Nonalcoholic fatty liver disease and cholelithiasis: hidden allies

Nonalcoholic fatty liver disease and cholelithiasis: hidden allies

M.A. Livzan, O.V. Gaus

Omsk State Medical University, Omsk

Nonalcoholic fatty liver disease (NAFLD) is among the most prevalent chronic liver diseases in the general population and may progress to steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma. A characteristic clinical pattern of NAFLD is a high rate of comorbid conditions, primarily obesity, cardiovascular disease, and type 2 diabetes mellitus. Among gastrointestinal comorbidities in NAFLD, particular attention has been drawn to its coexistence with cholelithiasis. This is attributable not only to the high prevalence of cholelithiasis in this patient population, but also to emerging evidence of mutually aggravating effects between these conditions, both with respect to the progression of liver pathology and the exacerbation of cardiometabolic risk. Moreover, contemporary studies indicate that worsening of NAFLD and cardiovascular disease is associated not only with cholelithiasis at the stage of established gallstones, but also with the post‑cholecystectomy period. This observation is largely explained by specific aspects of gallbladder physiology and the pivotal role of bile acids as key signaling molecules.

This review article summarizes current evidence on the risk factors and mechanisms underlying the comorbidity of NAFLD and cholelithiasis, evaluates its contribution to the development of cardiometabolic risk, and discusses current approaches to the management of such patients.

Keywords: nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, liver fibrosis, cholelithiasis, cholecystectomy, cardiometabolic risk, ursodeoxycholic acid.

For citation: Livzan M.A., Gaus O.V. Nonalcoholic fatty liver disease and cholelithiasis: hidden allies. RMJ. 2025;9:–37. DOI: 10.32364/2225-2282-2025-9-6