Objective:Our objective was to investigate whether determination of the quantity of visceral fat has an additional benefit in assessing atherosclerotic burden in men with type 2 diabetes compared with the traditional measurement of waist circumference (WC) alone.Methods:This was an observational study performed in 368 men with type 2 diabetes, consecutively enrolled in Diabetes Clinics. Common carotid artery far-wall intima-media thickness (IMT), WC and visceral fat thickness (VFT), as measured by ultrasonography, were measured for each subject. Abdominal and visceral obesity were defined as a WC >90 cm and a VFT ⩾47.6 mm, respectively.Results:Among subjects with abdominal obesity (n=174), 35 subjects did not have visceral obesity. In contrast, among the subjects without abdominal obesity (n=194), 88 patients had visceral obesity. Despite no differences in age, glucose control, lipid profile and treatment modalities, there was a significant difference in carotid IMT based on VFT strata, but not WC strata. The subjects without abdominal obesity, but who had visceral obesity, had a higher carotid IMT compared with subjects with abdominal obesity, but without visceral obesity (maximal, 0.94±0.35 vs 0.78±0.17 mm; and average, 0.74±0.19 vs 0.64±0.14 mm, respectively, P<0.001).Conclusions:Subjects having visceral obesity, regardless of a normal WC, showed a higher carotid IMT compared with those with increased WC, but less visceral fat. In addition to WC, a direct estimation for visceral fat may provide an additional role in assessing atherosclerotic burden in men with type 2 diabetes.