Background Non-alcoholic fatty liver disease (NAFLD) is a growing public health concern, particularly among individuals with metabolic syndrome. NAFLD is strongly associated with obesity, insulin resistance, dyslipidemia, and hypertension, making it a critical component of metabolic dysfunction. Understanding its prevalence and associated risk factors in adults with metabolic syndrome can help in early identification and management to prevent disease progression. Methodology This cross-sectional study was conducted at the Medical Teaching Institute Khalifa Gul Nawaz Teaching Hospital, Bannu, from 1st July 2023 to 30th June 2024. A total of 65 participants diagnosed with metabolic syndrome were recruited. NAFLD was diagnosed using ultrasonography, and metabolic parameters, including body mass index (BMI), fasting blood glucose, lipid profile, liver function tests, and blood pressure, were assessed. Data were analyzed using SPSS version 26, with categorical variables presented as frequencies and percentages, while continuous variables were expressed as mean ± standard deviation. Statistical comparisons were made using chi-square and t-tests, with p-values <0.05 considered significant. Results The prevalence of NAFLD in the study population was 64.6%. Participants with NAFLD had significantly higher BMI (31.1 ± 4.2 kg/m² vs. 26.3 ± 3.9 kg/m², p = 0.002), triglycerides (190.4 ± 42.7 mg/dL vs. 157.2 ± 35.6 mg/dL, p = 0.01), and fasting blood glucose (126.7 ± 14.5 mg/dL vs. 113.4 ± 12.9 mg/dL, p = 0.03) compared to non-NAFLD individuals. Elevated ALT levels were observed in NAFLD patients (58.3 ± 12.4 U/L vs. 35.6 ± 9.8 U/L, p < 0.001). The prevalence of NAFLD increased with BMI, with 20% of participants having NAFLD in the normal BMI category (<25 kg/m²), 58.3% in overweight individuals (25-29.9 kg/m²), and 81.8% in obese individuals (≥30 kg/m²). Conclusion NAFLD is highly prevalent among adults with metabolic syndrome, with obesity, dyslipidemia, and insulin resistance being key risk factors. The findings emphasize the need for early screening and lifestyle interventions to prevent disease progression in high-risk individuals. Given the metabolic nature of NAFLD, weight management and glycemic control should be prioritized in preventive strategies.