Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide and is closely associated with obesity, metabolic syndrome, and type 2 diabetes mellitus. With increasing prevalence of metabolic disorders, NAFLD is frequently encountered in patients presenting for elective surgery. Preoperative identification of NAFLD is important as it may influence perioperative outcomes. Materials and Methods: A prospective observational study was conducted among 200 patients undergoing elective surgery in a tertiary care hospital. Clinical evaluation, anthropometry, biochemical parameters, and abdominal ultrasonography were performed to diagnose NAFLD. Inclusion and exclusion criteria were predefined. Data were analyzed using appropriate statistical tests. Results: The overall prevalence of NAFLD was 38%. NAFLD was significantly associated with obesity, diabetes, dyslipidemia, and elevated liver enzymes (p < 0.05). Grade I steatosis was most common (63.2%). Patients with NAFLD showed higher BMI, fasting glucose, triglycerides, and ALT levels compared to non-NAFLD patients. Conclusion: NAFLD is highly prevalent among patients undergoing elective surgery. Routine preoperative screening, especially in patients with metabolic risk factors, may improve perioperative risk stratification and long-term outcomes.