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The impacts of cardiometabolic risk factors (CMRFs) and the biomarkers on disease severity in metabolic dysfunction-associated steatotic liver disease (MASLD) remain elusive. Accordingly, a multicenter study by recruiting MASLD patients from a nationwide registry database was conducted with a total of 2882 MASLD patients (54.1% males, mean age = 55.6 ± 13.9 years, mean body mass index [BMI] = 28.1 ± 4.9 kg/m²) being recruited. The proportions of patients carrying CMRFs of overweight/obesity, hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol level, and diabetes/prediabetes were 91.2%, 74.5%, 54.8%, 59.6%, and 74.5%, respectively. There was a significant linear trend between significant fibrosis and CMRFs (5.1%, 27%, and 54.6% in patients with one CMRF, 3 CMRFs, and ≥ 4 CMRFs, respectively, p = 0.009). The adjusted odds ratios (aOR) with 95% confidence intervals (CIs) for advanced fibrosis in patients of hemoglobin A1c (HbA1c) 5.7%-6.5%, 6.5%-8.0%, and > 8.0% were 1.02 (95% CI = 0.68-1.53, p = 0.93), 1.83 (95% CI = 1.16-2.88, p = 0.01), and 2.78 (95% CI = 1.45-5.34, p = 0.002), respectively. The significant risk factors for advanced fibrosis in MASLD were age > 60 years (aOR = 12.08, 95% CI = 6.23-23.46, p < 0.001), elevated transaminase level (aOR = 1.06, 95% CI = 1.05-1.09, p < 0.001), and diabetes (aOR = 1.51, 95% CI = 1.02-2.26, p = 0.04). In conclusion, there was a significant linear association between advanced fibrosis and the items of CMRFs. The HbA1c level could serve as a predictive biomarker for advanced fibrosis in MASLD with the implication that diabetes control is mandatory for patients with MASLD.