Despite the limitations of the present study, i.e. pilot study, small sample size, lack of control group and assessment of dietary or physical activity habits throughout the study, no blind protocol, no histological evidence, it uncovered remarkable multiple metabolic effects which are beneficial to preventing cardiovascular disease (the most common cause of death) in outpatients with MetS and NAFLD. Thus, the role of Spirulina supplementation as a natural food supplement in NAFLD patients should not be overlooked.