Introduction: hepatic steatosis (HS) has been previously considered as a valuable and long-established indicator for evaluation of metabolic syndrome (MetS) and cardio-metabolic risks. Recently, epicardial adipose tissue (EAT) has been proposed and up to be established to carry the same or more than of HS as regarding cardiometabolic risks. Hence, both of HS and cardiac steatosis coexist and interact with each other i.e. one reflects to the other. There are little data assessing the associations of hepatic and epicardial fat in non-metabolic-syndrome Egyptian adults. Objective: to evaluate the relationship between HS and EAT, and its relation to the components of metabolic syndrome. Patients and methods: We studied fifty HS patients accidentally discovered by abdominal ultrasound and fifty healthy matched controls with normal fat content in the liver (without HS) by ultrasound for comparison. Both groups underwent complete history taking, general examination, laboratory investigations and 2D transthoracic echo Doppler study at baseline and 18 months thereafter only for patient's group. Results: this study showed that, there is a positive correlation between HS and EAT and metabolic syndrome. HS and EAT are early and sensitive predictors for metabolic syndrome. Conclusion: hepatic and epicardial fat are early and strong predictors of metabolic syndrome.