Fatty liver disease is often called a “silent epidemic” because it can progress for years without symptoms until severe complications hit.

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as nonalcoholic fatty liver disease, affects about 38% of adults worldwide. As with many conditions, catching it early can make a world of difference to your liver health. One possible warning sign for MASLD could be gallstones, a common digestive issue.

Research has found a strong association between gallstones and MASLD. Studies suggest that people with gallstones may also be more likely to have an underlying problem with their liver.

Having gallstones might also lead to an earlier diagnosis of MASLD, said Robert J. Fontana, MD, a professor of medicine and director of the Transplant Hepatology Fellowship Program at the University of Michigan Health.

“The way you’re usually found to have gallstones is through an ultrasound, and inevitably, doctors are looking right at the liver,” he added.

How Are Gallstones Connected to MASLD And MASH?

Gallstones are hard “pebbles” made of cholesterol or bilirubin that form in the gallbladder, a small organ that stores bile to help digestion. While they can range in size from a grain of sand to a golf ball, they’re usually small and pass without causing pain or blockages.

Approximately 20% of adults worldwide develop gallstones, with cholesterol-based stones being the most common.

While more research is necessary to establish a direct link between MASLD and gallstones, studies show people with gallstones had a higher chance of being diagnosed with MASLD—3.3%, compared to 1% in those without gallstones.

Gallstones and metabolic liver diseases, including MASLD and its more severe form, Metabolic Dysfunction-Associated Steatohepatitis (MASH), share a connection in metabolic dysfunction.

Conditions like insulin resistance, obesity, and type 2 diabetes are key culprits that increase the risk of both gallstones and liver disease.

As these metabolic issues interfere with how the body processes fat, they can cause changes in the gallbladder and fat accumulation in the liver, possibly triggering the development of gallstones and fatty liver disease.

The underlying risk factors for MASLD make your bile more prone to thickening and forming stones, Fontana said. So rather than gallstones causing MASLD, both conditions likely share common predisposing factors, he added.

It may be too early to say the presence of gallstones could serve as a warning for liver disease, but when gallstone-related pain persists, it may be a good idea to visit your doctor before it progresses.

How to Reduce Your Risk of MASLD and Gallstones

Because treatments for fatty liver disease are still in development, and tests can fail to pick up MASLD, there’s no annual recommended screening.

Reducing risk factors like insulin sensitivity and obesity is the best preventative care for MASLD, Pratima Dibba, MD, a board-certified gastroenterologist and clinical instructor at NYU Grossman School of Medicine, told Verywell.

These three steps can also help lower one’s chances of developing gallstones, hypertension, and even diabetes, she added.

1. Stay Physically Active: Research shows regular exercise helps regulate insulin sensitivity and boosts metabolic health. Aerobic activities, such as walking, cycling, or swimming, are particularly effective, followed by resistance training, like weight lifting, for strengthening muscles and improving liver function.
2. Maintain a Healthy Weight: If you’re already at a healthy weight, maintaining that will help significantly. For those who are overweight, a gradual weight loss of 7 to 10% can help reduce fat build-up and inflammation in the liver. However, losing weight too quickly can actually raise the risk of gallstones.
3. Eat a Balanced Diet: As cholesterol plays a big role in gallstones forming, avoid eating too many foods with a high saturated fat content, like palm oil, cream, butter, and fatty cuts of meat.