Background: Metabolic syndrome (MetS) was found to be most strongly associated with the risk of gallbladder polyps (GBP). Recent studies have shown that obesity and impaired glucose tolerance are associated with GBP, which is currently believed to be a risk factor for gallbladder cancer. Thus, it seems likely that the prevalence of GBP is increasing. However, little research has been conducted on the relation between GBP and MetS combined with fatty liver disease (FLD). Objective: The purpose of this study was to evaluate the association between GBP and metabolic syndrome combined FLD. Methods: A cross-sectional design was used. Data were collected through an adult health screening program by a hospital in Changhua County, Taiwan, between 2010 and 2014. After GBP and FLD were confirmed through abdominal ultrasound scanning, the results were verified by a gastroenterologist. The MetS was defined according to the criteria set by the 2007 Health Promotion Administration, Ministry of Health and Welfare. This study evaluated the GBP prevalence and risk factors based on data obtained from physical examinations and blood tests. Results: The prevalence of MetS, GBP, and FLD was 18.8%, 12.9%, and 49.1%, respectively. The results indicated that there was no correlation between GBP and MetS combined with FLD. However, significant differences were observed in the influence on GBP of MetS combined with different degrees of FLD severity. MetS combined with mild FLD appeared to have the greatest effect on GBP, while MetS combined with severe FLD was found to have protective effects against GBP. The risk of GBP in male patients was higher than that in female patients (odds ratio [OR], 2.098; 95% confidence interval [CI], 1.717 to 2.563), and the risk of GBP in patients aged 40 or older was higher than that in patients under 40 (OR, 1.202; 95% CI, 1.019 to 1.417). Patients who had MetS combined with severe FLD showed a lower risk of GBP than patients who did not have MetS or FLD (OR, 0.395; 95% CI, 0.192 to 0.813). Conclusions: MetS combined with different degrees of FLD affects GBP. The effect of FLD on GBP is greater than that of MetS. Male gender and aged 40 or older are risk factors for GBP. MetS combined with severe FLD is a protective factor against GBP.