Background: Metabolic dysfunction-associated steatotic disease (MASLD) is the most common chronic liver disease that has become a leading health problem globally. Objectives: To determine the prevalence, grades and associated risk factors for MASLD in type 2 diabetes mellitus (T2DM) subjects at NAUTH, Nnewi, Nigeria. Materials and Methods: This was a cross-sectional study that was carried out among stable T2DM out-patients at NAUTH. Anthropometric and blood pressure (BP) measurements were done. Glycated haemoglobin and fasting lipid profile were assayed. Abdominal ultrasonography was performed to diagnose and stage MASLD. Data was analysed using SPSS version 25. Results of categorical variables were presented as frequencies and percentages, in tables. The mean values and standard deviation for the continuous variables were calculated. Chi-square test was used to determine the association between MASLD and MASLD stages with the risk factors. The level of significance was set at p ˂ 0.05. Results: A total of 142 T2DM subjects with complete results were analysed. The prevalence rate of MASLD was 46.5% among the subjects, with 47.9%, 35.2%, 14.1% and 2.8% of them having grades 0, 1, 2 and 3 MASLD, respectively. A statistically significant association was found between MASLD and educational levels (X2 = 20.732; p = 0.000), DM duration (X2 = 5.509; p = 0.019), global obesity (X2 = 6.079; p = 0.014) and anti-hypertensive medications use (X2 = 5.938; p = 0.015). Equally, significant association was found between MASLD grades and marital status (X2 = 9.181; p = 0.027), educational level (X2 = 25.492; p = 0.02), DM duration (X2 = 8.083; p = 0.044), abdominal obesity in the male subjects (X2 = 11.786; p = 0.003), global obesity (X2 = 9.736; p = 0.021) and diastolic hypertension (X2 = 14.509; p = 0.002) in the subjects. Conclusion: The prevalence of MASLD from the study was high and thus showed a high burden of the disease in T2DM subjects. MASLD and it stages showed significan