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Life sciences · Journal article
PLOS One · November 5, 2026
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Objective This study aimed to investigate the associations between different subtypes of Metabolic dysfunction-associated fatty liver disease (MAFLD) and carotid plaque, and to evaluate the independent association of the Fibrosis-4 (FIB-4) index with carotid plaque risk. Methods Multivariable logistic regression was used to assess associations of MAFLD subtypes and the FIB-4 index with carotid plaque. Two covariate‑selection strategies were adopted: confounders for MAFLD‑subtype analyses were chosen based on clinical considerations, while subgroup‑analysis confounders were screened using a univariable p < 0.10 threshold. Separate adjusted models were constructed disentangle the independent association of the composite FIB-4 score from its individual components. Results A total of 15,544 participants were included. After multivariable adjustment, lean MAFLD demonstrated an independent association with carotid plaque (OR=1.444), and its point estimate was numerically higher than those for diabetes-related MAFLD (OR = 1.354) and overweight/obesity-related MAFLD (OR = 1.172), although the confidence intervals overlapped. The FIB-4 index demonstrated a significant association with carotid plaque across all MAFLD subtypes (all p < 0.05) in models excluding its individual constituent components (OR range: 1.401–2.227). Conclusion Lean MAFLD is independently associated with carotid plaque. The FIB-4 index, a readily accessible noninvasive marker, shows consistent associations with carotid plaque across all MAFLD subtypes.