Objective:To explore the correlation between fibroblast growth factor 21(FGF21)and the occur-rence of carotid atherosclerotic plaques in patients with non-alcoholic fatty liver disease(NAFLD).Method:A total of 131 patients diagnosed with NAFLD from January 2023 to September 2023 were selected and divided into the plaque group and the no-plaque group based on the presence or absence of carotid atherosclerotic plaques.Addition-ally,39 healthy individuals undergoing routine check-ups at the same period were chosen as the control group.Ser-um levels of uric acid(UA),low-density lipoprotein cholesterol(LDL-C),small dense low-density lipoprotein cho-lesterol(sdLDL-C),high-density lipoprotein cholesterol(HDL-C),triglycerides(TG),total cholesterol(TC),and FGF21 were measured,and differences in these parameters were analyzed.Logistic regression analysis was em-ployed to determine the correlation between serum FGF21 levels and the occurrence of carotid atherosclerotic plaques in NAFLD patients.Results:Compared to the control group,both the no-plaque and plaque groups showed in-creased levels of UA,TC,TG,LDL-C,sdLDL-C,and FGF21,while HDL-C levels were reduced(P<0.05 or P<0.01).Compared to the no-plaque group,the plaque group had higher levels of LDL-C,sdLDL-C,and FGF21,with these differences were statistically significant(P<0.05 or P<0.01).After adjusting for covariates,logistic regression analysis revealed that increased serum FGF21 levels were positively correlated with the occurrence of ar-terial atherosclerotic plaques in NAFLD patients.Conclusion:Serum FGF21 levels are associated with the occur-rence of carotid atherosclerotic plaques in patients with NAFLD.