Identification of blood metabolites linked to the risk of cholelithiasis: a comprehensive Mendelian randomization study

Background and aims Observational and Mendelian randomization (MR) studies have identified several modifiable risk factors of cholelithiasis. However, there is limited evidence about the causal effect of blood metabolites on the cholelithiasis risk. Methods To have a comprehensive understanding to causal relations between blood metabolites and cholelithiasis, for the primary discovery, we applied two MR methods to explore the associations between 249 circulating metabolites and cholelithiasis. For secondary validations, we replicated the examinations using another metabolic dataset with 123 metabolites. The summary statistics of cholelithiasis were retrieved from FinnGen Consortium Release 5 and UK Biobank. Inverse-variance weighted, weight median and MR-egger methods were used for calculating causal estimates. Furthermore, Bayesian model averaging MR (MR-BMA) method was employed to detect the dominant causal metabolic traits with adjustment for pleiotropy effects. Results In the primary analysis, sphingomyelin showed consistent protective causal associations with cholelithiasis; while plasma cholesterol-associated traits showed generally inverse correlation with cholelithiasis risk. Notably, large numbers of traits within the (un)saturated fatty acid category demonstrated significant causal effects. Secondary analyses demonstrated similar results, with traits related to the levels of bisallylic groups in fatty acids showing protective effects. Lastly, MR-BMA analyses discovered that the degree of unsaturation plays a predominant role in reducing the risk of cholelithiasis. Conclusion Our MR study provides a complete atlas of associations between plasma metabolites on cholelithiasis risk. It highlighted that genetically predicted sphingomyelin and degree of unsaturation of fatty acid were causally associated with the reduced risk of cholelithiasis. Graphical abstract