Association of age, gender, and body mass index with gallstone disease: evidence from a case-control study at a tertiary care institute

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While various modifiable and non-modifiable risk factors—including age, gender, and body mass index (BMI)—have been commonly associated with GSD development, recent studies have reported inconsistent results. Additionally, regional disparities in GSD prevalence and risk factors remain insufficiently explored. The primary objective of this study is to assess the association of age, gender, and BMI with GSD among patients presenting to a high-volume tertiary care hospital in North Delhi. Methods: A hospital-based case-control study included ninety-one ultrasound-confirmed cases of GSD, and an equal number of age- and sex-matched controls without GSD were included. Data on demographics, lifestyle, medical history, and BMI were collected. Statistical analysis utilized Chi-square tests and conditional logistic regression, with significance set at p < 0.05. Result: Females constituted the majority of cases (85.7%), and nearly one-third belonged to the younger age group. Although the mean BMI was higher among cases, differences in age and BMI between cases and controls were not statistically significant. A positive family history of GSD or gallbladder carcinoma was the only factor showing a significant association, while no significant associations were observed with lifestyle factors such as diet, alcohol use, smoking, or physical activity. Conclusion: Female gender and positive family history remain important risk factors for GSD, while no significant associations were found with age, BMI, or lifestyle habits in this cohort. The findings show changing risk profiles. Case control study Cholecystitis Gallstone disease Risk factors Figures Figure 1 Introduction Gallstone disease (GSD) is one of the most common conditions worldwide, placing a significant burden on healthcare systems. Its prevalence varies widely across populations, ranging from 0.1% to 50.5% globally [ 1 , 2 ]. In Western countries, about 10–20% of the population is affected, while in India, estimates suggest approximately 6–9% [ 2 , 3 ]. North Indians have a 20-fold higher incidence of gallstones compared to South Indians [ 4 ]. GSD is a major health concern because untreated cases can lead to serious complications such as acute pancreatitis, mucocele, pyocele, cholangitis, and acute cholecystitis. Additionally, 70–90% of patients diagnosed with gallbladder cancer have a history of GSD, emphasizing the importance of early detection and management [ 5 ]. So far, several modifiable and non-modifiable risk factors linked to the development of GSD have been identified. Modifiable risk factors include obesity, diet, type 2 diabetes mellitus, dyslipidemia, rapid weight loss, childbirth, medications, and others, while non-modifiable risk factors are aging, female sex, ethnicity, and genetic predisposition [ 6 , 7 ]. Among these, advancing age, gender, and body mass index (BMI) are well established and are known to influence both the occurrence and progression of the disease. Studies have shown that men under 50 have a higher incidence of GSD compared to women, but after age 50, the incidence is higher in women [ 8 ]. Females are two to three times more likely than men to develop gallstones [ 9 ]. Higher BMI is linked with the development of GSD; however, there are variable reports in the literature on this [ 10 , 11 ]. A study didn’t find a significant association between GSD and BMI and reported the prevalence of GSD in 17% of individuals with a BMI of 24–29, 14% of those with a BMI of 25–29, and 13% of those with a BMI greater than 30 [ 12 ]. Similarly, advancing age is no longer consistently related to the prevalence of GSD. Many studies have now reported the growing incidence of GSD among younger individuals with normal BMI [ 13 , 14 ]. Male gender was once considered a major risk factor for GSD-related complications, but recent research has refuted this assumption. After adjusting for other variables, studies have found that male gender alone does not independently increase the risk of complications [ 15 ]. Given the limited data available on the relationship between age, gender, and body mass index (BMI) with gallstone disease (GSD) in this region, this study aims to evaluate the association of these factors with the risk of GSD in patients presenting to a tertiary care institute. The findings will contribute to a more comprehensive understanding of the risk factors for gallstone disease in this population. Materials & Methods A hospital-based Case-Control Study was conducted among patients in the General Surgery Department of a Tertiary care hospital in North Delhi. The cases comprised symptomatic and asymptomatic patients diagnosed with gallstone disease (GSD) based on ultrasound (USG) findings, aged above 18 years, presenting to the Surgery OPD or Emergency, and without known comorbidities. The Control Group consisted of age- and sex-matched individuals attending the Surgical OPD, confirmed negative for GSD by USG, and without significant comorbidities. Patients with diabetes, hypertension, HIV, HBV, or endocrinopathies were excluded from both groups. The required minimum sample size was determined using the statistical formula, The minimum required sample size for the study is 180 participants, comprising 90 cases and 90 controls, calculated based on standard deviations (σ1, σ2), the difference in group means (Δ), the sample size ratio (κ = n2/n1), and statistical power (Z1-β) at a two-sided significance level (Z1-α/2). Ethical Considerations and Confidentiality Ethical approval for this study was obtained from the Institutional Ethical Committee (IEC). Informed consent was obtained from all participants before enrolment, and they were informed of their right to withdraw at any time without justification. Confidentiality and anonymity were strictly maintained by ensuring that no personally identifiable information was recorded. All data were securely stored and accessible only to the research team for analysis. Data Collection Following approval from the Institutional Ethical Committee (IEC), data were collected using a self-designed, pre-validated proforma. Informed written consent was obtained from all participants before enrolment. The proforma included demographic details such as name, age, gender, place of residence, and socio-economic status (assessed using the Modified Kuppuswamy Scale). Lifestyle factors, including smoking, tobacco use, alcohol consumption, dietary habits (vegetarian/non-vegetarian), and physical activity levels, were also recorded. Physical activity was categorized as "active" for individuals engaging in at least 15 minutes of exercise per day or 1.5 hours per week, while those below this threshold were classified as "sedentary." Clinical symptoms such as fever, abdominal pain, heartburn, dyspepsia, vomiting, jaundice, and their duration and frequency were documented. Details of previous hospitalizations, abdominal surgeries, and family history of gallstone disease or gallbladder cancer were also noted. Weight was measured using an automated hospital weighing scale with accuracy up to two decimal places, while height was measured using a stadiometer in an erect posture from the floor to the top of the head, also recorded to two decimal places. Body mass index (BMI) was calculated using the formula: BMI=Weight (kg)/Height (m) 2 . BMI values were classified based on the Asian BMI criteria. [16] Data management and statistical Analysis: Data were recorded in MS Excel. Observations were expressed as mean ± standard deviation and range for continuous data, while categorical data were shown as percentages or proportions. Normality of the data was assessed using the Shapiro-Wilk test. The Chi-square test was employed to evaluate the association among categorical variables. Forward stepwise (conditional) logistic regression was used to identify statistically significant risk factors and independent predictors of gallstone disease. All statistical analyses were performed with SPSS 26.0. A p-value of <0.05 was considered statistically significant. Results After applying the predefined inclusion and exclusion criteria, a total of 91 individuals diagnosed with GSD were selected for the case group. An equal number of 91 subjects without GSD were enrolled as controls. The ages of participants in both groups ranged from 18 to 70 years. Notably, about one-third of the cases were in the younger age group of 18–30 years. Regarding gender distribution, the case group was mostly female, comprising 78 females (85.7%) and 13 males (14.3%). Similarly, among the controls, there were 80 females (87.9%) and 11 males (12.1%), indicating a comparable gender ratio between the groups. In terms of body mass index (BMI) distribution, the largest proportion of cases (36.3%) was in the Obese I category (BMI: 25–29.9 kg/m2). In contrast, the largest proportion of controls (41.8%) had a normal BMI (18.5–24.9 kg/m2). Despite these differences in BMI categories, statistical analysis showed no significant difference between cases and controls regarding BMI. Table 1 . provides a detailed comparison of the socio-demographic characteristics, behavioural factors, family history, and BMI profiles between the cases and controls in the study. In general, both groups exhibited similar baseline attributes, ensuring comparability between cases and controls. However, a statistically significant difference was observed in the prevalence of family history related to gallstone disease (GSD) or gallbladder carcinoma. Specifically, 25% of individuals in the case group reported a family history of GSD or gallstone cancer, in contrast to only 11 participants among the controls who indicated a positive family history. Using Forward Stepwise (Conditional) logistic regression, among all the variables, only Family history of GSD/Carcinoma GB entered the final model as a statistically significant predictor with an odds ratio [Exp(B)] of 0.431 (95% CI: 0.195–0.952). Abdominal pain was the most common presentation among the cases of GSD, followed by vomiting and dyspepsia (Fig. 1 ). Table 1 Baseline characteristics. Variables Case (n = 91) [Frequency (%)] Control (n = 91) [Frequency (%)] P- value Age 18–30 years 32 (35.2) 27 (29.7) 0.502 31–40 years 19 (20.9) 24 (26.4) 41–50 years 23 (25.3) 28 (30.8) Above 50 17 (18.7) 12 (13.2) Sex Female 78 (85.7) 80 (87.9) 0.661 Male 13 (14.3) 11 (12.1) BMI (kg/m²) Underweight (< 18.5 kg/m 2 ) 5 (5.5) 5 (5.5) 0.301 Normal (18.5–24.9 kg/m 2 ) 29 (31.9) 38 (41.8) Overweight (25.0-29.9 kg/m 2 ) 15 (16.5) 19 (20.9) Obese I (30.0-34.9 kg/m 2 ) 33 (36.3) 20 (22) Obese II (35.0-39.9 kg/m 2 ) 9 (9.9) 9 (9.9) Socioeconomic status Upper 1 (1.1) 2 (2.2) 0.954 Upper middle 8 (8.8) 6 (6.6) Lower middle 43 (47.3) 45 (49.5) Upper lower 37 (40.7) 36 (39.6) Lower 2 (2.2) 2 (2.2) Smoking Yes 4 (4.4) 4 (4.4) 1.000 No 87 (95.6) 87 (95.6) Tobacco Yes 5 (5.5) 4 (4.4) 0.732 No 86 (94.5) 87 (95.6) Alcohol consumption Yes 8 (8.8) 7 (7.7) 0.788 No 83 (91.2) 84 (92.3) H/O Hospitalization Yes 20 (22) 27 (29.7) 0.236 No 71 (78) 64 (70.3) Physical activity Sedentary 44 (48.4) 35 (38.5) 0.178 Active 47 (51.6) 56 (61.5) Dietary Habits Vegetarian 37 (40.7) 35 (38.5) 0.762 Non-Vegetarian 54 (59.3) 56 (61.5) Family h/o GSD, Carcinoma of GB Yes 22 (24.2) 11 (12.1) 0.034 No 69 (75.8) 80 (87.9) Table 2 summarises the findings related to body mass index (BMI) and age among cases and controls. The cases demonstrated a higher mean BMI (Mean ± SD: 24.54 ± 0.39 kg/m²; median: 24.73 kg/m²) compared to the controls (Mean ± SD: 23.78 ± 0.42 kg/m²; median: 23.04 kg/m²). Regarding age, the mean age for cases was 39.15 ± 1.29 years (median: 38 years), while the controls had a mean age of 38.57 ± 1.22 years (median: 40 years). Despite these numerical differences, statistical analysis revealed no significant differences between cases and controls in terms of BMI or age, indicating that these variables were similarly distributed across both groups. Table 2 Association of Age and BMI among cases and controls. Measurements Case (n = 91) Control (n = 91) p Value Mean ± SD Median ± IQR Mean ± SD Median ± IQR BMI (kg/m²) 24.54 ± 0.39 24.73 ± 4.73 23.78 ± 0.42 23.04 ± 5.32 0.502 Age 39.15 ± 1.29 38 ± 21 38.57 ± 1.22 40 ± 19 0.301 An analysis of the distribution of body mass index (BMI) and age among male and female participants diagnosed with gallstone disease (GSD) is presented in Table 3 . The findings demonstrate distinct patterns in BMI categories between genders. Among female cases, the largest proportion—38.6%—was classified in the Obese I category, corresponding to BMI values between 25 and 29.9 kg/m². Conversely, most male cases—38.4%—were found within the normal BMI range, defined as 18.5 to 22.9 kg/m². Despite these apparent differences in BMI distribution between males and females with GSD, statistical analysis revealed no significant association between BMI and gender, as indicated by a p-value of 0.819. Regarding age distribution, most female participants diagnosed with GSD were concentrated in the younger age group of 18–30 years. In contrast, the highest proportion of male cases occurred in the 41–50 years age bracket. However, statistical testing showed that there was no significant association between age and gender among individuals with GSD, with a p-value of 0.160 supporting this finding. Statistical analysis revealed no significant association between age and body mass index (BMI) among participants diagnosed with gallstone disease (GSD) (p = 0.423). (Table 4 ) Table 3 Association of BMI and Age, with Gender among cases of GSD. Variables Female (n = 78) [Frequency (%)] Male (n = 13) [Frequency (%)] P value BMI Underweight (< 18.5) 4 (5.1) 1 (7.6) 0.819 Normal (18.5–22.9) 24 (30.7) 5 (38.4) Overweight (23- 24.9) 13 (16.7) 2 (15.3) Obese I (25- 29.9) 30 (38.6) 3 (23) Obese II (30 or more) 7 (8.9) 2 (15.3) Age 18–30 years 31 (39.7) 1 (7.6) 0.160 31–40 years 15 (19.2) 4 (21.1) 41–50 years 18 (23) 5 (38.4) Above 50 years 14 (18) 3 (30.8) Table 4 Association of BMI and Age among cases of Gallstone Disease Age BMI (kg/m²) P value Underweight (< 18.5) Normal (18.5–22.9) Overweight (23- 24.9) Obese I (25- 29.9) Obese II (30 or more) 18–30 years 4 (12.5) 11 (34.4) 4 (12.5) 12 (37.5) 1 (3.1) 0.423 31–40 years 1 (5.3) 7 (36.8) 3 (15.8) 6 (31.6) 2 (10.5) 41–50 years 0 (0.0) 9 (39.1) 4 (17.4) 7 (30.4) 3 (13.0) Above 50 years 0 (0.0) 2 (11.8) 4 (23.5) 8 (47.1) 3 (17.6) Discussion Although several findings of this case-control study align with previous research, some results are significant and challenge the established link between age, obesity, and GSD risk. Consistent with earlier studies, this research also shows that females, especially those of childbearing age, are more likely to develop gallstone disease (GSD). Unlike the traditional view, our results reveal that a notable portion of GSD cases occurred in a relatively younger population under 40 years old, and no positive association of BMI with gender and age was found among GSD cases [ 16 ]. Family history was identified as a significant risk factor for gallstone disease (GSD), independent of gender, suggesting a genetic predisposition. Conversely, no significant associations were observed between GSD and lifestyle factors such as diet, smoking, alcohol consumption, or physical activity in this study. Most GSD cases in this study were from the lower-middle socioeconomic class, suggesting diet, education, or healthcare access may be factors. Females of childbearing age have an increased susceptibility to developing GSD, which is largely attributed to hormonal influences such as elevated estrogen levels and the use of oral contraceptives [ 17 ]. Estrogen is found to be responsible for Cholesterol supersaturation of bile by increasing the secretion of Biliary cholesterol [ 18 ]. The reported female-to-male prevalence ratio of GSD varies significantly across different regions worldwide, with estimates ranging from 2:1 to 6:1 [ 1 , 9 , 19 , 20 ]. In this study, the female-to-male ratio among GSD cases was 6:1. Previously, advancing age was identified as a risk factor for GSD; however, recent studies have reported a high prevalence of GSD among younger individuals [ 13 , 21 ]. This study showed that 56% of cases are below the age of 40 years, with a Mean age of 39.15 ± 1.29 years, which is in line with some of the previous studies [ 13 , 21 ]. Previous research has identified high BMI as a potential risk factor for the development of GSD [ 16 , 22 , 23 ]. Although a greater proportion of GSD cases in this study had a BMI exceeding 25 kg/m², the data did not indicate a significant positive correlation between obesity and the prevalence of GSD. This result aligns with previous research, which similarly reported no significant association between BMI and GSD occurrence [ 12 ]. Furthermore, unlike previous studies that identified a positive association between obesity and female gender, this study found no significant correlation between BMI and either gender or age [ 16 , 24 ]. This study found no association between GSD and modifiable factors like diet, smoking, alcohol use, or physical activity. The link between GSD and these lifestyle factors is still debated, with studies showing conflicting results [ 25 , 26 , 27 ]. In contrast to our results, substantial evidence suggests that alcohol consumption is associated with a reduced risk of GSD [ 28 ]. This study observed a significant association between family history and the development of GSD, which may indicate that genetic factors contribute to GSD. Other studies have also reported that a positive family history is linked to an increased risk of gallstone formation [ 12 , 25 , 29 , 30 ]. The results of this study not only confirm previously established risk factors for GSD but also underscore the regional differences in demographic and metabolic risk factors associated with the disease. Nonetheless, this study is subject to several limitations. The study was conducted at a single tertiary care hospital in Delhi, with a limited sample size that may limit its generalizability. There may be potential bias in self-reported data and from confounders that are not measured, such as precise dietary intake or genetics. Selection of the cases and the controls from the same settings after matching them for age and sex may create selection bias. In the future, large-scale, multicentric studies are required to confirm the findings of this study and further explore the regional and ethnic factors responsible for the causation of GSD. Conclusion This study reinforces prior evidence that females have a greater predisposition to gallstone disease (GSD), consistent with the established understanding of gender-related risk factors. However, in contrast to previous studies that identified advancing age as a risk factor, the current results do not reveal a statistically significant correlation between GSD and older age. A significant association between GSD and family history indicates possible genetic susceptibility. Further research is needed to identify alleles linked to gallstone disease. Unlike prior research, this study did not find a significant link between GSD and lifestyle factors like BMI, smoking, alcohol use, physical activity, or diet. Traditionally, "Fat, Forty, Female, Fair, Fertile" were seen as key GSD risk factors, but recent studies, including this one, suggest these may be changing. These findings indicate evolving risk profiles and highlight the need for further research to clarify the determinants of GSD. Declarations Presentation at a meeting: Nil Source(s) of support: Nil Conflicting Interest: - Nil Statements: - The manuscript is original work & has been read and approved by all the authors. Requirements for authorship have been met. Funding: Nil Conflicts of interest: There are no conflicts of interest. Ethical approval : Ethical approval for this study was obtained from the Institutional Ethical Committee (Ref No. – IEC. 22356- 57 Dated 27.08.2022. Consent to participate: Informed consent was obtained from all participants before enrolment, and they were informed of their right to withdraw at any time without justification. Confidentiality and anonymity were strictly maintained by ensuring that no personally identifiable information was recorded. The study adhered to the principles of the Declaration of Helsinki, 2013. Written consent for publication: Not applicable. Data availability statement: Data supporting the results of this study can be obtained from the corresponding author upon reasonable request. Code availability: Not applicable. Large Language Model (LLM): Grammarly & Copilot (Microsoft) was used to improve language, grammar, and phrasing. Author contributions: Conceptualization: J.K., K.A.; Methodology: K.A., J.K., R.A., R.R.; Data analysis: J.K., K.A., R.A.; Writing–original draft preparation: J.K., K.A., R.A.; Writing – review and editing: J.K., K.A.; Supervision: J.K. 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Family history of gallstones and the risk of biliary tract cancer and gallstones: a population‐based study in Shanghai, China. International journal of cancer. 2007 Aug 15;121(4):832-8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-7963284","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":544639127,"identity":"e0884324-4f55-42d3-8a04-ea3ed3b683f9","order_by":0,"name":"Komal Agarwal","email":"","orcid":"","institution":"Sanjay Gandhi Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Komal","middleName":"","lastName":"Agarwal","suffix":""},{"id":544639128,"identity":"685d76fd-ed5f-4c95-93d3-34957bf48bd7","order_by":1,"name":"Jitendra 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09:21:38","extension":"xml","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":115318,"visible":true,"origin":"","legend":"","description":"","filename":"ddd20c4dc4404df7ad605f6303e92df21structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7963284/v1/2d224d1ecf011e4fb0e479b5.xml"},{"id":95905292,"identity":"e6697c9b-a9f7-41c3-996d-8a5ce8e593f9","added_by":"auto","created_at":"2025-11-14 09:21:37","extension":"html","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":128519,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7963284/v1/952bbc1074c02d2b646839e6.html"},{"id":95905280,"identity":"7001d744-4c26-4585-88b1-533ea9931df1","added_by":"auto","created_at":"2025-11-14 09:21:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":78280,"visible":true,"origin":"","legend":"\u003cp\u003eSymptoms and signs observed among the cases.\u003c/p\u003e","description":"","filename":"Figure1Symptomssignsobservedamongthecases.png","url":"https://assets-eu.researchsquare.com/files/rs-7963284/v1/e60bccaeca9a06c74e13e3cd.png"},{"id":96255352,"identity":"c79ba64c-9b7b-40e8-876e-a38c7701d4ac","added_by":"auto","created_at":"2025-11-19 07:48:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":862436,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7963284/v1/05b0e08c-b968-4110-a7b4-c86165661225.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAssociation of age, gender, and body mass index with gallstone disease: evidence from a case-control study at a tertiary care institute\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGallstone disease (GSD) is one of the most common conditions worldwide, placing a significant burden on healthcare systems. Its prevalence varies widely across populations, ranging from 0.1% to 50.5% globally [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In Western countries, about 10\u0026ndash;20% of the population is affected, while in India, estimates suggest approximately 6\u0026ndash;9% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. North Indians have a 20-fold higher incidence of gallstones compared to South Indians [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. GSD is a major health concern because untreated cases can lead to serious complications such as acute pancreatitis, mucocele, pyocele, cholangitis, and acute cholecystitis. Additionally, 70\u0026ndash;90% of patients diagnosed with gallbladder cancer have a history of GSD, emphasizing the importance of early detection and management [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSo far, several modifiable and non-modifiable risk factors linked to the development of GSD have been identified. Modifiable risk factors include obesity, diet, type 2 diabetes mellitus, dyslipidemia, rapid weight loss, childbirth, medications, and others, while non-modifiable risk factors are aging, female sex, ethnicity, and genetic predisposition [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Among these, advancing age, gender, and body mass index (BMI) are well established and are known to influence both the occurrence and progression of the disease. Studies have shown that men under 50 have a higher incidence of GSD compared to women, but after age 50, the incidence is higher in women [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Females are two to three times more likely than men to develop gallstones [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHigher BMI is linked with the development of GSD; however, there are variable reports in the literature on this [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A study didn\u0026rsquo;t find a significant association between GSD and BMI and reported the prevalence of GSD in 17% of individuals with a BMI of 24\u0026ndash;29, 14% of those with a BMI of 25\u0026ndash;29, and 13% of those with a BMI greater than 30 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Similarly, advancing age is no longer consistently related to the prevalence of GSD. Many studies have now reported the growing incidence of GSD among younger individuals with normal BMI [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Male gender was once considered a major risk factor for GSD-related complications, but recent research has refuted this assumption. After adjusting for other variables, studies have found that male gender alone does not independently increase the risk of complications [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGiven the limited data available on the relationship between age, gender, and body mass index (BMI) with gallstone disease (GSD) in this region, this study aims to evaluate the association of these factors with the risk of GSD in patients presenting to a tertiary care institute. The findings will contribute to a more comprehensive understanding of the risk factors for gallstone disease in this population.\u003c/p\u003e"},{"header":"Materials \u0026 Methods","content":"\u003cp\u003eA hospital-based Case-Control Study was conducted among patients in the General Surgery Department of a Tertiary care hospital in North Delhi. The cases comprised symptomatic and asymptomatic patients diagnosed with gallstone disease (GSD) based on ultrasound (USG) findings, aged above 18 years, presenting to the Surgery OPD or Emergency, and without known comorbidities. The Control Group consisted of age- and sex-matched individuals attending the Surgical OPD, confirmed negative for GSD by USG, and without significant comorbidities.\u0026nbsp;Patients with diabetes, hypertension, HIV, HBV, or endocrinopathies were excluded from both groups.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The required minimum sample size was determined using the statistical formula,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1763110254.png\" width=\"747\" height=\"130\"\u003e\u003c/p\u003e\n\u003cp\u003eThe minimum required sample size for the study is 180 participants, comprising 90 cases and 90 controls, calculated based on standard deviations (\u0026sigma;1, \u0026sigma;2), the difference in group means (\u0026Delta;), the sample size ratio (\u0026kappa; = n2/n1), and statistical power (Z1-\u0026beta;) at a two-sided significance level (Z1-\u0026alpha;/2).\u003c/p\u003e\n\u003cp\u003eEthical Considerations and Confidentiality\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Institutional Ethical Committee (IEC). Informed consent was obtained from all participants before enrolment, and they were informed of their right to withdraw at any time without justification. Confidentiality and anonymity were strictly maintained by ensuring that no personally identifiable information was recorded. All data were securely stored and accessible only to the research team for analysis.\u003c/p\u003e\n\u003cp\u003eData Collection\u003c/p\u003e\n\u003cp\u003eFollowing approval from the Institutional Ethical Committee (IEC), data were collected using a self-designed, pre-validated proforma. Informed written consent was obtained from all participants before enrolment. The proforma included demographic details such as name, age, gender, place of residence, and socio-economic status (assessed using the Modified Kuppuswamy Scale). Lifestyle factors, including smoking, tobacco use, alcohol consumption, dietary habits (vegetarian/non-vegetarian), and physical activity levels, were also recorded. Physical activity was categorized as \u0026quot;active\u0026quot; for individuals engaging in at least 15 minutes of exercise per day or 1.5 hours per week, while those below this threshold were classified as \u0026quot;sedentary.\u0026quot;\u003c/p\u003e\n\u003cp\u003eClinical symptoms such as fever, abdominal pain, heartburn, dyspepsia, vomiting, jaundice, and their duration and frequency were documented. Details of previous hospitalizations, abdominal surgeries, and family history of gallstone disease or gallbladder cancer were also noted. Weight was measured using an automated hospital weighing scale with accuracy up to two decimal places, while height was measured using a stadiometer in an erect posture from the floor to the top of the head, also recorded to two decimal places. Body mass index (BMI) was calculated using the formula: BMI=Weight (kg)/Height (m)\u003csup\u003e2\u003c/sup\u003e. BMI values were classified based on the Asian BMI criteria. \u003csup\u003e[16]\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eData management and statistical Analysis:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData were recorded in MS Excel. Observations were expressed as mean \u0026plusmn; standard deviation and range for continuous data, while categorical data were shown as percentages or proportions. Normality of the data was assessed using the Shapiro-Wilk test. The Chi-square test was employed to evaluate the association among categorical variables. Forward stepwise (conditional) logistic regression was used to identify statistically significant risk factors and independent predictors of gallstone disease. All statistical analyses were performed with SPSS 26.0. A p-value of \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAfter applying the predefined inclusion and exclusion criteria, a total of 91 individuals diagnosed with GSD were selected for the case group. An equal number of 91 subjects without GSD were enrolled as controls. The ages of participants in both groups ranged from 18 to 70 years. Notably, about one-third of the cases were in the younger age group of 18\u0026ndash;30 years. Regarding gender distribution, the case group was mostly female, comprising 78 females (85.7%) and 13 males (14.3%). Similarly, among the controls, there were 80 females (87.9%) and 11 males (12.1%), indicating a comparable gender ratio between the groups. In terms of body mass index (BMI) distribution, the largest proportion of cases (36.3%) was in the Obese I category (BMI: 25\u0026ndash;29.9 kg/m2). In contrast, the largest proportion of controls (41.8%) had a normal BMI (18.5\u0026ndash;24.9 kg/m2). Despite these differences in BMI categories, statistical analysis showed no significant difference between cases and controls regarding BMI.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. provides a detailed comparison of the socio-demographic characteristics, behavioural factors, family history, and BMI profiles between the cases and controls in the study. In general, both groups exhibited similar baseline attributes, ensuring comparability between cases and controls. However, a statistically significant difference was observed in the prevalence of family history related to gallstone disease (GSD) or gallbladder carcinoma. Specifically, 25% of individuals in the case group reported a family history of GSD or gallstone cancer, in contrast to only 11 participants among the controls who indicated a positive family history. Using Forward Stepwise (Conditional) logistic regression, among all the variables, only Family history of GSD/Carcinoma GB entered the final model as a statistically significant predictor with an odds ratio [Exp(B)] of 0.431 (95% CI: 0.195\u0026ndash;0.952). Abdominal pain was the most common presentation among the cases of GSD, followed by vomiting and dyspepsia (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCase (n\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e\u003cp\u003e[Frequency (%)]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e\u003cp\u003e[Frequency (%)]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP- value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;30 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (35.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27 (29.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.502\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u0026ndash;40 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (20.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24 (26.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41\u0026ndash;50 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (25.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28 (30.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbove 50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (18.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (13.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78 (85.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80 (87.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.661\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (12.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eBMI (kg/m\u0026sup2;)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnderweight (\u0026lt;\u0026thinsp;18.5 kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (5.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (5.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e0.301\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNormal (18.5\u0026ndash;24.9 kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29 (31.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38 (41.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverweight (25.0-29.9 kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (16.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19 (20.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eObese I (30.0-34.9 kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33 (36.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20 (22)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eObese II (35.0-39.9 kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (9.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (9.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eSocioeconomic status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUpper\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e0.954\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUpper middle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (8.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (6.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLower middle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43 (47.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45 (49.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUpper lower\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (40.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36 (39.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLower\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (2.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e87 (95.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87 (95.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eTobacco\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (5.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.732\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86 (94.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87 (95.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eAlcohol consumption\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (8.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (7.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.788\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83 (91.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84 (92.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eH/O Hospitalization\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27 (29.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.236\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71 (78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64 (70.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003ePhysical activity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSedentary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44 (48.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35 (38.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.178\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eActive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47 (51.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56 (61.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eDietary Habits\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVegetarian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (40.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35 (38.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.762\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-Vegetarian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54 (59.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56 (61.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eFamily h/o GSD, Carcinoma of GB\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (24.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (12.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.034\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69 (75.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80 (87.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarises the findings related to body mass index (BMI) and age among cases and controls. The cases demonstrated a higher mean BMI (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD: 24.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39 kg/m\u0026sup2;; median: 24.73 kg/m\u0026sup2;) compared to the controls (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD: 23.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42 kg/m\u0026sup2;; median: 23.04 kg/m\u0026sup2;). Regarding age, the mean age for cases was 39.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29 years (median: 38 years), while the controls had a mean age of 38.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22 years (median: 40 years). Despite these numerical differences, statistical analysis revealed no significant differences between cases and controls in terms of BMI or age, indicating that these variables were similarly distributed across both groups.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation of Age and BMI among cases and controls.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeasurements\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eCase (n\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMedian\u0026thinsp;\u0026plusmn;\u0026thinsp;IQR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMedian\u0026thinsp;\u0026plusmn;\u0026thinsp;IQR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI (kg/m\u0026sup2;)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.73\u0026thinsp;\u0026plusmn;\u0026thinsp;4.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23.04\u0026thinsp;\u0026plusmn;\u0026thinsp;5.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.502\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38\u0026thinsp;\u0026plusmn;\u0026thinsp;21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40\u0026thinsp;\u0026plusmn;\u0026thinsp;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.301\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAn analysis of the distribution of body mass index (BMI) and age among male and female participants diagnosed with gallstone disease (GSD) is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The findings demonstrate distinct patterns in BMI categories between genders. Among female cases, the largest proportion\u0026mdash;38.6%\u0026mdash;was classified in the Obese I category, corresponding to BMI values between 25 and 29.9 kg/m\u0026sup2;. Conversely, most male cases\u0026mdash;38.4%\u0026mdash;were found within the normal BMI range, defined as 18.5 to 22.9 kg/m\u0026sup2;. Despite these apparent differences in BMI distribution between males and females with GSD, statistical analysis revealed no significant association between BMI and gender, as indicated by a p-value of 0.819. Regarding age distribution, most female participants diagnosed with GSD were concentrated in the younger age group of 18\u0026ndash;30 years. In contrast, the highest proportion of male cases occurred in the 41\u0026ndash;50 years age bracket. However, statistical testing showed that there was no significant association between age and gender among individuals with GSD, with a p-value of 0.160 supporting this finding. Statistical analysis revealed no significant association between age and body mass index (BMI) among participants diagnosed with gallstone disease (GSD) (p\u0026thinsp;=\u0026thinsp;0.423). (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation of BMI and Age, with Gender among cases of GSD.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale (n\u0026thinsp;=\u0026thinsp;78) [Frequency (%)]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale (n\u0026thinsp;=\u0026thinsp;13) [Frequency (%)]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnderweight (\u0026lt;\u0026thinsp;18.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (7.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e0.819\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNormal (18.5\u0026ndash;22.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (30.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (38.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverweight (23- 24.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (15.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eObese I (25- 29.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (38.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (23)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eObese II (30 or more)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (8.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (15.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;30 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31 (39.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (7.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.160\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u0026ndash;40 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (19.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (21.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41\u0026ndash;50 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (38.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbove 50 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (30.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation of BMI and Age among cases of Gallstone Disease\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnderweight (\u0026lt;\u0026thinsp;18.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNormal (18.5\u0026ndash;22.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOverweight (23- 24.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eObese I (25- 29.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eObese II (30 or more)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u0026ndash;30 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (34.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12 (37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.423\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u0026ndash;40 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (5.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (36.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (15.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 (31.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (10.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e41\u0026ndash;50 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (39.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (17.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (30.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (13.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbove 50 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (23.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8 (47.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (17.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAlthough several findings of this case-control study align with previous research, some results are significant and challenge the established link between age, obesity, and GSD risk. Consistent with earlier studies, this research also shows that females, especially those of childbearing age, are more likely to develop gallstone disease (GSD). Unlike the traditional view, our results reveal that a notable portion of GSD cases occurred in a relatively younger population under 40 years old, and no positive association of BMI with gender and age was found among GSD cases [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Family history was identified as a significant risk factor for gallstone disease (GSD), independent of gender, suggesting a genetic predisposition. Conversely, no significant associations were observed between GSD and lifestyle factors such as diet, smoking, alcohol consumption, or physical activity in this study. Most GSD cases in this study were from the lower-middle socioeconomic class, suggesting diet, education, or healthcare access may be factors.\u003c/p\u003e\u003cp\u003eFemales of childbearing age have an increased susceptibility to developing GSD, which is largely attributed to hormonal influences such as elevated estrogen levels and the use of oral contraceptives [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Estrogen is found to be responsible for Cholesterol supersaturation of bile by increasing the secretion of Biliary cholesterol [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The reported female-to-male prevalence ratio of GSD varies significantly across different regions worldwide, with estimates ranging from 2:1 to 6:1 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In this study, the female-to-male ratio among GSD cases was 6:1. Previously, advancing age was identified as a risk factor for GSD; however, recent studies have reported a high prevalence of GSD among younger individuals [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This study showed that 56% of cases are below the age of 40 years, with a Mean age of 39.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29 years, which is in line with some of the previous studies [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePrevious research has identified high BMI as a potential risk factor for the development of GSD [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Although a greater proportion of GSD cases in this study had a BMI exceeding 25 kg/m\u0026sup2;, the data did not indicate a significant positive correlation between obesity and the prevalence of GSD. This result aligns with previous research, which similarly reported no significant association between BMI and GSD occurrence [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Furthermore, unlike previous studies that identified a positive association between obesity and female gender, this study found no significant correlation between BMI and either gender or age [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study found no association between GSD and modifiable factors like diet, smoking, alcohol use, or physical activity. The link between GSD and these lifestyle factors is still debated, with studies showing conflicting results [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In contrast to our results, substantial evidence suggests that alcohol consumption is associated with a reduced risk of GSD [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This study observed a significant association between family history and the development of GSD, which may indicate that genetic factors contribute to GSD. Other studies have also reported that a positive family history is linked to an increased risk of gallstone formation [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe results of this study not only confirm previously established risk factors for GSD but also underscore the regional differences in demographic and metabolic risk factors associated with the disease. Nonetheless, this study is subject to several limitations. The study was conducted at a single tertiary care hospital in Delhi, with a limited sample size that may limit its generalizability. There may be potential bias in self-reported data and from confounders that are not measured, such as precise dietary intake or genetics. Selection of the cases and the controls from the same settings after matching them for age and sex may create selection bias. In the future, large-scale, multicentric studies are required to confirm the findings of this study and further explore the regional and ethnic factors responsible for the causation of GSD.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study reinforces prior evidence that females have a greater predisposition to gallstone disease (GSD), consistent with the established understanding of gender-related risk factors. However, in contrast to previous studies that identified advancing age as a risk factor, the current results do not reveal a statistically significant correlation between GSD and older age. A significant association between GSD and family history indicates possible genetic susceptibility. Further research is needed to identify alleles linked to gallstone disease. Unlike prior research, this study did not find a significant link between GSD and lifestyle factors like BMI, smoking, alcohol use, physical activity, or diet. Traditionally, \"Fat, Forty, Female, Fair, Fertile\" were seen as key GSD risk factors, but recent studies, including this one, suggest these may be changing. These findings indicate evolving risk profiles and highlight the need for further research to clarify the determinants of GSD.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003ePresentation at a meeting: Nil\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource(s) of support: Nil\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicting Interest: - Nil\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatements: -\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe manuscript is original work \u0026amp; has been read and approved by all the authors.\u003c/p\u003e\n\u003cp\u003eRequirements for authorship have been met.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e Nil\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest:\u0026nbsp;\u003c/strong\u003eThere are no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e: Ethical approval for this study was obtained from the Institutional Ethical Committee (Ref No. \u0026ndash; IEC. 22356- 57 Dated 27.08.2022.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u003c/strong\u003e Informed consent was obtained from all participants before enrolment, and they were informed of their right to withdraw at any time without justification. Confidentiality and anonymity were strictly maintained by ensuring that no personally identifiable information was recorded. The study adhered to the principles of the Declaration of Helsinki, 2013.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWritten consent for publication:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement:\u0026nbsp;\u003c/strong\u003eData supporting the results of this study can be obtained from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLarge Language Model (LLM):\u003c/strong\u003e Grammarly \u0026amp; Copilot (Microsoft) was used to improve language, grammar, and phrasing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e Conceptualization: J.K., K.A.; Methodology: K.A., J.K., R.A., R.R.; Data analysis: J.K., K.A., R.A.; Writing\u0026ndash;original draft preparation: J.K., K.A., R.A.; Writing \u0026ndash; review and editing: J.K., K.A.; Supervision: J.K.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWang X, Yu W, Jiang G, Li H, Li S, Xie L, Bai X, Cui P, Chen Q, Lou Y, Zou L, Li S, Zhou Z, Zhang C, Sun P, Mao M. Global Epidemiology of Gallstones in the 21st Century: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol. 2024 Aug;22(8):1586-1595.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDhamnetiya D, Goel MK, Dhiman B, Pathania OP. Gallstone disease and quantitative analysis of independent biochemical parameters: Study in a tertiary care hospital of India. Journal of laboratory physicians. 2018 Oct;10(04):448-52.\u003c/li\u003e\n \u003cli\u003eBagepally BS, Haridoss M, Sasidharan A, Jagadeesh KV, Oswal NK. Systematic review and meta-analysis of gallstone disease treatment outcomes in early cholecystectomy versus conservative management/delayed cholecystectomy. BMJ Open Gastroenterology. 2021 Jul 1;8(1):e000675.\u003c/li\u003e\n \u003cli\u003eDutta U, Bush N, Kalsi D, Popli P, Kapoor VK. Epidemiology of gallbladder cancer in India. Chin Clin Oncol. 2019 Aug 1;8(4):33.\u003c/li\u003e\n \u003cli\u003eCianci P, Restini E. Management of cholelithiasis with choledocholithiasis: Endoscopic and surgical approaches. World Journal of Gastroenterology. 2021 Jul 28;27(28):4536.\u003c/li\u003e\n \u003cli\u003ePak M, Lindseth G. Risk Factors for Cholelithiasis. Gastroenterol Nurs. 2016 Jul-Aug;39(4):297-309.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSu, Py., Hsu, YC., Cheng, Yf. et al. Strong association between metabolically-abnormal obesity and gallstone disease in adults under 50\u0026thinsp;years. BMC Gastroenterol 19, 117 (2019).\u003c/li\u003e\n \u003cli\u003eDray X, Joly F, Reijasse D, Attar A, Alves A, Panis Y, Valleur P, Messing B. Incidence, risk factors, and complications of cholelithiasis in patients with home parenteral nutrition. Journal of the American College of Surgeons. 2007 Jan 1;204(1):13-21.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eNovacek G. Gender and gallstone disease. Wien Med Wochenschr. 2006 Oct;156(19-20):527-33.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLiu T, Wang W, Ji Y, Wang Y, Liu X, Cao L, Liu S. Association between different combination of measures for obesity and new-onset gallstone disease. PLoS One. 2018 May 17;13(5):e0196457.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKharga B, Sharma BK, Singh VK, Nishant K, Bhutia P, Tamang R, Jain N. Obesity Not Necessary, Risk of Symptomatic Cholelithiasis Increases as a Function of BMI. J Clin Diagn Res. 2016 Oct;10(10):PC28-PC32.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSalinas, G. MD; Vel\u0026aacute;squez, C. MD; Saavedra, L. MD; Ram\u0026iacute;rez, E. MD; Angulo, H. MD; Tamayo, J. C. MD; Orellana, A. MD; Huivin, Z. MD; Valdivia, C. MD; Rodr\u0026iacute;guez, W. MD. Prevalence and Risk Factors for Gallstone Disease. Surgical Laparoscopy, Endoscopy \u0026amp; Percutaneous Techniques 14(5):p 250-253, October 2004.\u003c/li\u003e\n \u003cli\u003eKazi FN, Ghosh S, Sharma JVP, Saravanan S, Patil S. Trends in Gallbladder Disease in Young Adults: A Growing Concern. Cureus. 2022 Aug 29;14(8):e28555.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGirme A, Gupta V, Shah B. Recent age-specific trends in the incidence of cholelithiasis. J Chem Health Risks. 2024;14(1):359-64.\u003c/li\u003e\n \u003cli\u003eKumar J, Kumar P, Meena K, Siddiqui AA. Male gender as an independent risk factor for laparoscopic cholecystectomy: An outcome analysis at a teaching institute. Saudi Journal for Health Sciences. 2017 May 1;6(2):104\u003c/li\u003e\n \u003cli\u003eGirdhar S, Sharma S, Chaudhary A, Bansal P, Satija M. An epidemiological study of overweight and obesity among women in an urban area of North India. Indian journal of community medicine: official publication of Indian Association of Preventive \u0026amp; Social Medicine. 2016 Apr;41(2):154.\u003c/li\u003e\n \u003cli\u003eUhler ML, Marks JW, Judd HL. Estrogen replacement therapy and gallbladder disease in postmenopausal women. Menopause. 2000 Jan 1;7(3):162-7.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"18\" type=\"1\"\u003e\n \u003cli\u003eTierney S, Nakeeb A, Wong O, Lipsett PA, Sostre S, Pitt HA, Lillemoe KD. Progesterone alters biliary flow dynamics. Annals of surgery. 1999 Feb;229(2):205.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"19\"\u003e\n \u003cli\u003eUnisa S, Jagannath P, Dhir V, Khandelwal C, Sarangi L, Roy TK. Population-based study to estimate prevalence and determine risk factors of gallbladder diseases in the rural Gangetic basin of North India. HPB (Oxford). 2011 Feb;13(2):117-25.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBesra RC, Khan M, Mandal P, Roy A, Das S. A study on the prevalence of gallbladder disease and its associated factors in a tertiary hospital of Eastern India. Int J Acad Med Pharm. 2024;6(2):782-788.\u003c/li\u003e\n \u003cli\u003eAli A, Perveen S, Khan I, Ahmed T, Nawaz A, Rab A. Symptomatic Gallstones in Young Patients Under the Age of 30 Years. Cureus. 2021 Nov 25;13(11):e19894.\u003c/li\u003e\n \u003cli\u003eZhou J, Yu W, Jiang G, Li H, Luo J, Li S, Xie L, Bai X, Xia J, Mao M, Gao M, Lu J, Wang X. Risk of Gallstones Increases with Multiple Dimensions of Obesity Indexes: A Prospective Study Based on the UK Biobank. Obes Facts. 2025 Mar 26:1-13.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eParra-Landazury NM, Cordova-Gallardo J, M\u0026eacute;ndez-S\u0026aacute;nchez N. Obesity and Gallstones. Visc Med. 2021 Oct;37(5):394-402.\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"24\" type=\"1\"\u003e\n \u003cli\u003eSun H, Tang H, Jiang S, Zeng L, Chen EQ, Zhou TY, Wang YJ. Gender and metabolic differences of gallstone diseases. World journal of gastroenterology: WJG. 2009 Apr 4;15(15):1886.\u003c/li\u003e\n \u003cli\u003eDhamnetiya D, Goel MK, Dhiman B, Pathania OP. Gallstone disease and its correlates among patients attending teaching hospital of North India. Journal of family medicine and primary care. 2019 Jan;8(1):189.\u003c/li\u003e\n \u003cli\u003eSachdeva S, Khan Z, Ansari MA, Khalique N, Anees A. Lifestyle and gallstone disease: scope for primary prevention. Indian J Community Med. 2011 Oct;36(4):263-7.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKarayal\u0026ccedil;in R, Gen\u0026ccedil; V, Karaca AS, \u0026Ouml;zakşıt G. Prevalence of cholelithiasis in a Turkish population sample of postmenopausal women. Turk J Gastroenterol. 2010 Dec;21(4):416-20. PMID: 21331996.\u003c/li\u003e\n \u003cli\u003eCha BH, Jang MJ, Lee SH. Alcohol Consumption Can Reduce the Risk of Gallstone Disease: A Systematic Review with a Dose-Response Meta-Analysis of Case-Control and Cohort Studies. Gut Liver. 2019 Jan 15;13(1):114-131.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePatel AM, Yeola M, Mahakalkar C. Demographic and Risk Factor Profile in Patients of Gallstone Disease in Central India. Cureus. 2022 May 14;14(5).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHsing AW, Bai Y, Andreotti G, Rashid A, Deng J, Chen J, Goldstein AM, Han TQ, Shen MC, Fraumeni Jr JF, Gao YT. Family history of gallstones and the risk of biliary tract cancer and gallstones: a population‐based study in Shanghai, China. International journal of cancer. 2007 Aug 15;121(4):832-8.\u003c/li\u003e\n\u003c/ol\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":"Case control study, Cholecystitis, Gallstone disease, Risk factors","lastPublishedDoi":"10.21203/rs.3.rs-7963284/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7963284/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Gallstone disease (GSD) poses a major health burden worldwide, contributing significantly to morbidity. While various modifiable and non-modifiable risk factors—including age, gender, and body mass index (BMI)—have been commonly associated with GSD development, recent studies have reported inconsistent results. Additionally, regional disparities in GSD prevalence and risk factors remain insufficiently explored. The primary objective of this study is to assess the association of age, gender, and BMI with GSD among patients presenting to a high-volume tertiary care hospital in North Delhi.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A hospital-based case-control study included ninety-one ultrasound-confirmed cases of GSD, and an equal number of age- and sex-matched controls without GSD were included. Data on demographics, lifestyle, medical history, and BMI were collected. Statistical analysis utilized Chi-square tests and conditional logistic regression, with significance set at p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult:\u003c/strong\u003e Females constituted the majority of cases (85.7%), and nearly one-third belonged to the younger age group. Although the mean BMI was higher among cases, differences in age and BMI between cases and controls were not statistically significant. A positive family history of GSD or gallbladder carcinoma was the only factor showing a significant association, while no significant associations were observed with lifestyle factors such as diet, alcohol use, smoking, or physical activity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Female gender and positive family history remain important risk factors for GSD, while no significant associations were found with age, BMI, or lifestyle habits in this cohort. The findings show changing risk profiles.\u003c/p\u003e","manuscriptTitle":"Association of age, gender, and body mass index with gallstone disease: evidence from a case-control study at a tertiary care institute","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-14 09:21:33","doi":"10.21203/rs.3.rs-7963284/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":"0ee6723f-4334-4ceb-bc56-1d5eaaa2b523","owner":[],"postedDate":"November 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-17T06:54:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-14 09:21:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7963284","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7963284","identity":"rs-7963284","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}