Various systemic metabolic diseases arise from prolonged crosstalk across multiple organs, triggering serious impairments in various physiological systems. These diseases are intricate systemic pathologies characterized by complex mechanisms and an unclear etiology, making the treatment challenging. Efforts have been made to develop in vitro models to understand these diseases and devise new treatments. However, there are limitations in reconstructing the causal relationships between diseases and interorgan crosstalk, including the tissue-specific microenvironment. Alternatively, multi-organ microphysiological systems (MOMPS) present new possibilities for capturing the complexity of systemic metabolic diseases by replicating human microphysiology and simulating diverse interorgan crosstalk. Controlled interactions and scalable representations of biological complexity in MOMPS offer a more accurate portrayal of organ interactions, enabling the identification of novel relationships between organ crosstalk, metabolism, and immunity. This, in turn, can yield valuable insights into disease mechanisms and drug development research and enhance the efficiency of preclinical studies. In this review, the examples and technical capabilities of MOMPS pathological modeling for various diseases are discussed, leveraging state-of-the-art biofabrication technology of MOMPS. It evaluates the current opportunities and challenges in this field. Multi-organ microphysiological systems (MOMPS) replicate human microphysiology and interorgan crosstalk. The precise fabrication of MOMPS requires various elements, including biomaterials, cell sources, accurate organ crosstalk, biofabrication techniques, and humanized design. The MOMPS enhances the understanding of systemic metabolic disease mechanisms, improves drug development, and increases the efficiency of preclinical studies by capturing the complexity of organ interactions and tissue-specific microenvironments..image (c) 2024 WILEY-VCH GmbH