Objective To investigate the association of central obesity (Waist-to-Hip Ratio) and carotid intima-media thickness (IMT) in Han, Uygur and Kazak female adults in Xinjiang. Methods Four-stage stratified cluster random sampling was used to select adult samples aged over 35 years in different districts in Xinjiang, and then a study was conducted using a questionnaire, physical exams (including blood pressure, height, weight, waist length, and hip length) and lab biochemical tests, while IMT was measured by ultrasound. According to WHR, the people were divided into two groups (WHR≥0.9 group and WHRlt;0.9 group). Results 14 618 cases had been surveyed, including 7 294 female adults (Han: 2 793 cases; Uygur: 2 490 cases; and Kazak: 2 011 cases). Among the same nationality, the WHR≥0.9 group had higher levels of systolic pressure, diastolic pressure, urea nitrogen, fasting blood-glucose, triglyceride and total cholesterol than the WHRlt;0.9 group, with significant differences (P=0.000). The two groups were the same in creatinine, high-density lipoprotein cholesterol and low density lipoprotein with no significant differences (Pgt;0.05). Among all people, the WHR≥0.9 group had slightly thicker IMT than the WHRlt;0.9 group (P=0.17). Among the Han nationality, the two groups were the same in IMT (P=0.23). Uygur’s IMT and Kazak’s IMT in the WHR≥0.9 group were thicker than that in the WHRlt;0.9 group (P=0.00). Among different populations, in the WHR≥0.9 group, Kazak’s IMT was the thickest, while Uygur’s IMT was the thinner, with significant differences (P=0.00). Within the WHR≥0.9 group, in different age groups, Kazak’s IMT was the thickest; except in the group of aged over 75 years, there were significant differences among other subgroups, the Han group, and the Uygur group (all Plt;0.05). The result of logistic regression showed that, WHR≥0.9 was an independent risk factor of IMT thickening among the three groups. Conclusion WHR increase is positively associated with IMT among the three nationalities. Also, WHR≥0.9 was an independent risk factor of IMT in all the three nationalities.