Ghrelin is deregulated in obesity-associated insulin resistance (IR) while visfatin features a role in glucose uptake regulation, inflammation and IR. This study aimed to conduct comparisons and correlations of ghrelin and visfatin plasma levels in nondiabetic metabolic syndrome (MetS) and MetS-prediabetic/type 2 diabetes mellitus (T2DM) patients. In a cross-sectional study of 30 normoglycemic lean subjects (control), 31 MetS subjects, and 30 MetS-prediabetic/T2DM, plasma ghrelin and visfatin were measured by colorimetric-enzymatic assays. The comparison of both biomarkers between study groups and the correlation between them as well as with participants' adiposity, hematologic, and atherogenicity indices were conducted. Ghrelin levels (pg/mL) lacked any statistically significant difference between each of nondiabetic MetS (618.10 ± 93.22, p = 0.103) or MetS-pre/T2DM (498.17 ± 103.21, p = 0.454) vs. the normoglycemic lean control (369.38 ± 111.76). Visfatin level (ng/mL) in MetS patients with pre/T2DM (19.24 ± 2.05, p = 0.003) or without pre/T2DM (18.43 ± 1.83, p = 0.002) was significantly higher as compared to healthy controls' (8.62 ± 2.23). There was a direct ghrelin-visfatin correlation in the whole study population as well as in both MetS and MetS-pre/T2DM arms (p < 0.001). In nondiabetic MetS patients, ghrelin and visfatin proportionally correlated with waist/hip ratio (WHR; p = 0.032 vs. p = 0.008, respectively) while ghrelin correlated directly with BMI (p = 0.034). In MetS-pre/T2DM, visfatin correlated directly with body adiposity index (p = 0.039) but inversely with WHR (p = 0.011), while ghrelin and visfatin directly correlated with mean platelet volume (p = 0.025 vs. p = 0.030, respectively) and ghrelin proportionally correlated with platelet/lymphocyte ratio (p = 0.034). In effect, ghrelin and visfatin molecular interplays with adiposity and blood indices in the MetS derangements may present potential pharmacotherapeutic targets in metabolism and prediabetes anomalies. [ABSTRACT FROM AUTHOR]