Background: We sought to determine the changing prevalence, incidence, and temporal trends in real-world, recorded diagnoses of metabolic dysfunction-associated steatotic liver disease (MASLD) and assess availability of fibrosis risk stratification following awareness campaigns and guideline updates over the last decade. Methods: This population-based cohort study identified MASLD diagnoses made between 2003 to 2022 in the UK primary-care Clinical Practice Research Datalink (CPRD) to estimate prevalence and incidence. A nested case-control analysis, utilising 1:4 age-, sex-, and general practice-matched controls, assessed clinical characteristics, availability of Fibrosis-4 (Fib-4) components, and its temporal trend pre- and post-2015. Findings: 11.7 million individuals were active in CPRD in 2022. 365,797 comprised the study cohort of people with a MASLD diagnosis (matched to 1,460,288 controls). From 2012-2022, recorded MASLD prevalence rose from 0.52% [N=51,028] to 2.42% [N=283,762] (p