Background: Metabolic-associated fatty liver disease (MAFLD) is a common disease worldwide. Micro-RNA-122 is known to be the most abundant micro-RNA expressed in the liver. Objective: To evaluate the association of micro-RNA-122 and the degree of steatosis and fibrosis in obese patients with MAFLD. Methods: The study included 120 obese Egyptian patients with MAFLD, which were diagnosed and classified according to ultra-sonographic liver findings. All patients enrolled in the study were subjected to thorough clinical examination and laboratory investigations (serum micro-RNA-122 levels by PCR, lipid profile, liver biochemistry, and functions). Fibro-scan was used to assess the level of fibrosis. Results: There was a significant increase in levels of micro-RNA-122 in obese patients with MAFLD compared to controls (p<0.001). Micro-RNA-122 level was lower in patients with mild liver steatosis than patients with moderate or severe steatosis (p<0.001). It was lower in patients with a mild degree of fibrosis than those with mild or moderate fibrosis (p<0.001). Micro-RNA -122 was significantly positively correlated with low-density cholesterol and triglycerides level, and liver enzymes, and negatively correlated to high-density cholesterol (p<0.001). Conclusion:Serum micro-RNA-122 could be a useful predictor of assessing MAFLD severity regarding level of steatosis or fibrosis.