The rising prevalence of fatty liver disease and constipation is becoming a significant public health concern, especially in urban populations with sedentary lifestyles and poor dietary habits. While these conditions may appear unrelated, emerging research highlights a deeper biological link through the gut–liver axis, suggesting they often coexist due to shared metabolic risk factors.
“Although constipation and fatty liver disease appear quite unrelated, there is growing research evidence that they may be connected through metabolic pathways and gut health. While constipation cannot induce fatty liver disease, they can occur together, often as they share the same risk factors and physiological mechanisms,” said Dr. Aravind Badiger, Technical Director, BDR Pharmaceuticals.
Non-alcoholic fatty liver disease (NAFLD) - now increasingly referred to as metabolic dysfunction–associated steatotic liver disease (MASLD) - is characterized by excess fat accumulation in the liver in individuals who consume little or no alcohol. Strongly linked to obesity, insulin resistance, type 2 diabetes, and dyslipidemia, fatty liver is often silent in its early stages.
However, if left unaddressed, it can progress to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and even liver cancer. Alarmingly, this condition is now being diagnosed in younger individuals, including those in their 20s and 30s, reflecting a shift driven largely by lifestyle changes.
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Constipation is defined by infrequent bowel movements, difficulty passing stools, or a sense of incomplete evacuation. Common causes include low fiber intake, inadequate hydration, lack of physical activity, and irregular bowel habits. Stress, medications, and underlying metabolic or gastrointestinal disorders may also contribute.
Chronic constipation can disrupt the balance of gut bacteria, leading to gut dysbiosis, which plays a role in broader metabolic health issues.
Chronic constipation disrupts the balance of gut bacteria, leading to gut dysbiosis
The gut–liver axis connects digestive health and liver function through the portal circulation. Nutrients, toxins, and microbial products from the gut travel directly to the liver. When gut health is compromised, due to dysbiosis or increased intestinal permeability, it can trigger low-grade inflammation and metabolic disturbances that contribute to fatty liver disease.
Although constipation does not directly cause fatty liver, prolonged intestinal transit time may increase exposure to harmful metabolites, indirectly affecting liver health. “Changes in gut microbiota (dysbiosis) and intestinal permeability have been suggested in the pathogenesis of fatty liver disease. Although constipation itself is not a direct cause, the relatively longer time for intestinal transit and increased contact with potentially toxigenic metabolites may affect microbial composition and induce low-grade inflammation,” said Dr. Badiger.
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