Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease globally, affecting up to 38% of the global adult population. It is a multisystem disease where systemic insulin resistance and related metabolic dysfunction play a key role in its development and complications, including cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), and certain extrahepatic cancers. In 2023, three large liver associations proposed that metabolic dysfunction-associated steatotic liver disease (MASLD) should replace NAFLD, with metabolic dysfunction-associated steatohepatitis (MASH) replacing non-alcoholic steatohepatitis. Over 99% of individuals with NAFLD meet MASLD criteria. MASLD is a significant risk factor for major adverse cardiovascular events, with pooled mortality rates of 12.6 per 1000 person-years for all-cause mortality, 4.2 per 1000 person-years for cardiac-specific mortality, 2.8 per 1000 person-years for extrahepatic cancer-specific mortality, and 0.92 per 1000 person-years for liver-specific mortality. Large cohort studies show that MASLD is an independent risk factor for CVD morbidity and mortality, with a pooled hazard ratio (HR) of 1.45 for fatal and nonfatal CVD events. MASLD is also associated with an increased risk of hepatocellular carcinoma (HCC), with a higher incidence rate in patients with advanced fibrosis or cirrhosis. MASLD is associated with increased risks of various extrahepatic cancers, including thyroid, gastrointestinal, lung, breast, gynaecological, and urinary system cancers. A meta-analysis of observational studies found that MASLD was significantly associated with a 2.5-fold increased risk of thyroid cancer and a 1.5–2-fold increased risk of gastrointestinal cancers. These findings were confirmed in a retrospective cohort study from Germany, showing higher incidence rates of skin, digestive organ, prostate, breast, and gynaecological cancers in MASLD patients. MASLD is also associated with chronic liver inflammation and low-grade systemic inflammation, which contribute to CVD and malignant complications. Key pathophysiological components include metabolic dysfunction, atherogenic dyslipidaemia, and gut microbiota alterations. These factors, along with proinflammatory diets and intestinal dysbiosis, contribute to the development of liver inflammation and systemic low-grade inflammation in MASLD. MASLD is associated with increased risks of extrahepatic cancers, including colorectal, oesophageal, prostate, and breast cancers. Adipokine disturbances, such as reduced adiponectin levels, and other inflammatory pathways, such as oxidative stress and insulin resistance, may contribute to the development of these cancers. CVD risk assessment in MASLD is crucialNon-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease globally, affecting up to 38% of the global adult population. It is a multisystem disease where systemic insulin resistance and related metabolic dysfunction play a key role in its development and complications, including cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), and certain extrahepatic cancers. In 2023, three large liver associations proposed that metabolic dysfunction-associated steatotic liver disease (MASLD) should replace NAFLD, with metabolic dysfunction-associated steatohepatitis (MASH) replacing non-alcoholic steatohepatitis. Over 99% of individuals with NAFLD meet MASLD criteria. MASLD is a significant risk factor for major adverse cardiovascular events, with pooled mortality rates of 12.6 per 1000 person-years for all-cause mortality, 4.2 per 1000 person-years for cardiac-specific mortality, 2.8 per 1000 person-years for extrahepatic cancer-specific mortality, and 0.92 per 1000 person-years for liver-specific mortality. Large cohort studies show that MASLD is an independent risk factor for CVD morbidity and mortality, with a pooled hazard ratio (HR) of 1.45 for fatal and nonfatal CVD events. MASLD is also associated with an increased risk of hepatocellular carcinoma (HCC), with a higher incidence rate in patients with advanced fibrosis or cirrhosis. MASLD is associated with increased risks of various extrahepatic cancers, including thyroid, gastrointestinal, lung, breast, gynaecological, and urinary system cancers. A meta-analysis of observational studies found that MASLD was significantly associated with a 2.5-fold increased risk of thyroid cancer and a 1.5–2-fold increased risk of gastrointestinal cancers. These findings were confirmed in a retrospective cohort study from Germany, showing higher incidence rates of skin, digestive organ, prostate, breast, and gynaecological cancers in MASLD patients. MASLD is also associated with chronic liver inflammation and low-grade systemic inflammation, which contribute to CVD and malignant complications. Key pathophysiological components include metabolic dysfunction, atherogenic dyslipidaemia, and gut microbiota alterations. These factors, along with proinflammatory diets and intestinal dysbiosis, contribute to the development of liver inflammation and systemic low-grade inflammation in MASLD. MASLD is associated with increased risks of extrahepatic cancers, including colorectal, oesophageal, prostate, and breast cancers. Adipokine disturbances, such as reduced adiponectin levels, and other inflammatory pathways, such as oxidative stress and insulin resistance, may contribute to the development of these cancers. CVD risk assessment in MASLD is crucial