Gallbladder (GB) stones are a common gastrointestinal disorder influenced by metabolic and lifestyle factors. Visceral adiposity has been proposed as a key contributor to GB stone pathogenesis, but evidence using direct quantification of visceral fat in men is limited. This study aimed to investigate the association between visceral fat area, measured by abdominal pelvic computed tomography (CT), and the prevalence of GB stones in Korean men.

In this retrospective cross-sectional study, 2939 Korean men who underwent abdominal pelvic CT and ultrasonography during routine health examinations were included. Visceral and subcutaneous fat areas were quantified at the L3 vertebral level using CT images. Participants were categorized into quartiles based on fat area. Logistic regression models assessed the relationship between fat distribution and GB stone prevalence, adjusting for demographic, clinical, lifestyle, and biochemical factors.

The mean age was 52.4 ± 9.6 years. The prevalence of GB stones increased significantly with higher visceral fat quartiles (p=0.010), while no significant trend was observed with subcutaneous fat. In the fully adjusted model, men in the highest visceral fat quartile had more than twice the odds of having GB stones compared to those in the lowest quartile (OR 2.108, 95 % CI 1.014–4.385, p=0.046), while subcutaneous fat showed no significant association.

Increased visceral fat, rather than subcutaneous fat, is independently associated with the presence of GB stones in Korean men. These findings highlight visceral adiposity as a significant risk factor for GB stone formation and suggest that incorporating visceral fat assessment could enhance risk stratification and early identification of individuals at risk.