Background:Non-alcoholic fatty liver disease (NAFLD) is becoming recognized as a component of the metabolic syndrome and insulin resistance. There has been recent interest in the association between epicardial fat and atherosclerotic disease with increased risk of cardiovascular mortality and morbidity. Aim of the work: In this study we investigated the relationship between the metabolic syndrome with liver involvement and epicardial fat. Patients and methods: 85 patients who had the criteria of metabolic syndrome are subjected to thorough clinical evaluation. Abdominal circumference, body mass indexand waist/hip ratio were recorded for all patients. Laboratory investigations including urine, complete blood picture, fasting and postprandial blood glucose, uric acid, blood urea and creatinine,C-reactive protein (CRP) , lipid profile, liver enzymes and bilirubin were done to all patients. Ultrasonography was used to grade fatty liver and measure the thickness of epicardial fat. Results: Patients with high ALT levels have significantly higher (p<0.01) AST, fasting blood glucose (FBG), uric acid, triglyceride (TG) level, more epicardial fat and waist circumference (p<0.05) compared to those with normal levels. Patients with high grade of fatty liver have significantly higher total cholesterol, TG, FBG, AST, ALT, uric acid levels, more epicardial fat and waist circumference (p<0.01) compared to those with mild and moderate. ALT, FBG and TG are significantly higher in patients with detectable epicardial fat than those without (p<0.01). There were significant direct correlations between epicardial fat thickness with FBG (r= 0.324; p<0.01), TG (r= 0.217; p<0.05), AST (r= 0.493; p<0.01), ALT (r= 0.561; p<0.01), and grade of fatty liver (r= 0.479; p<0.01). Also there were significant direct correlations between FBG with waist circumference (r= 0.422; p = 0.01), TG level (r = 0.370; p<0.01), HDL-C (r = 0.284; p<0.05) and grade of fatty liver (r = 0.533; p = 0.01).  There were significant direct correlations between grade of fatty liver with waist circumference (r= 0.264; p<0.05), TG (r= 0.407; p<0.01), uric acid (r= 0.288; p<0.05), and AST levels (r= 0.642 p<0.01). CRP was found correlated only with liver enzymes (r = 0.481;p<0.05). Simple logistic regression analysis revealed that epicardial fat thickness (mm) showed a trend in patients with NAFLD and metabolic syndrome. Conclusion: Echocardiographic assessment of epicardial adipose tissue, abdominal ultrasound assessment of NAFLD and transaminase level might serve as a reliable marker of visceral adiposity and more severe degree of metabolic syndrome.