Abstract: Arsenic is a common environmental toxicant. Arsenic exposure has been associated with increased risks of various diseases. Metabolic-associated fatty liver disease, a chronic liver disease highly associated with metabolic syndrome, has been increasingly prevalent. Epidemiological studies and animal experimental studies have shown that arsenic exposure is involved in the development and progression of metabolic-associated fatty liver disease through a variety of mechanisms. In this paper, we present a comprehensive systematic review of the mechanisms of arsenic exposure impacting metabolic-associated fatty liver disease, including oxidative stress, mitochondrial dysfunction, inflammatory response, endoplasmic reticulum stress, epigenetic regulation, and gut-liver axis activation.