Abstract: AIM To describe the characteristics of fat distribution in obesity and to explore its relationship to the occurrence and severity of metabolic disorder and coronary artery diseases. METHODS Fifty-seven patients (43 males and 14 females) with definite abdominal obesity, mean age of 52.44±11.47 yeas were included in this study. Fat accumulation in heart, aorta and abdominal viscera were quantified by 64-slice computer tomography. Peri-renal fat accumulation was measured by ultrasound. Traditional cardiovascular risk factors and metabolic risk factors were also examined. RESULTS VAT, peri-renal fat and Gessini score were significantly larger in patients with metabolic syndrome (MS) than those without ［(2290±601) cc versus.(3024±792) cc; (13.4±1.1) mm2 vs.(18.8±2.2) mm2; (20±3) vs.(46±6); P<0.05, P<0.01］. VAT was significantly associated with the pressence of MS by multivariate logistic regression (OR=1.002, 95%CI 1.000-1.003, P<0.05). WHR, number of MS components, diabetes mellitus, CYS-C, EAT and pericoronary adipose tissue in Gessini score>80 group were significantly higher than those in Gessini score 40~80 group and Gessini score<40 group ［(1.10±0.01) vs.(0.96±0.01), (0.96±0.01)；(4.38±0.38) vs.(3.35±0.27), (2.71±0.27); 71% vs. 17%, 6%; (1.33±0.21) mg/L vs.(1.03±0.07 ) mg/L, (0.86±0.04) mg/L; (217±58) cc vs.(201±18) cc, (129±18) cc; (17.0±1.2) mm vs.(14.3±0.6) mm, (10.4±0.6) mm; P<0.05, P<0.01］. Multivariate stepwise regression analysis showed a significant relationship between Gessini score and MS, pericoronary adipose tissue thickness and cystatin. CONCLUSION Varying locations of body fat distribution play different roles in obesity-related metabolic cardiovascular disease in abdominal obesity.