Metabolic dysfunction-associated steatotic liver disease (MASLD) is a systemic metabolic disorder characterized by hepatic steatosis occurring in the context of cardiometabolic dysfunction and capable of progressing to metabolic dysfunction-associated steatohepatitis (MASH), fibrosis, cirrhosis, and hepatocellular carcinoma. Its pathogenesis involves adipose-tissue insulin resistance, excessive hepatic fatty-acid influx, de novo lipogenesis, lipotoxicity, mitochondrial and endoplasmic-reticulum stress, inflammation, dysregulated adipokines, hepatocyte death, and fibrogenesis. Tocotrienols, naturally occurring vitamin E isoforms abundant in palm oil and other botanical sources, have attracted interest because their biological activity extends beyond conventional antioxidant effects toward modulation of inflammatory, metabolic, and cell-signaling pathways. This qualitative literature review critically synthesizes evidence published predominantly from 2020–2026 concerning palm-derived tocotrienol-rich fractions and other defined tocotrienol preparations in MASLD. Human studies suggest improvements in fatty-liver indices, insulin resistance, aminotransferases, oxidative stress markers, inflammatory cytokines, adiponectin, leptin, and cytokeratin-18. Nevertheless, most adult MASLD trials evaluated annatto-derived δ/γ-tocotrienol rather than palm-derived preparations, and clinically definitive evidence for MASH resolution or fibrosis regression remains lacking. The review argues that tocotrienols should be understood as potential multi-node metabolic modulators rather than merely antioxidants. Future trials require standardized source and isoform characterization, improved bioavailability, modern imaging and fibrosis endpoints, integration with contemporary standard-of-care therapies, longer follow-up, and precision-metabolic phenotyping before tocotrienols can be positioned as evidence-based adjunctive interventions for MASLD.