Background and Aims: Accumulated studies have report-ed the key role of circulating fetuin-A in the development and progression of nonalcoholic fatty liver disease (NAFLD) but the results have not been consistent. In this study, we performed a systematic review and meta-analysis to explore the relationship between circulating fetuin-A level and the development and classification of NAFLD. Methods: The PubMed, EMBASE, and Cochrane Library databases were searched to obtain the potentially relevant studies up to May 2020. Standardized mean differences (SMD) and 95％ con-fidence intervals of circulating fetuin-A levels were extracted and summarized. Sensitivity, subgroup analysis and meta-regression analysis were performed to investigate the po-tential heterogeneity. Association of circulating fetuin-A level with classification of NAFLD was also reviewed. Results: A total of 17 studies were included, composed of 1,755 NAFLD patients and 2,010 healthy controls. Meta-analysis results showed that NAFLD patients had higher circulating fetuin-A level (SMD=0.43, 95％ confidence interval [CI]: 0.22-0.63, p<0.001) than controls. Subgroup analysis indicated that circulating fetuin-A level was markedly increased in adult NAFLD patients (SMD=0.48, 95％ CI: 0.24-0.72, p<0.001) and not in pediatric/adolescent patients compared to con-trols. Circulating fetuin-A level was markedly increased in ultrasound-proven NAFLD pediatric/adolescent patients (SMD=0.42, 95％ CI: 0.12-0.72, p=0.007), other than in the liver biopsy-proven NAFLD pediatric/adolescent patients. Body mass index might be the influencing factor to the het-erogeneity in adult patients. Circulating fetuin-A level was not associated with the classification of NAFL vs. nonalco-holic steatohepatitis (NASH). Whether the circulating fetuin-A level was associated with the development of fibrosis re-mains controversial. Conclusions: Circulating fetuin-A level was significantly higher in NAFLD patients and was not as-sociated with the classification of NAFL vs. NASH. Whether the circulating fetuin-A level was associated with the devel-opment of fibrosis remains controversial.