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Background Over one-third of adults worldwide suffer from metabolic dysfunction-associated steatotic liver disease (MASLD), which has become the most prevalent chronic liver disease in the world.MASLD is a substantial cause of cirrhosis, hepatocellular carcinoma (HCC), and liver transplantation since about 5% of the individuals affected develop end-stage liver disease.According to recent statistics, prevalence rates in Egypt are quite high, surpassing 40% in the overall population and 30% in young individuals.Aim To assess the prevalence of advanced fibrosis in asymptomatic Egyptian patients with MASLD.Methods This is a cross-sectional study conducted at Damanhur National Medical Institute from August 2024 to January 2026. Data including history, physical examination, BMI, laboratory investigation including liver function tests, renal function tests, lipid profile, fasting blood sugar, glycated hemoglobin, complete blood count, virological markers, and transient elastography from patients presented by asymptomatic MASLD were collected.Results In our cohort, we collected the data from 103 patients, 56 males (54.37%) and 47 females (45.63%). The mean BMI of our patients was 33.6 ± 6.4. 74.8% of our patients were obese (n=77), while 19.4% were overweight (n=20) and 5.8% were normal weight (n=6).71 (68.9%) of our patients were diabetic while 66.99% were hypertensive (n=69).Regarding hepatic steatosis, 9 patients (8.73%) were found to have S0 steatosis, 19 patients (18.45%) S1, 33 patients (32.04%) S2, and 42 patients (40.78%) S3 steatosis.Regarding fibrosis stage, 45 of our patients (43.69%) were found to have advanced fibrosis (F3 and F4) while F2 was found in 11 patients (10.68%), and F0, F1 were found in 47 cases (45.63%).Conclusions Advanced hepatic fibrosis/cirrhosis is a significant health problem in asymptomatic patients with MASLD which is usually overlooked.Identification and management of those patients is of great importance to reduce the risk of serious complications of liver cirrhosis and progression to hepatocellular carcinoma.