{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T06:19:12Z","timestamp":1783491552605,"version":"3.55.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cholelithiasis is a common, costly gastrointestinal disease with a rising global prevalence, and diet-related inflammation is closely associated with the onset of cholelithiasis. The energy-adjusted dietary inflammatory index (E-DII) provides a robust measure of dietary inflammatory potential by accounting for total energy intake, but prospective data on its link to cholelithiasis in general populations remain scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We explored this association in a large prospective cohort of 202,129 adults aged 40\u201369 from the UK Biobank. E-DII scores were derived from 24-h dietary recall data, and Cox regression models were used to examine associations between E-DII quartiles and cholelithiasis. Restricted cubic spline (RCS) regression characterized nonlinear relationships, with subgroup and sensitivity analyses (competing risk models, propensity score matching) validating findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In fully adjusted model, the hazard ratios (HRs) with 95% confidence intervals (CIs) for cholelithiasis across higher E-DII quartiles were 1.05(0.97, 1.12), 1.00 (0.93, 1.08) and 1.19 (1.11, 1.28) compared to the lowest quartile, respectively. The RCS analysis showed a nonlinear and positive association between E-DII and cholelithiasis. Risk increased when E-DII was below \u22121.891, decreased slightly from \u22121.891 to \u22120.507, and increased continuously after \u22120.507. Subgroup and sensitivity analyses largely corroborated the primary findings, indicating robustness of the observed associations. No association was observed between E-DII and cholelithiasis-related mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this large prospective cohort study, higher E-DII scores were associated with an increased risk of cholelithiasis, exhibiting a nonlinear pattern. These findings suggest that dietary adjustment may be beneficial for cholelithiasis prevention and warrant further targeted research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1858498","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:58:47Z","timestamp":1783490327000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of energy-adjusted dietary inflammatory index with risk of cholelithiasis: a prospective cohort study"],"prefix":"10.3389","volume":"14","author":[{"given":"Jiayue","family":"Zhu","sequence":"first","affiliation":[{"name":"Faculty of Military Health Service, Naval Medical University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinghong","family":"Zhai","sequence":"additional","affiliation":[{"name":"Clinical Research Unit, School of Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai JiaoTong University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Yuan","sequence":"additional","affiliation":[{"name":"Faculty of Military Health Service, Naval Medical University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suming","family":"Dai","sequence":"additional","affiliation":[{"name":"Faculty of Military Health Service, Naval Medical University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangyuan","family":"Hu","sequence":"additional","affiliation":[{"name":"Faculty of Military Health Service, Naval Medical University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Liu","sequence":"additional","affiliation":[{"name":"Faculty of Military Health Service, Naval Medical University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1093\/ajcn\/nqaa154","article-title":"A healthy lifestyle pattern and the risk of symptomatic gallstone disease: results from 2 prospective cohort studies","volume":"112","author":"Wirth","year":"2020","journal-title":"Am J Clin Nutr"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e529","DOI":"10.1016\/j.cgh.2020.12.034","article-title":"Obesity, type 2 diabetes, lifestyle factors, and risk of gallstone disease: a Mendelian randomization investigation","volume":"20","author":"Yuan","year":"2022","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"148","DOI":"10.3238\/arztebl.2020.0148","article-title":"The treatment of gallstone disease","volume":"117","author":"Gutt","year":"2020","journal-title":"Dtsch Arztebl Int"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1002\/hep.32183","article-title":"Insights into modifiable risk factors of cholelithiasis: a Mendelian randomization study","volume":"75","author":"Chen","year":"2022","journal-title":"Hepatology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1080\/17474124.2019.1549988","article-title":"Cholesterol cholelithiasis: part of a systemic metabolic disease, prone to primary prevention","volume":"13","author":"Di Ciaula","year":"2019","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"13","DOI":"10.3390\/jpm11010013","article-title":"Gallstone disease, obesity and the Firmicutes\/Bacteroidetes ratio as a possible biomarker of gut dysbiosis","volume":"11","author":"Grigor'eva","year":"2020","journal-title":"J Pers Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1186\/s12876-023-02943-9","article-title":"Dietary inflammatory index and risk of gallstone disease in Iranian women: a case-control study","volume":"23","author":"Ghorbani","year":"2023","journal-title":"BMC Gastroenterol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1093\/advances\/nmy071","article-title":"Perspective: the dietary inflammatory index (dii)-lessons learned, improvements made, and future directions","volume":"10","author":"H\u00e9bert","year":"2019","journal-title":"Adv Nutr"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1016\/j.sleh.2020.09.002","article-title":"Associations between dietary inflammatory index and sleep problems among adults in the United States, Nhanes 2005-2016","volume":"7","author":"Kase","year":"2021","journal-title":"Sleep Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1820","DOI":"10.1017\/S0007114522002574","article-title":"Association between inflammatory potential of diet and markers of malnutrition in haemodialysis patients","volume":"129","author":"Arab","year":"2023","journal-title":"Br J Nutr"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1089\/bfm.2022.0182","article-title":"The association of the inflammatory index of the maternal diet with the type of delivery, maternal nutritional status, and the lipid profile of human milk","volume":"18","author":"Bueno","year":"2023","journal-title":"Breastfeed Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1429883","DOI":"10.3389\/fnut.2024.1429883","article-title":"The association between energy-adjusted dietary inflammatory index and metabolic syndrome and its mediatory role for cardiometabolic diseases: a prospective cohort study","volume":"11","author":"Pourmontaseri","year":"2024","journal-title":"Front Nutr"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"946","DOI":"10.3390\/antiox12040946","article-title":"Changes in dietary inflammatory index score over time and cancer development in rural post-menopausal women","volume":"12","author":"Jackson","year":"2023","journal-title":"Antioxidants (Basel)"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1403438","DOI":"10.3389\/fnut.2024.1403438","article-title":"Association between dietary inflammatory index and gallstones in US adults","volume":"11","author":"Luo","year":"2024","journal-title":"Front Nutr"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2236551","DOI":"10.1080\/07853890.2023.2236551","article-title":"Relationship between non-energy-adjusted and energy-adjusted dietary inflammatory index and the healthy eating Index-2015: an analysis of the National Health and nutrition examination survey (Nhanes) 2015-2018","volume":"55","author":"Dinatale","year":"2023","journal-title":"Ann Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"eadf4428729","DOI":"10.1126\/scitranslmed.adf4428","article-title":"Prospective study design and data analysis in UK biobank","volume":"16","author":"Allen","year":"2024","journal-title":"Sci Transl Med"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.clnu.2024.12.019","article-title":"Quantity and quality of dietary carbohydrates, low-grade inflammation, and risk of chronic obstructive pulmonary disease and lung function","volume":"45","author":"Fang","year":"2024","journal-title":"Clin Nutr"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1342","DOI":"10.1177\/2047487320903866","article-title":"Energy-adjusted dietary inflammatory index scores predict long-term cardiovascular disease mortality and other causes of death in an ecological analysis of the seven countries study","volume":"28","author":"Puddu","year":"2021","journal-title":"Eur J Prev Cardiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1039\/D5FO03952E","article-title":"Pro-inflammatory and pro-oxidant diets and Ckd risk across cardiovascular-kidney-metabolic syndrome stages: a multi-omics mediation analysis","volume":"17","author":"Zhang","year":"2026","journal-title":"Food Funct"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"111344699","DOI":"10.3389\/fnut.2024.1344699","article-title":"Association of pro-inflammatory diet with increased risk of gallstone disease: a cross-sectional study of NHANES January 2017-march 2020","volume":"11","author":"Cheng","year":"2024","journal-title":"Front Nutr"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e000944","DOI":"10.1136\/bmjgast-2022-000944","article-title":"Association between the dietary inflammatory index with gallstone disease: finding from Dena Persian cohort","volume":"9","author":"Sadri","year":"2022","journal-title":"BMJ Open Gastroenterol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e41745","DOI":"10.1097\/MD.0000000000041745","article-title":"The mediating role of circulating inflammatory cytokines in causal associations between plasma metabolites and asymptomatic bile duct and cholecyst calculus: a Mendelian randomization study","volume":"104","author":"Peng","year":"2025","journal-title":"Medicine (Baltimore)"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e71656","DOI":"10.1096\/fj.202503254RRRRRR","article-title":"Gut microbiome Dysbiosis promotes gallstone formation via bile acid metabolic disorder: a multiomics study","volume":"40","author":"Huang","year":"2026","journal-title":"FASEB J"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/jmwh.12959","article-title":"Cholelithiasis: presentation and management","volume":"64","author":"Littlefield","year":"2019","journal-title":"J Midwifery Womens Health"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"9720","DOI":"10.3389\/fendo.2018.00720","article-title":"Association between type I and II diabetes with gallbladder stone disease","volume":"9","author":"Chen","year":"2018","journal-title":"Front Endocrinol (Lausanne)"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1159\/000517270","article-title":"Risk factors for gallstones and cholecystectomy: a large-scale population-based prospective cohort study in Japan","volume":"40","author":"Colvin","year":"2022","journal-title":"Dig Dis"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1186\/s12876-022-02149-5","article-title":"The association between hypertension and the risk of gallstone disease: a cross-sectional study","volume":"22","author":"Zhang","year":"2022","journal-title":"BMC Gastroenterol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1866","DOI":"10.7150\/ijms.98492","article-title":"Association of tooth loss and gallstones: National Health and nutrition examination survey 2017-2018","volume":"21","author":"Yu","year":"2024","journal-title":"Int J Med Sci"},{"key":"ref29","first-page":"151","article-title":"Management of cholelithiasis with concomitant choledocholithiasis","volume":"54","author":"Akmal","year":"2022","journal-title":"Acta Med Indones"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"908174376","DOI":"10.1016\/j.ejphar.2021.174376","article-title":"Recent advances, novel targets and treatments for cholelithiasis; a narrative review","author":"Swarne","year":"2021","journal-title":"Eur J Pharmacol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"156815","DOI":"10.1016\/j.cyto.2024.156815","article-title":"Immune traits in combination with inflammatory proteins revealing the pathogenesis of autoimmune liver diseases: A Mendelian randomization study","volume":"185","author":"Wang","year":"2025","journal-title":"Cytokine"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1858498\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:58:48Z","timestamp":1783490328000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1858498\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,8]]},"references-count":31,"alternative-id":["10.3389\/fpubh.2026.1858498"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1858498","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,8]]},"article-number":"1858498"}}