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The width and height keys can be used without the other, in which case the aspect ratio of the image is kept and it is just scaled to that width or height, respectively. So \includegraphics[width=\textwidth]{<file>} and \includegraphics[height=\textheight]{<file>} will both keep the aspect ratio.

Another usage would be to use both simultaneously, in which case the image will get distorted to match both dimensions, having the specified width and height , so \includegraphics[width=\textwidth,height=\textheight]{<file>} will have exactly those dimensions.

The third variant is to use both and additionally the keepaspectratio option. In this case the image will keep its aspect ratio and will be scaled such that it is as big as possible without having a bigger width or height than the specified values, so \includegraphics[keepaspectratio,width=\textwidth,height=\textheight]{<file>} will have the biggest possible size while staying in those constraints without being distorted.

An example document using the three variants:

\documentclass[]{article}
\usepackage[]{graphicx}
\begin{document}
\includegraphics[width=5cm]{example-image-duck}
\includegraphics[height=4cm]{example-image-duck}
\includegraphics[width=5cm,height=4cm]{example-image-duck}
\includegraphics[keepaspectratio,width=5cm,height=4cm]{example-image-duck}
\end{document}