Background and Aims: Nonalcoholic fatty liver disease, now renamed metabolic dysfunction-associated fatty liver disease (MAFLD), is common in obese patients. Intragastric balloon (IGB), an obesity management tool with low com-plication risk, might be used in MAFLD treatment but there is still unexplained heterogeneity in results across stud-ies. Methods: We conducted a systematic search of 152 citations published up to September 2020. Meta-analyses, stratified analyses, and meta-regression were performed to evaluate the efficacy of IGB on homeostasis model as-sessment of insulin resistance (HOMA-IR), alanine ami-notransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transpeptidase (GGT), and to identify pa-tients most appropriate for IGB therapy. Results: Thirteen observational studies and one randomized controlled trial met the inclusion criteria (624 participants in total). In the overall estimate, IGB therapy significantly improved the se-rum markers change from baseline to follow-up [HOMA-IR: 1.56, 95％ confidence interval (CI)=1.16–1.95; ALT: 11.53 U/L, 95％ CI=7.10–15.96; AST: 6.79 U/L, 95％ CI=1.69–11.90; GGT: 10.54 U/L, 95％ CI=6.32–14.75]. In the strati-fied analysis, there were trends among participants with ad-vanced age having less change in HOMA-IR (1.07 vs. 1.82). The improvement of insulin resistance and liver biochemis-tries with swallowable IGB therapy was no worse than that with endoscopic IGB. Multivariate meta-regression analy-ses showed that greater HOMA-IR loss was predicted by younger age (p=0.0107). Furthermore, effectiveness on ALT and GGT was predicted by basal ALT (p=0.0004) and GGT (p=0.0026), respectively. Conclusions: IGB is effec-tive among the serum markers of MAFLD. Younger patients had a greater decrease of HOMA-IR after IGB therapy.