Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is the most common liver disease worldwide, affecting 38% of the adult population globally. We examined the impact of the Mediterranean Diet and Ultra Processed Food (UPF) intake on the risk of prevalent MASLD in older adults. Our major findings include that increased adherence to a Mediterranean Dietary pattern was associated with a decreased risk of MASLD. Additionally, we found that high UPF intake was associated with an increased risk of MASLD. Furthermore, our study found that even with a high UPF intake, the risk of MASLD decreased if the individual also had a higher Mediterranean Diet intake compared to a lower Mediterranean Diet intake. These results are of particular importance in older people, given the known links between MASLD, metabolic comorbidities and frailty. Public health messaging should focus on promoting Mediterranean dietary habits, and ways to help older people achieve this given the social and economic barriers they may face.