Abstract: Objective To explore the correlations between human body fat distribution and carotid atherosclerosis. Methods Adult healthy individuals who underwent physical examinations at the Health Management Center of the International Medical Department (Xidan Campus) of Peking Union Medical College Hospital between January 2020 and January 2023 were selected as study participants. Baseline data, laboratory indicators, Inbody body composition analysis, and carotid ultrasound examination results were collected. Participants were divided into carotid atherosclerosis group and control group based on carotid ultrasound examination results. Baseline data, laboratory indicators, and body composition differences between the two groups were compared, and multivariate Logistic regression analysis was conducted to investigate the correlation between carotid atherosclerosis and body composition. To further explore the correlation between fat distribution and carotid atherosclerosis, the ratio of trunk fat to limb fat (trunk fat/limb fat), visceral fat area, and waist-to-hip ratio were stratified into Q1, Q2, Q3, and Q4 groups (with Q1 group as the reference) based on quartiles (Q1 to Q4), and a forest plot was constructed to analyze the risk of carotid atherosclerosis in each subgroup. Results A total of 2221 participants were included in this study, including 1194 males (53.76%) and 1027 females (46.24%), with a mean age of (50.28±10.93) years. There were 1049 cases in the carotid atherosclerosis group and 1172 cases in the control group. Baseline data analysis showed that the carotid atherosclerosis group had a higher age and male proportion compared to the control group (both P<0.001). The carotid atherosclerosis group also had significantly higher levels of body weight, body mass index (BMI), waist-to-hip ratio, body fat mass, trunk fat, trunk fat/limb fat, and visceral fat area compared to the control group (all P<0.001). Laboratory test results indicated that the carotid atherosclerosis group had significantly higher levels of blood glucose, glycated hemoglobin, triglycerides, and uric acid compared to the control group (all P<0.001). Multivariate Logistic regression analysis revealed that after adjusting for age, gender, smoking history, and drinking history, body fat mass, trunk fat, trunk fat/limb fat, and waist-to-hip ratio were significantly associated with the risk of carotid atherosclerosis (P<0.05). Compared with the Q1 group, the Q4 group had a significantly increased risk of atherosclerosis (OR=1.81, 95% CI: 1.26 to 2.61, P<0.01). However, there was no significant correlation between waist-to-hip ratio, visceral fat area, and carotid atherosclerosis (P>0.05). Conclusions There is a significant correlation between trunk fat/limb fat and the occurrence of carotid atherosclerosis. The correlation between visceral fat and carotid atherosclerosis is more complex and requires further exploration and research with an increased sample size. In the future, the sample size should be expanded, and more precise methods for measuring fat distribution should be adopted to validate the conclusions of this study.