ORIGINAL RESEARCH article
Front. Med.
Sec. Hepatobiliary Diseases
High visceral adiposity and low skeletal muscle mass independently predict the development of acute cholecystitis in patients with gallstones: a retrospective cohort study
Provisionally accepted
ABDULLAH ENES ATAŞ1*
Şeyma Ünüvar2- 1Department of Radiology, Necmettin Erbakan Universitesi, Meram, Türkiye
- 2Department of Radiology, Konya Sehir Hastanesi, Konya, Türkiye
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: While cholelithiasis is common, predicting which patients will develop acute cholecystitis (AC) remains a clinical challenge, as traditional risk factors like Body Mass Index (BMI) lack specificity. This study aimed to determine if CT-derived visceral adiposity and sarcopenia can predict the transition from asymptomatic cholelithiasis to clinical AC. Methods: This retrospective cohort study included 622 adult patients with cholelithiasis, identified via CT scans performed between 2015 and 2025. Patients were divided into an AC group (n=164), who developed AC during follow-up, and a control group (n=458) who did not. Body composition metrics, including visceral fat area (VFA) and skeletal muscle index (SMI), were quantified from axial CT images at the L3 vertebral level. A multivariate logistic regression analysis was performed to identify independent predictors of developing AC. Results: The AC group had significantly higher VFA and lower SMI compared to the control group. Multivariate analysis identified several independent predictors for developing AC, including hypertension (OR: 2.71, p<0.001), hyperlipidemia (OR: 2.88, p<0.001), and a 10 cm² increase in VFA (OR: 1.34, p<0.001). In contrast, a per-unit increase in SMI was found to be protective (OR: 0.94, p=0.001). The predictive model demonstrated strong discriminatory power with an Area Under the Curve (AUC) of 0.857. Conclusion: Visceral adiposity and sarcopenia are strong, independent predictors of the development of AC. These findings suggest that AC is a complication of a systemic metabolic state and that CT-based body composition analysis is a valuable tool for risk stratification in patients with cholelithiasis.
Keywords: acute cholecystitis, visceral adiposity, Sarcopenia, Body Composition, Cholelithiasis
Received: 14 Oct 2025; Accepted: 17 Nov 2025.
Copyright: © 2025 ATAŞ and Ünüvar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: ABDULLAH ENES ATAŞ, aenesatas@gmail.com
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.