BACKGROUND: Metabolic dysfunction-associated fatty liver disease (MAFLD) has recently replaced nonalcoholic fatty liver disease (NAFLD) as a term that more accurately describes its pathogenesis. (), a bacterium that infects over half the world's population, has been increasingly linked to various extragastric diseases. However, the impact of on MAFLD in the Chinese population remains unexplored. METHODS: A retrospective cross-sectional study was conducted, encompassing 5619 participants from the First Affiliated Hospital of Wenzhou Medical University, spanning from April 2016 to August 2017. Detection of was achieved through the C urea breath test or gastric biopsies with histochemical staining. Fatty liver was primarily diagnosed via ultrasound and assessed alongside metabolic indicators to confirm MAFLD. Logistic regression was utilized to evaluate the association between and MAFLD. RESULTS: No significant correlation between infection and MAFLD was found in the overall population through either univariate (OR=1.136, 95%CI 0.995-1.297, p=0.059) or multivariate logistic regression analysis (OR=1.036, 95%CI 0.877-1.224, p=0.675). However, subgroup analysis revealed a significant association in overweight individuals (BMI ≥ 23 kg/m) within the MAFLD group (51.2% vs. 35.5%, p=0.002), a pattern not observed in the non-MAFLD group (47.7% vs. 45.4%, p=0.126). This association persisted after adjusting for confounders (OR=1.957, 95%CI 1.176-3.256, p=0.010). CONCLUSION: Overweight individuals with MAFLD have a higher prevalence of infection than their lean counterparts. This suggests a detrimental cycle between overweight status and infection in MAFLD patients, potentially exacerbating metabolic deterioration. Therefore, eradication of infection may have positive implications for reducing the incidence rate of overweight MAFLD.