BACKGROUND: The visceral adiposity index (VAI) and hypertriglyceridemic waist phenotype (the simultaneous presence of waist circumference (WC)>= 90/80 cm for men/women and plasma triglyceride (TG) concentration >= 1.7 mmol l(-1) for both genders) have been identified as good indicators of visceral adiposity, which is an independent risk factor for diabetes. The Chinese population is characterized by a predominance of visceral fat accumulation despite having comparatively low weight. These two surrogate markers of visceral adiposity might effectively identify Chinese adults who are at risk of getting diabetes. We aimed to examine the association between VAI and risk of diabetes or between the hypertriglyceridemic waist phenotype and diabetes risk. METHODS: We conducted a cross-sectional analysis of 7639 Chinese men and women aged >= 18 years using data from the China Health and Nutrition Survey 2009. Logistic regression was used to evaluate the associations. RESULTS: For men, compared with participants in the lowest quartile of VAI scores, the multivariable-adjusted odds ratios (ORs) (with 95% confidence intervals) for diagnosed diabetes were 1.1 (0.7-1.7), 1.9 (1.3-2.8) and 3.6 (2.5-5.3) for those in the second, third, and top quartile of VAI scores, respectively. For women, the corresponding figures were 0.9 (0.5-1.4), 1.7 (1.1-2.6) and 2.8 (1.9-4.2), respectively. The multivariate-adjusted ORs (with 95% confidence intervals) for diabetes in men with the hypertriglyceridemic waist phenotype compared with men with both WC and TG measurements below the defined cut points were 3.7 (2.6-5.4). For women, the corresponding figure was 3.7 (2.4-5.5). For both men and women, the associations between the 4th quartile of VAI scores and risk of diabetes or between the hypertriglyceridemic waist phenotype and risk of diabetes were consistently seen in various subgroups. CONCLUSION: Among Chinese adults, high VAI scores and the hypertriglyceridemic waist phenotype are strongly associated with diabetes risk.