AIM:To determine the optimal cut-points of visceral adipose tissue (VAT) areas at different anatomic levels to discriminate participants with cardiometabolic risk factors in a Chinese middle-aged population. METHODS:A total of 1744 individuals who underwent regular health checks in Nanjing BENQ Medical Center from January 2013 to December 2016 were included in this cross-sectional study. VAT areas were measured by abdominal quantitative computed tomography at the L2/3 intervertebral disk and umbilicus levels. Cardiometabolic risk factors including serum triglycerides, HDL cholesterol levels, plasma glucose and blood pressure were defined using IDF 2005 criteria for metabolic syndrome. RESULTS:The cut-points for VAT area at the umbilicus level were 111 cm2 for men and 96 cm2 for women to identify people with one or more cardiometabolic risk factors. For VAT area at the L2/3 level, the optimal cut-points were 142 cm2 for men and 115 cm2 for women. A VAT area at the L2/3 level of ≥ 142 cm2 for men or 115 cm2 for women significantly increased the prevalence of hyperglycaemia [odds ratio (OR) 3.18, 95% confidence interval (CI) 2.45-4.13], hypertension (OR 2.81, 95% CI 2.27-3.49) and dyslipidaemia (OR 4.37, 95% CI 3.50-5.45) after adjusting age. CONCLUSIONS:The optimal cut-points for VAT area at the umbilicus level and L2/3 level were 111 cm2 and 142 cm2 for men and 96 cm2 and 115 cm2 for women to identify participants with one or more cardiometabolic risk factors.