Public health policies in metabolic dysfunction-associated steatotic liver disease (MASLD) are still lacking. This study aims to estimate the prevalence and severity of MASLD in primary health care (PHC) through non-invasive markers. Two-phase study, including a retrospective (RETR) and a prospective (PROS) one, was carried out in PHC in Brazil. In RETR, metabolic and hepatic profiles of 12,054 patients, including FIB-4, were evaluated. In PROS, 350 patients were randomly selected and submitted to a clinical and nutritional assessment. RETR (65.4% women, mean age 55.3 years old): dyslipidemia, hypertension, and type 2 diabetes mellitus (T2DM) present in 40.8%, 34.3%, and 12.2% of the electronic health records, respectively. Fasting glucose >100 mg/dL in 34.5%, and glycated hemoglobin higher than 5.7% in 51.5%, total cholesterol >200mg/dL and triglycerides >150mg/dL in 40.8% and 32.1%, respectively. Median FIB-4 was of 1.33, 5% >2.67. No one had MASLD as a diagnostic hypothesis; PROS(71.8% women, mean age 58 years old): body mass index (BMI) ≥30 kg/m² in 31.8%. MASLD prevalence (FLI≥ 30 + cardiometabolic features) of 62.1%; 39.4% of patients had FLI ≥60, with higher BMI, waist circumference, fasting glucose, triglycerides, AST, ALT and GGT, as well as lower HDL-cholesterol (p<0.001). FIB-4>1.3 in 40% and NAFLD Fibrosis Score (NFS)>-1.45 in 59.2% of steatotic patients. There is a high prevalence of MASLD in PHC, with a significant risk of liver fibrosis. These findings reinforce we need to develop public policies to defeat MASLD epidemics.