ABSTRACT Background Gallstones are a common digestive disorder linked to a bile composition imbalance. Uric acid (UA) and high‐density lipoprotein cholesterol (HDL‐C) are key metabolic markers associated with gallstone risk. Objective To investigate the association between the uric acid to HDL‐C ratio (UHR) and gallstone risk. Methods Using 2017–2020 NHANES data, we included participants with complete UHR and gallstone information. Analyses included weighted multivariate logistic regression, restricted cubic splines (RCS) for nonlinearity, subgroup/interaction tests, and sensitivity analysis using multiple imputation. Results Among 6354 participants, UHR was positively associated with gallstones. The fully adjusted model revealed that for every 1‐unit increase in UHR, the incidence of gallstones increased by 4% (OR = 1.04, 95% CI: 1.00–1.08, p = 0.045). RCS indicated a nonlinear relationship ( P nonlinear < 0.001) with an inflection at 14.6: risk increased significantly below 14.6 but weakened above it. Subgroup analysis revealed a remarkable interaction within the asthma subgroup ( P forinteraction = 0.017). Sensitivity analysis corroborated the robustness of these findings. Conclusion UHR, a novel inflammatory and metabolic marker, is closely related to gallstone risk. Its predictive value is particularly high in the lower range (< 14.6), offering a new reference for screening high‐risk populations for gallstones.
Yu et al. (2026) studied this question.