Background. Nonalcoholic fatty liver disease is closely associated with the metabolic syndrome. Aim. We evaluated the association among the metabolic syndrome, and the severity of fatty liver with a scoring system of ultrasonographic fi ndings. Methods. Subjects consisted of 72 patients who were selected from two clinics of Cardiology and one of Gastroenterology and Hepatology. We scored the ultrasonographic fi ndings from 0 to 6 points and evaluated the correlation with all components of the metabolic syndrome. Results. The metabolic syndrome was diagnosed in 44 (61%) of 72 subjects. The score signifi cantly correlated with all components of the metabolic syndrome, including weight, BMI, waist circumference, blood pressure, HDL and LDL. The degree of association between the score and presence of metabolic syndrome using rank correlation (Spearman’s rho [ρ]) was 0,7. Conclusions. The scoring system with abdominal ultrasonography could provide accurate information about hepatic steatosis and the metabolic syndrome.