Background: Hepatic steatosis is the accumulation of triglycerides within hepatocytes. It may be broadly classified into alcoholic and non-alcoholic fatty liver disease, whereby non-alcoholic fatty liver disease is steatosis secondary to causes such as steatogenic medication. Liver biopsy remains the gold standard for diagnosis of hepatic steatosis. However, it is invasive and may potentially suffer from sampling errors. Hepatic steatosis may be diagnosed on unenhanced CT if the hepatic attenuation is less than 40 HU, or if the attenuation of the liver is at least 10 HU less than the spleen. Over the past three decades, non-alcoholic fatty liver disease (NAFLD) has emerged as one of the most common causes of liver cirrhosis in the West. It may be considered to represent another feature of metabolic syndrome. The prevalence of NAFLD has been found to be lower in the African American population when compared to European American or Hispanics, even after controlling for obesity and insulin resistance. The prevalence of hepatic steatosis in the local population is unknown. No studies looking at the association between metabolic syndrome and non-alcoholic fatty liver disease have been done in the local population. Objectives: To determine the prevalence of Hepatic steatosis in patients undergoing unenhanced abdominal CT at Aga Khan University Hospital Nairobi. To determine the association between non-alcoholic fatty liver disease and metabolic syndrome in these patients. Study design: Cross sectional analytical study of resident indigenous African patients undergoing an unenhanced CT abdomen at Aga Khan University Hospital, Nairobi’s (AKUHN) Radiology department. Study protocol: Data from 246 patients who meet the inclusion and exclusion criteria was collected. The prevalence of hepatic steatosis was determined in this population. Metabolic syndrome was diagnosed using the WHO definition. Association of the various components of metabolic syndrome and hepatic steatosis was determined. Findings and discussion: The prevalence of hepatic steatosis in the study population was 13.4%. The study was not powered to assess for difference in prevalence in the two sexes. There was a strong association of hepatic steatosis and diabetes, with diabetics 3 times more likely to have hepatic steatosis. An association was found between the components of metabolic syndrome and hepatic steatosis.