ObjectiveTo investigate the association between metabolic associated fatty liver disease （MAFLD） and carotid atherosclerotic plaque. MethodsA total of 1 107 patients who were hospitalized in The Second Affiliated Hospital of Kunming Medical University from July， 2014 to December， 2022 were enrolled， and all patients underwent abdominal ultrasound and CT angiography of the head and neck arteries. Baseline data and clinical diagnosis were collected， and the patients were divided into MAFLD group with 499 patients and non-MAFLD group with 608 patients based on medical history， clinical tests， and imaging findings. According to the CT value， carotid plaques were classified into calcified plaques， non-calcified plaques， and mixed plaques. According to the NASCET criteria， carotid stenosis was categorized as normal vessel， slight stenosis， mild stenosis， moderate stenosis， and severe stenosis/occlusion. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate Logistic regression analyses were used to investigate the influencing factors for carotid atherosclerosis. ResultsCompared with the non-MAFLD group， the MAFLD group had a significantly higher proportion of patients with calcified plaques （74.3% vs 63.3%， P<0.05）， non-calcified plaques （27.1% vs 17.1%， P<0.05）， or mixed plaques （27.3% vs 20.7%， P<0.05）， as well as a significantly higher proportion of patients with mild stenosis （50.9% vs 44.9%， P<0.05）， moderate stenosis （14.6% vs 8.4%， P<0.05）， or severe stenosis/occlusion （6.6% vs 3.5%， P<0.05）. The univariate logistic regression analysis showed that MAFLD was a risk factor for calcified carotid plaques， non-calcified plaques， and mixed plaques， and it was also a risk factor for mild stenosis， moderate stenosis， and severe stenosis/occlusion of the carotid artery （all P<0.05）. After adjustment for confounding factors， the multivariate Logistic regression analysis showed that MAFLD was an independent risk factor for calcified plaque， non-calcified plaque， mixed plaque， and moderate stenosis of the carotid arteries （all P<0.05）. ConclusionMAFLD is an independent risk factor for moderate stenosis， calcified plaques， non-calcified plaques， and mixed plaques of the carotid arteries.