Objective: The study's objective was to analyze the association between the adherence to the Mediterranean diet (MD) and the presence of nonalcoholic fatty liver disease (NAFLD) in children. Methods: The study consisted of three groups of children. Group 1 included obese/overweight children with recent diagnosis of NAFLD (n=106, 12.42.6 years). Group 2 included obese children without NAFLD (n=21, 11.32.6 years). Group 3 included the healthy children (without known chronic disease) with normal BMI (n=54, 11.82.9 years). Compliance to the MD was assessed by the KIDMED index score. Results: KIDMED index score in obese children with NAFLD, without NAFLD, and healthy children were 2.6 +/- 2.4, 4.6 +/- 1.2, and 6.2 +/- 1.9, respectively (p<0.05 for group 1 versus 2, 1 versus 3, and 2 versus 3). Diet compliance was good in only 4.7% of the patients with NAFLD, whereas it was 31.5% in healthy children. KIDMED index score was negatively correlated with BMI (p<0.05, r=-0.53), but no correlation was found with other parameters. The area under the receiver operation curve (AUROC) for predicting fatty liver disease in obese children (n=127) with BMI and KIDMED index score was 0.78 (p<0.05) and 0.24 (p<0.05), respectively. BMI >26 has a sensitivity of 79.2% and specificity of 52.4%, and KIDMED index score 3 has a sensitivity of 66.9% and specificity of 76.1%. Conclusions: MD is an inexpensive and nontoxic dietary regimen and may be used as a therapeutic option in obese children with NAFLD.