With lifestyle changes metabolism-related fatty liver disease MAFLD accounts for a gradual increase in chronic liver disease affecting 25% of adults worldwide and being thought to be co-present with other chronic liver diseases. MAFLD is not only closely related to the occurrence and development of chronic hepatitis cirrhosis hepatocellular carcinoma but also considered as a cause and effect with obesity and type 2 diabetes. Besides it also promotes the onset of hypothyroidism metabolic syndrome cardiovascular disease and malignant tumors. Given the fact that there is currently no specific drug for treatment adopting a healthy lifestyle and weight loss are key to the prevention and treatment of MAFLD and its comorbidities. The ketogenic diet is a therapeutic diet with low carbohydrate high fat and appropriate protein that converts the body's energy supply from glucose to fat mobilization which in turn produces the energy supply mode of ketone bodies. Based on this theoretical basis ketogenic diet is considered to have the potential to reduce body mass improve insulin resistance regulate glycolipid metabolism. And the effect of it as the adjuvant treatment for diabetes mellitus type 2 and obesity has been verified in many animal models and clinical trials. Still the clinical application of ketogenic diet in MAFLD is mostly short-term research and the relationship between the two is still in the exploration stage. This article reviews the research reports on how ketogenic diets reduce body mass and improve insulin resistance in patients with MAFLD.