Abstract Background: Many international organizations have rec-ognized obesity as a chronic disease, with significant contri-bution to the global mortality and morbidity. Besides, obese patients are at higher risk of death than non-obese individuals. Obesity is a major driver for disability, early retirement, and psychological disorders as well. Abdominal wall fat index (AFI) is a widely utilized sonographic measure for regional fat accumulation; it is calculated as a ratio of the highest to lowest preperitoneal and subcutaneous fat thicknesses, respectively. Carotid Intima Media Thickness (CIMT) is a well-established marker for early atherosclerosis. In this study we investigated the relationship between abdominal wall fat index (AFI) and Carotid Intima Thickness (CIMT) with lipid profile among overweight and obese patients. Aim of Study: Investigating the relationship between abdominal wall fat index (AFI) and Carotid Intima Media Thickness (CIMT) as measured by ultrasonography with lipid profile among overweight and obese patients. Patients and Methods: We conducted a cross-sectional study on 60 adult participants ranging from 22 to 66 years old of both genders. The patients were divided into three groups according to the AFI value into: Group I (AFI <0.7), group II (AFI <1.4), and group III (AFI ³1.4). AFI and CIMT measured using ultrasonography and lipid profile was obtained. Results: Participants in group III (mean=53.7±11.0 years old) were significantly older than other studied groups; and were more likely to be hypertensive and diabetic. There was a statistically significant difference between studied groups regarding body mass index (BMI; p=0.001), the highest level was among group III (mean BMI=34.1±5.8Kg/m2). There were positive correlations between lipid profile parameters and the AFI. Furthermore, there was a statistically significant difference between groups regarding CIMT (p=0.001). CIMT was the highest among group III (mean of 1.4±0.3mm), followed by group II (mean of 1.2±0.3mm), and group I (mean of 0.7±0.3mm).CIMT was positively correlated with AFI (r=0.747, p=0.001). BMI was highest among group III (mean of 34.1±5.8), followed by group II (mean of 30.3±4.0), and group I (mean of 25.0±2.2) BMI was positively correlated with AFI (p=0.001). Conclusions: AFI has a significant positive correlation with CIMT and preperitoneal fat thickness. AFI can be a useful marker in evaluating and predicting disorders of me-tabolism, circulation and atherosclerosis.