Review for 10.1186/s12876-025-03846-7 (2025)

Title: Long-term weight change patterns in American adulthood in relation to gallstones:
evidence from NHANES
Version: 0 Date: 27 Feb 2025
Reviewer's report:
Thank you for inviting me to review the manuscript titled "Long-term weight change patterns
in American adulthood in relation to gallstones: evidence from NHANES". I appreciate the
opportunity to evaluate this important piece of research.
Summary: The study investigates the association between long-term weight change patterns
throughout adulthood and the risk of developing gallstones, using data from the National Health
and Nutrition Examination Survey (NHANES) from 2017-2020. It focuses on U.S. adults aged
40-70 and assesses weight status at three distinct points in time (age 25, 10 years prior to
baseline, and baseline) to explore the relationship with gallstone incidence. The results suggest
that a stable obesity pattern starting from early adulthood is associated with an increased risk
of gallstones. Subgroup analysis highlighted stronger associations among women, those with
diabetes, and individuals with low physical activity.
Clinical Comments:
Clinical Relevance of Weight Management: The study highlights the importance of managing
obesity, particularly in early adulthood, to prevent long-term complications such as gallstones.
Clinicians should emphasize the prevention of obesity in younger adults and encourage weight
maintenance or loss strategies as part of a broader metabolic syndrome prevention plan.
Target Populations for Intervention: The findings underscore that women, individuals with
diabetes, and those with low physical activity have stronger associations with gallstones.
Healthcare providers should consider these groups as priority targets for interventions aimed
at reducing gallstone risk, including lifestyle modifications such as increased physical activity
and dietary changes.
Potential for Public Health Strategies: This study provides valuable insights for public health
campaigns focusing on weight management and gallstone prevention. Given the substantial
healthcare burden of gallstones, targeting early weight management and addressing risk factors
in adulthood could reduce both the incidence of gallstones and associated healthcare costs.
Statistical Comments:
Consideration of Confounding Factors: The analysis adequately adjusted for key covariates such
as demographic characteristics and disease status. However, further discussion on the potential
confounding effects of genetic factors and their interaction with environmental factors like diet
or medication could enhance the interpretation of the results.
Use of Logistic Regression Models: The logistic regression models used are appropriate for
estimating the odds ratios of gallstones. It might be valuable to discuss the potential limitations of
relying on self-reported gallstone diagnosis, as recall bias could influence the results. Sensitivity
analyses could strengthen confidence in the findings, particularly by addressing potential biases
related to self-reported data.
Statistical Power and Sample Size: The study includes a large sample size, which strengthens
the validity of the results. However, in subgroup analyses (such as for the "obese to non-obese"
group), sample sizes are smaller, which may affect the statistical power of these comparisons.
A discussion on the limitations of subgroup analyses due to sample size would be helpful in
understanding the robustness of the findings.