs\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.355072463768117%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.91304347826087%\"\u003e\n \u003cp\u003eCPs group (n=1555)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"34.23913043478261%\"\u003e\n \u003cp\u003eControl group (n=1555)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.492753623188406%\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.355072463768117%\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.91304347826087%\"\u003e\n \u003cp\u003e41.66\u0026plusmn;13.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"34.23913043478261%\"\u003e\n \u003cp\u003e41.66\u0026plusmn;13.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.492753623188406%\"\u003e\n \u003cp\u003e\u0026gt; 0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.355072463768117%\"\u003e\n \u003cp\u003eGender (female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.91304347826087%\"\u003e\n \u003cp\u003e832 (53.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"34.23913043478261%\"\u003e\n \u003cp\u003e832 (53.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.492753623188406%\"\u003e\n \u003cp\u003e\u0026gt; 0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.355072463768117%\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.91304347826087%\"\u003e\n \u003cp\u003e23.51 \u0026plusmn; 3.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"34.23913043478261%\"\u003e\n \u003cp\u003e23.33 \u0026plusmn; 3.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.492753623188406%\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.355072463768117%\"\u003e\n \u003cp\u003eObesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.91304347826087%\"\u003e\n \u003cp\u003e449 (28.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"34.23913043478261%\"\u003e\n \u003cp\u003e422\u0026nbsp;(27.14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.492753623188406%\"\u003e\n \u003cp\u003e0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.355072463768117%\"\u003e\n \u003cp\u003eSystolic BP \u0026ge; 140mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.91304347826087%\"\u003e\n \u003cp\u003e210 (13.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"34.23913043478261%\"\u003e\n \u003cp\u003e248 (15.95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.492753623188406%\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.355072463768117%\"\u003e\n \u003cp\u003eDiastolic BP \u0026ge; 90mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.91304347826087%\"\u003e\n \u003cp\u003e177 (11.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"34.23913043478261%\"\u003e\n \u003cp\u003e201 (12.92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.492753623188406%\"\u003e\n \u003cp\u003e0.207\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.355072463768117%\"\u003e\n \u003cp\u003eFatty liver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.91304347826087%\"\u003e\n \u003cp\u003e686 (44.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"34.23913043478261%\"\u003e\n \u003cp\u003e597 (38.39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.492753623188406%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.355072463768117%\"\u003e\n \u003cp\u003eFBG (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.91304347826087%\"\u003e\n \u003cp\u003e5.10 \u0026plusmn; 0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"34.23913043478261%\"\u003e\n \u003cp\u003e5.15 \u0026plusmn; 0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.492753623188406%\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.355072463768117%\"\u003e\n \u003cp\u003eTC (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.91304347826087%\"\u003e\n \u003cp\u003e4.48 \u0026plusmn; 0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"34.23913043478261%\"\u003e\n \u003cp\u003e4.47 \u0026plusmn; 0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.492753623188406%\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.355072463768117%\"\u003e\n \u003cp\u003eTG (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.91304347826087%\"\u003e\n \u003cp\u003e1.06 (0.74,1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"34.23913043478261%\"\u003e\n \u003cp\u003e0.93 (0.66,1.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.492753623188406%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.355072463768117%\"\u003e\n \u003cp\u003eHDL (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.91304347826087%\"\u003e\n \u003cp\u003e1.36 \u0026plusmn; 0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"34.23913043478261%\"\u003e\n \u003cp\u003e1.48 \u0026plusmn; 0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.492753623188406%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.355072463768117%\"\u003e\n \u003cp\u003eLDL \u0026gt; 3.12 mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.91304347826087%\"\u003e\n \u003cp\u003e512 (32.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"34.23913043478261%\"\u003e\n \u003cp\u003e459 (29.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.492753623188406%\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.355072463768117%\"\u003e\n \u003cp\u003eALT \u0026gt; 40 IU/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.91304347826087%\"\u003e\n \u003cp\u003e132 (8.49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"34.23913043478261%\"\u003e\n \u003cp\u003e146 (9.39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.492753623188406%\"\u003e\n \u003cp\u003e0.414\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.355072463768117%\"\u003e\n \u003cp\u003eAST \u0026gt; 40 IU/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.91304347826087%\"\u003e\n \u003cp\u003e58 (3.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"34.23913043478261%\"\u003e\n \u003cp\u003e50 (3.22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.492753623188406%\"\u003e\n \u003cp\u003e0.493\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.355072463768117%\"\u003e\n \u003cp\u003eDyslipidemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.91304347826087%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"34.23913043478261%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.492753623188406%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.355072463768117%\"\u003e\n \u003cp\u003eTC \u0026ge; 6.2mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.91304347826087%\"\u003e\n \u003cp\u003e52 (3.34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"34.23913043478261%\"\u003e\n \u003cp\u003e34 (2.19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.492753623188406%\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.355072463768117%\"\u003e\n \u003cp\u003eTG \u0026ge; 2.3mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.91304347826087%\"\u003e\n \u003cp\u003e172 (11.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"34.23913043478261%\"\u003e\n \u003cp\u003e78 (5.02%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.492753623188406%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"27.355072463768117%\"\u003e\n \u003cp\u003eDecreased HDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.91304347826087%\"\u003e\n \u003cp\u003e473 (30.42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"34.23913043478261%\"\u003e\n \u003cp\u003e307 (19.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.492753623188406%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData expressed as mean \u0026plusmn; SD or number (%) except median (25th percentile, 75th percentile) for TG\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eGPs\u0026nbsp;\u003c/em\u003egallbladder polyps,\u003cem\u003e\u0026nbsp;CPs\u0026nbsp;\u003c/em\u003echolesterol polyps, \u003cem\u003eBMI\u003c/em\u003e body mass index, \u003cem\u003eBP\u003c/em\u003e blood pressure, \u003cem\u003eFBG\u003c/em\u003e fasting blood glucose, \u003cem\u003eTC\u003c/em\u003e total cholesterol, \u003cem\u003eTG\u003c/em\u003e triglyceride, \u003cem\u003eHDL\u003c/em\u003e high-density lipoprotein, \u003cem\u003eLDL\u003c/em\u003e low-density lipoprotein, \u003cem\u003eALT\u003c/em\u003e alanine aminotransferase, \u003cem\u003eAST\u0026nbsp;\u003c/em\u003easpartate aminotransferase\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e Results of multivariate logistic regression analysis\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.11392405063291%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.43399638336347%\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.5497287522604%\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.90235081374322%\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.11392405063291%\"\u003e\n \u003cp\u003eFatty liver (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.43399638336347%\"\u003e\n \u003cp\u003e1.285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.5497287522604%\"\u003e\n \u003cp\u003e1.111\u0026ndash;1.485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.90235081374322%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.11392405063291%\"\u003e\n \u003cp\u003eLDL \u0026gt; 3.12 mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.43399638336347%\"\u003e\n \u003cp\u003e1.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.5497287522604%\"\u003e\n \u003cp\u003e0.974\u0026ndash;1.329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.90235081374322%\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.11392405063291%\"\u003e\n \u003cp\u003eTG \u0026ge; 2.3mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.43399638336347%\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.5497287522604%\"\u003e\n \u003cp\u003e1.423\u0026ndash;2.537\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.90235081374322%\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.11392405063291%\"\u003e\n \u003cp\u003eDecreased HDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.43399638336347%\"\u003e\n \u003cp\u003e1.632\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.5497287522604%\"\u003e\n \u003cp\u003e1.375\u0026ndash;1.937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.90235081374322%\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eOR\u003c/em\u003e odds ratio, \u003cem\u003eCI\u003c/em\u003e confidence interval\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eLDL\u003c/em\u003e low-density lipoprotein, \u003cem\u003eTG\u003c/em\u003e triglyceride, \u003cem\u003eHDL\u003c/em\u003e high-density lipoprotein\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Gallbladder polyps, Cholesterol polyps, Dyslipidemia, Fatty liver, Risk factors","lastPublishedDoi":"10.21203/rs.3.rs-1902351/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1902351/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e\u0026nbsp;Gallbladder polyps are often found in clinical examination, of which cholesterol polyps (CPs) account for the vast majority. However, there is limited evidence-based guidance on the management of CPs patients. This study aimed to determine the risk factors for CPs formation and provide bases for optimizing treatment and prevention strategies.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u0026nbsp;In this multicenter retrospective case-control study, patients with pathologically-proven CPs between September 2018 to June 2022 were included in the CPs group. The control group included age- and gender-matched subjects sonographically diagnosed without GPs or other gallbladder lesions, randomly selected from the health checkup center in a 1:1 (CPs: control) ratio. Clinical characteristics, ultrasound findings, and laboratory examination results were reviewed and compared between the two groups to determine the risk factors for CPs.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eIn total, 3110 patients who met the inclusion criteria were equally enrolled in CPs and the control groups. The mean age of CPs patients was 41.66±13.18 years, with the highest proportion in the 30-39 years group. On multivariate analysis, triacylglycerol ≥ 2.3mmol/L, decreased high-density lipoprotein (HDL), and fatty liver were significantly associated with CPs (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001 and \u003cem\u003eP\u003c/em\u003e = 0.001, respectively). There was no strong correlation between CPs and other parameters, such as body mass index, blood pressure, total cholesterol, and liver function.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u0026nbsp;The morbidity of CPs displayed a younger trend and was closely associated with two types of dyslipidemia: decreased HDL and increased triacylglycerol. Moreover, fatty liver was found to be an independent risk factor for CPs.\u003c/p\u003e","manuscriptTitle":"Risk factors for cholesterol polyps in the gallbladder: a multicenter retrospective case-control study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-08-01 16:14:18","doi":"10.21203/rs.3.rs-1902351/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7ec86f7d-fd9d-403d-a786-0d8b69b7aaca","owner":[],"postedDate":"August 1st, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-09-22T05:29:26+00:00","versionOfRecord":[],"versionCreatedAt":"2022-08-01 16:14:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1902351","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1902351","identity":"rs-1902351","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}