This study analyzed the relationship between obesity, metabolic syndrome (MetS) and its individual components, iron metabolism, and hepatic alterations in a pediatric group of patients. We mostly concentrated on the role of serum ferritin as a marker of inflammation. We conducted a retrospective study, in which we determined the presence of MetS and hepatic ultrasound changes in a cohort of 68 pediatric patients and examined the changes in serum iron and ferritin levels. MetS prevalence was significantly higher in obese children (64%) compared to those with average weight (11.1%). Abdominal circumference, triglycerides, and high-density lipoprotein cholesterol were the most relevant MetS criteria. Serum iron levels were significantly lower, while ferritin levels increased proportionally with MetS number of components. Liver ultrasound findings confirmed a strong association between hepatic steatosis and MetS, with advanced ultrasonographic scores correlating with increased ferritin and serum iron deficiency. These results reinforce the interplay between iron metabolism and inflammation in pediatric MetS. Given this study's unicentric design and limited ethnic diversity, further large-scale, longitudinal studies are needed to confirm these findings and improve early screening strategies for pediatric metabolic complications.