Aim The aim of this study was to evaluate metabolic syndrome (MetS) frequency and carotid artery intima-media thickness (IMT) as risk factors for atherosclerosis in patients with nonalcoholic fatty liver disease. Methods A case-control study was conducted on 40 biopsy-proven NAFLD patients and 40 age-matched healthy control subjects. Common carotid artery IMT and MetS criteria [according to the Third Report of the National Cholesterol Education Expert Panel on Detection, evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP-ATPIII), the International Diabetes Federation (IDF), the American Heart Association in conjunction with the National Heart, Lung, and Blood Institute (AHA/NHLBI)] were evaluated for all study subjects. Results MetS according to NCEP-ATPIII, IDF and AHA/NHLBI criteria was present in 55, 67.5 and 62.5% of NAFLD patients, respectively. The mean IMT was significantly higher in NAFLD patients (0.646 +/- 0.091 mm) than control subjects (0.544 +/- 0.067 mm), (P < 0.001). Among the vascular risk factors evaluated, the diagnosis of NAFLD and increased body mass index were significant independent predictors of increased IMT. Conclusions As cardiovascular risk factors, both MetS and increased IMT occur frequently among NAFLD patients. Screening for both conditions might be beneficial for assessment of future atherosclerotic complications.