Increased iron is suspected to enhance hepatic injury associated with nonalcoholic fatty liver disease (NAFL). We evaluated the impact of iron accumulation on the outcome of NAFL. Patients with NAFL were identified from our database. Twenty-two clinicodemographic and 19 pathological features were available for each patient. Histological staining (Perls' Prussian blue), hepatic iron concentration (HIC), and hepatic iron index (HII) were determined. Data on follow-up, mortality, and cause of death were analyzed. In 65 patients with available liver biopsy blocks, HIC and HII were 1,171 ± 717 μg/g dry weight and 0.43 ± 0.30 μmol/g/yr, respectively. Males had more iron accumulation (HIC: 1,514 ± 836 vs. 859 ± 389, P = .0001; and HII: 0.58 ± 0.35 vs. 0.29 ± 0.16, P =.0001). In type II diabetics, both HIC (977 ± 769 vs. 1,301 ± 659; P < .05) and HII (0.30 ± 0.23 vs. 0.52 ± 0.32; P < .05) were lower. Iron accumulation was not related to other variables analyzed. Increased iron was not seen in those with higher grades of fibrosis or other pathological features associated with the aggressive form of NAFL (hepatocyte necrosis, fibrosis, ballooning degeneration, and Mallory hyaline). Iron accumulation was not associated with increased overall mortality, liver-related mortality, or development of cirrhosis. In summary, in most patients with NAFL, significant iron accumulation is not seen. Additionally, in our series of patients with NAFL, iron is not associated with poor clinical or pathological outcomes.