The Potential of Microbiota-Modulating Dietary Strategies in Gallstone Prevention: Evidence from 2 Large Population- Based Cohorts

Background/Aims: Gut–microbiota dysbiosis has been implicated in gallstone formation through alterations in bile acid and cholesterol metabolism, but whether adherence to a microbiota-supportive diet is associated with gallstone disease at the population level remains unclear. The current study examined the cross-sectional association between the Dietary Index for Gut Microbiota (DI-GM) and the prevalence of gallstone disease.

Materials and Methods: The current study analyzed National Health and Nutrition Examination Survey (NHANES) 2017-2020 (n = 7198 adults aged ≥20 years) and the UK Biobank (n = 126 478) cross-sectionally. DI-GM was calculated using 14 food components in NHANES and 13 food components in the UK Biobank. Gallstone disease was ascertained by self-report in NHANES and by self-report supplemented with inpatient ICD-10 K80 codes in the UK Biobank. The authors used logistic regression (survey-weighted for NHANES and unweighted for the UK Biobank) and restricted cubic splines. A demographic and behavioral adjusted model estimated the total effect and a cardiometabolic adjusted model was used as a conservative sensitivity analysis.

Results: Higher DI-GM scores were associated with lower odds of prevalent gallstones in both cohorts. In the total-effect model, each 1-point increment in the DI-GM score was associated with 13% lower odds of gallstone disease in NHANES (odds ratio (OR) = 0.87, 95% confidence interval (CI): 0.83-0.92) and 7% lower odds in the UK Biobank (OR = 0.93, 0.91-0.95). These associations were attenuated but remained significant after cardiometabolic adjustment (NHANES 0.92, 0.87–0.98; UK Biobank 0.95, 0.93-0.97; both P ≤ .007). Compared with the lowest DI-GM category, the highest category was associated with lower odds of gallstone disease in both NHANES (OR, 0.73; 95% CI, 0.60-0.89) and the UK Biobank (OR, 0.80; 95% CI, 0.74-0.87). Restricted cubic spline analyses supported a linear association, and the subgroup and sensitivity analyses yielded consistent results.

Conclusion: In 2 demographically distinct populations, greater adherence to a gut microbiota-supportive diet was independently associated with lower odds of prevalent gallstone disease. These cross-sectional findings require prospective confirmation before causal or preventive inferences are drawn.

Cite this article as: He H, Li L, Yang X. The potential of microbiota-modulating dietary strategies in gallstone prevention: Evidence from 2 large population-based cohorts. Turk J Gastroenterol. 2026;37(8):880-894.