Non-alcoholic fatty liver disease (NAFLD) is estimated to occur in about 50% of obese children. The purpose of this study is to examine the association of anthropometric, biochemical and liver indexes in obese children with and without NAFLD and its relation with insulin resistance (IR). Forty-three obese children participated in the study. NAFLD was diagnosed by ultrasonography. Liver indices (SGOT, SGPT), lipid profile, glucose and insulin levels were performed in all patients. IR was measured by means of the homeostasis model assessment and oral glucose insulin sensitivity. Among the 43 obese patients, 18/43 (41.8%) had NAFLD based on ultrasonography. Fifty percent of them had mild steatosis and 50% had moderate/severe steatosis. In logistic regression analysis of factors associated with NAFLD, homeostasis model assessment IR (ExpB, 1.607; 95% confidence interval, 1.058-2.440; P <0.02) and high-density lipoprotein (0.952; 95% confidence interval, 0.814-1.075; P <0.03) were the most significant. IR, as has already been proved, is associated with NAFLD. Furthermore, high-density lipoprotein levels seem to play an additional role in predicting NAFLD in obese children.