Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is characterized by excessive triglyceride accumulation in the liver, the presence of one or more cardiometabolic risk factors, and an absence of harmful alcohol intake. Oxidative stress plays a crucial role in the development and severity of this disease, contributing to an increased cardiovascular risk (CVR). Malondialdehyde (MDA), an oxidative biomarker resulting from lipid peroxidation, is closely associated with metabolic dysfunction. This study aimed to evaluate the role of MDA as a predictor of steatosis severity and CVR. Methodology: An observational cross-sectional study was conducted in a population with MASLD with hepatic steatosis confirmed by ultrasonography and computed tomography. Subjects were classified according to severity of the hepatic steatosis as grade I or grade II-III. Nutritional, anthropometric, and serum biochemical parameters were measured. MDA levels were determined using a spectrophotometric method. The CVR was assessed using waist-to-hip ratio (WHR), triglycerides-glucose (TyG) index, lipid accumulation product (LAP), and atherogenic index of plasma (AIP). Receiver operating characteristic (ROC) curve analysis was performed to identify MDA cut-off value, followed by multivariable logistic regression to assess its association with severity of steatosis adjusted for body fat percentage. Results: A total of 50 patients were included (21 men and 29 women). An MDA cut-off value ≥ 0.13 nmol/mL was associated with higher severity (grade II-III vs. grade I) (OR = 5.0; 95% CI: 1.20-20.0; p = 0.022). Higher WHR values were found in subjects with grade I (p = 0.049), and elevated TyG index values were observed in patients with grade I-III (p = 0.042) both indicating increased CVR. Conclusions: Elevated MDA levels and higher body fat percentage were associated with higher degree of hepatic steatosis and increased CVR in the population from southeastern Mexico.