This systematic review and meta-analysis aimed to determine the global prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) in hepatocellular carcinoma (HCC) cohorts, including the proportion where MAFLD is the sole liver disease (single-MAFLD) and the proportion where MAFLD is a contributing factor in mixed-MAFLD cases. The study included 22 studies with a total of 56,565 individuals with HCC, covering various geographical regions. The overall prevalence of MAFLD in HCC was found to be 48.7%, with 12.4% of cases being single-MAFLD and 36.3% being mixed-MAFLD. Mixed-MAFLD HCC was more common in North America (64%) and Europe (54%) compared to Asia (37%). Single-MAFLD HCC was associated with older age, female gender, and lower likelihood of cirrhosis. Mixed-MAFLD HCC had higher platelet counts and lower likelihood of macrovascular invasion compared to non-MAFLD HCC. The study highlights the importance of accurately diagnosing MAFLD to better understand its role in HCC and guide treatment strategies.This systematic review and meta-analysis aimed to determine the global prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) in hepatocellular carcinoma (HCC) cohorts, including the proportion where MAFLD is the sole liver disease (single-MAFLD) and the proportion where MAFLD is a contributing factor in mixed-MAFLD cases. The study included 22 studies with a total of 56,565 individuals with HCC, covering various geographical regions. The overall prevalence of MAFLD in HCC was found to be 48.7%, with 12.4% of cases being single-MAFLD and 36.3% being mixed-MAFLD. Mixed-MAFLD HCC was more common in North America (64%) and Europe (54%) compared to Asia (37%). Single-MAFLD HCC was associated with older age, female gender, and lower likelihood of cirrhosis. Mixed-MAFLD HCC had higher platelet counts and lower likelihood of macrovascular invasion compared to non-MAFLD HCC. The study highlights the importance of accurately diagnosing MAFLD to better understand its role in HCC and guide treatment strategies.