Abstract: Objective To analyze the importance of AFP level in nonalcoholic fatty liver disease (NAFLD). Methods Degree of liver steatosis in 97 patients was graded into three groups. As a control group, patients without fatty liver or other liver diseases were included. All patients and controls were carried out a physical examination, biochemical analyses including liver function tests, the components of the metabolic syndrome, and the homeostasis model assessment to estimate insulin resistance (HOMA-IR) score were also performed. Results Body mass index, AST, ALT, glucose, insulin and HOMA-IR in patients with NAFLD were higher than that in control group. The TG, TC, LDL-C, and HDL-C levels in NAFLD group were higher than that in control. A statistically significant increase in AFP levels was noted in patients with NAFLD when compared with controls (5.43±2.65 IU/mL vs 2.33±0.99 IU/mL, P<0.05). A statistically significant increase in AFP levels was noted in patients with grade 3 NAFLD when compared with grade 1 (6.69±2.36 IU/mL vs 3.56±1.20 IU/mL, P<0.05) and grade 2 NAFLD groups (6.69 IU/mL±2.36 IU/mL vs 4.27±1.79 IU/mL, P<0.05). AFP in grade 2 NAFLD group was significantly higher than that in grade 1. AFP was correlated with NAFLD grade. According to multivariate analysis, the correlation between NAFLD grade and serum AFP levels was independent factors to NAFLD. Conclusion Patients with NAFLD have higher AFP levels than those with fatty liver changes. The AFP levels might be used to identify the grade of liver steatosis in patients with nonalcoholic fatty liver disease.