Summary: Metabolic-associated fatty liver disease (MAFLD) is the most common chronic hepatic disease worldwide, showing increasing incidence. In a fraction of patients, MAFLD takes a histologically aggressive course leading to cirrhosis and hepatocellular carcinoma. MAFLD is also a metabolic disease with extensive multiorgan involvement, causing cardiovascular diseases, chronic kidney disease and osteoporosis. The causes of premature mortality in MAFLD are represented by cardiovascular diseases, followed by liver-related complications. Management of patients with MAFLD is focused on the diagnosis of early stages of diabetes and atherosclerosis, and identification of advanced liver brosis by non-invasive examinations. A healthy lifestyle leading to body mass reduction is the cornerstone for MAFLD therapy. The goal of pharmacological treatment is to prevent the progression of MAFLD, but no single preparation can ensure regression of inflammation, let alone improvement of fibrosis. Improved understanding of the pathogenesis and progression of MAFLD opens the way to novel therapies currently being explored in clinical trials.