Our aim was to study whether visceral adiposity is a predictor of diabetic fatty liver in Korean type 2 diabetes mellitus. In this study, abdominal ultrasonography was used to assess the presence of fatty liver in 1,898 patients with type 2 diabetes. We measured visceral fat thickness by high-resolutional ultrasonography and insulin resistance by Kitt. Half of the cohort had a fatty liver (50.2%). High visceral fat thickness had the highest odds ratio for developing fatty liver in both sexes (odds ratio [S.D]: 3.14 [2.24-4.69], p<0.00 in male, 2.84 [2.04-3.93], p<0.00 in female). In addition, visceral fat thickness of 42.45 and 37.7 mm in men and women, respectively, were chosen as the discriminating value to predict the presence of fatty liver with a sensitivity of 71% and 73% and a specificity of 70% and 70% in men and women, respectively. The area under the receiver-operating characteristics curve was 0.759 in men and 0.764 in women. Therefore we could conclude that the degree of visceral adiposity predicts the presence of fatty liver type 2 diabetes mellitus, whether centrally obese or not, suggesting that hepatic fat accumulation in a diabetic fatty liver may be influenced by visceral fat accumulation regardless of waist circumference.