Abstract
Objective: The aim of this study is to identify the relationship between carotid intima-media thickness (c-imt) and non-alcoholic fatty liver disease (NAFLD), and to determine whether NAFLD is an independent predictor for the progression of atherosclerosis. 
 Method: This is a prospective randomized controlled study. 103 NAFLD patients who have hepatosteatosis with grade II and above were enrolled in this study. Patients were divided into NAFLD with metabolic syndrome (MS) and NAFLD without MS groups and compared with 50 healthy people. Basal demographic characteristics and C-imt of all patients and control group were measured. 
 Results: C-imt and carotid cross sectional area rates in the NAFLD groups were significantly higher than those in the control group. The mean and max. c-imt levels were significantly higher in the NAFLD group with metabolic syndrome (p<0,001). Homeostatic Model of Assessment-Insulin Resistance (HOMA-IR) levels were increased in the group with metabolic syndrome than those in the group without metabolic syndrome, with statistical significance (p<0.001). There was no difference in c-imt levels between HOMA-IR positive and negative groups (p=0.254) in patients with NAFLD and without metabolic syndrome. There was only a mild positive corelation between c-imt levels and high sensitive C-Reactive protein (hs-CRP) levels in metabolic syndrome positive group (p=0.026 r=0.30). 
 Conclusion: NAFLD was a significant predictor to determine the increased risk of carotid atherosclerosis.
Highlights
Non-alcoholic fatty liver disease (NAFLD), is a condition defined in increasing frequency in patients without excessive alcohol consumption characterized by significant lipid deposition in hepatocytes
Homeostatic Model of Assessment-Insulin Resistance (HOMA-IR) levels were increased in the group with metabolic syndrome than those in the group without metabolic syndrome, with statistical significance (p
There was no difference in c-imt levels between HOMA-IR positive and negative groups (p=0.254) in patients with NAFLD and without metabolic syndrome
Summary
Non-alcoholic fatty liver disease (NAFLD), is a condition defined in increasing frequency in patients without excessive alcohol consumption characterized by significant lipid deposition in hepatocytes. Findings from recent studies suggest that non-alcoholic fatty liver disease is a metabolic disease in which insulin resistance is a common, primary factor in addition to hypertension, diabetes and atherosclerosis.[2,3,4] Abdominal obesity, type 2 diabetes, insulin resistance, hypertension, and dyslipidemia which are typical components of metabolic syndrome, are pathological conditions frequently associated with NAFLD and their association increases the possibility of the more complicated forms of NAFLD in patients.[5,6] This situation strongly supports the idea that NAFLD may be a hepatic manifestation of metabolic syndrome (MS). Recent publications showed that cardiovascular complications constitute the most common cause of death in NAFLD patients.[7]
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