ArticleScientific reports2026
Association between total dietary sugar intake and gallstones in Americans.
Article in Scientific reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Excessive intake of sugar is an important risk factor for gallstones. This study aimed to investigate the association between dietary total sugar intake and gallstone risk in the U.S. adult population. We conducted a cross-sectional analysis using data from 8975 eligible participants in the National Health and Nutrition Examination Survey (NHANES) 2017–2023. Dietary total sugar intake (g/day) was assessed via two 24-hour dietary recalls. Gallstones status comes from self-reported information. Multivariable logistic regression, restricted cubic splines (RCS) regression model, and subgroup analysis were employed to evaluate associations. We randomly divided the entire dataset into a 70% train set to train the model and a 30% test set. The Synthetic Minority Over-sampling Technique (SMOTE) algorithm was used to balance the two gallstone and non- gallstone groups to a ratio of 1:1. Machine learning including XGBoost algorithm with 10-fold cross-validation and grid search on the training set to adjust hyperparameters and SHapley Additive exPlanations (SHAP) analysis were used to further explore the potential correlation. Each 100 g/day increase in total sugar intake was associated with a 41% higher gallstone risk after adjusting for all covariates (OR = 1.41, 95%, CI:1.20–1.65, P < 0.001). A linear dose-response relationship was observed in RCS regression model (P for linear = 0.130). Subgroup analyses showed consistent associations across populations (P for interaction > 0.05). XGBoost performed well on the test set (AUC = 0.896). SHAP analysis confirmed sugar intake as the sixth top predictor, with revealing age, gender, and BMI as stronger determinants. In addition, partial dependency plot revealed high sugar intake increased the risk of gallstones. Higher dietary sugar intake is significantly associated with increased gallstone risk, independent of traditional metabolic factors. These findings may support sugar reduction as a potential preventive strategy, warranting further longitudinal and mechanistic studies.
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