From the Guidelines
Gallstones themselves do not directly cause fatty liver disease, but these two conditions often share common risk factors and can coexist in the same patient. Fatty liver disease, particularly non-alcoholic fatty liver disease (NAFLD), develops when excess fat accumulates in liver cells due to factors like obesity, insulin resistance, high blood sugar, and high triglycerides 1. Gallstones, on the other hand, form when substances in bile crystallize in the gallbladder. Both conditions are associated with metabolic syndrome, obesity, diabetes, and poor diet.
Key Points to Consider
- The presence of gallstones might indicate that a person has risk factors that could also lead to fatty liver disease.
- If you have gallstones, it would be prudent to discuss with your doctor about screening for fatty liver disease, especially if you have other risk factors.
- Management typically involves lifestyle modifications including weight loss, regular exercise, avoiding alcohol, and following a balanced diet low in refined carbohydrates and saturated fats 2.
- These changes can help address both conditions simultaneously by improving overall metabolic health.
Current Guidelines and Recommendations
According to the latest clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD), case-finding strategies for MASLD with liver fibrosis should be applied in individuals with cardiometabolic risk factors, abnormal liver enzymes and/or radiological signs of hepatic steatosis, particularly in the presence of type 2 diabetes or obesity with additional metabolic risk factor(s) 1.
Treatment and Prevention
A stepwise approach using blood-based scores and imaging techniques is suitable to rule-out/in advanced fibrosis, which is predictive of liver-related outcomes. In adults with MASLD, lifestyle modification—including weight loss, dietary changes, physical exercise and discouraging alcohol consumption—as well as optimal management of comorbidities is advised 1.
From the Research
Association between Cholelithiasis and Steatosis
- Cholelithiasis (gallstones) and steatosis (fatty liver disease) are two common disorders that often coexist in patients, particularly those with obesity and insulin resistance 3, 4, 5, 6.
- Studies have found a bidirectional relationship between the incidence of non-alcoholic fatty liver disease (NAFLD) and gallstone disease (GSD), where an increase in either can lead to an increase in the other 3, 4, 5, 6.
- The association between NAFLD and GSD is partially explained by common pathogenic links, including obesity, insulin resistance, and diabetes 3, 4, 5, 6.
Risk Factors and Prevalence
- NAFLD is an independent risk factor for GSD, and conversely, GSD is also an independent risk factor for NAFLD 3, 4, 5, 6.
- The prevalence of NAFLD is higher in patients with GSD, and patients with GSD are more likely to have NAFLD 4, 5.
- Cholecystectomy (surgical removal of the gallbladder) may also be a risk factor for NAFLD development 3, 5.
Mechanisms and Underlying Factors
- The precise underlying mechanisms of the association between GSD and NAFLD need to be better delineated, but recent findings on the endocrine actions of bile acids and the gallbladder provide a framework for further research 3.
- The development of FABACs (Fatty Acid and Bile Acid Conjugates) has shown promise in preventing the formation of cholesterol crystals and dissolving existing ones, and may also have beneficial effects on cholesterol metabolism and the prevention of fatty liver disease 7.