The metabolic syndrome is a condition in which people have at least 3 of the following abnormalities: overweight, high blood pressure, high triglyceride levels (a bad type of fat in the blood), low high-density lipoprotein cholesterol levels (“good” cholesterol), and high blood sugar levels. People with the metabolic syndrome are at risk for type 2 diabetes and cardiovascular disease, including heart attack and stroke. Nonalcoholic fatty liver disease is a condition where fat deposits in the liver. Alcohol use also leads to fatty deposits in the liver, which is why nonalcoholic fatty liver disease specifically refers to fatty liver in people who do not consume alcohol. Nonalcoholic fatty liver disease is generally not a serious condition and rarely leads to more serious liver problems, but it can interfere with normal liver function. Previous studies have shown associations of some of the individual features of metabolic syndrome with nonalcoholic fatty liver disease; however, they have not looked at what happens to the liver over time in people with the metabolic syndrome.