Abstract: Metabolic-associated fatty liver disease (MAFLD) is a liver disease with high prevalence and great harm, which is closely related to metabolic syndrome, obesity and diabetes. Ketogenic diet is a therapeutic diet with high fat, low carbohydrate and appropriate protein, which can effectively reduce body mass and improve the level of insulin resistance. The proportion of fat in ketogenic diet is relatively high, and the relationship between ketogenic diet and MAFLD is not clear. This study aims to review the mechanism of ketogenic diet in the prevention and treatment of metabolic related fatty liver disease, such as improving insulin level, reducing body mass, changing liver mitochondrial metabolism, changing intestinal microbial composition and playing a synergetic effect with aerobic exercise.