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Controlled Attenuation Parameter and Gallstone Disease Risk: A Retrospective Cohort Study with Mediation Analysis and
Xuan Bai1,2, Xiaofang Li3, Qiaoling Wang4
1Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China.
Clinical Epidemiology
|April 8, 2026
Summary
Elevated controlled attenuation parameter (CAP) levels, a marker for fatty liver, significantly increase gallstone disease (GSD) risk, especially in women. Persistently high CAP and reduced high-density lipoprotein cholesterol (HDL-C) are key factors.
Area of Science:
- Hepatology
- Gastroenterology
- Epidemiology
Background:
- The relationship between controlled attenuation parameter (CAP), a noninvasive marker for hepatic steatosis, and gallstone disease (GSD) is not well understood.
- Hepatic steatosis is a growing health concern with potential systemic implications.
Purpose of the Study:
- To investigate the association between CAP levels and GSD risk.
- To explore the impact of longitudinal CAP trajectories on GSD development.
- To identify potential mediating pathways, such as lipid profiles, in the CAP-GSD relationship.
Main Methods:
- A dynamic cohort of 6,308 adults without baseline GSD was followed from 2020 to 2025.
- Multivariate Cox regression, restricted cubic spline (RCS), and mediation analyses were employed.
- Group-based trajectory modeling (GBTM) identified CAP patterns over time and their association with GSD incidence.
Main Results:
- Each 1-SD increase in CAP was linked to a 40% higher GSD risk, with a stronger effect in women.
- A linear dose-response relationship was observed between CAP and GSD risk.
- Persistently high CAP trajectories showed a 3.85-fold increased GSD risk, and high-density lipoprotein cholesterol (HDL-C) mediated 27.49% of this association.
Conclusions:
- CAP is a significant, linear predictor of GSD risk, particularly pronounced in women.
- Sustained high CAP levels are associated with substantially elevated GSD risk.
- HDL-C plays a crucial role as a mediator in the pathway from CAP to GSD.
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