BACKGROUND: Visfatin is increasingly associated with several obesity-related diseases. The study is to evaluate if aberrant expression of circulating visfatin occurs in gallstone disease. METHODS: An enzyme-linked immunosorbent assay was used to examine serum visfatin levels in 79 patients with cholesterol gallstones, 71 with pigment gallstones, and 223 healthy controls. The chemical composition of extracted gallstones was determined by Fourier transform infrared spectroscopy. RESULTS: Serum visfatin levels were markedly elevated in the cholesterol and pigment gallstones in comparison with healthy controls. Furthermore, increased visfatin levels were associated with formation of the cholesterol and pigment gallstones. Intriguingly, a significant positive correlation between serum visfation levels and white cell count was noted in the cholesterol gallstones and controls. Moreover, the positive correlation in the cholesterol gallstones was more significant in the body mass index >/=25 subgroup than in the body mass index <25 subgroup. CONCLUSIONS: Gallstone disease is associated with altered circulating visfatin. The proinflammatory effect of circulating visfatin in gallstone disease deserves further investigation.