OBJECTIVE: The purpose of this article is to determine whether there is an association between visceral adiposity measured on CT colonography (CTC) and colorectal polyps. MATERIALS AND METHODS: Patients who underwent CTC and same-day optical colonoscopy (n = 1186) were analyzed. Visceral adipose tissue volumes and volume percentages relative to total internal body volume were measured on slices in the L2-L3 regions on supine CTC scans with validated fully automated software. Student t test, odds ratio, logistic regression, and receiver operating characteristic analyses were performed. RESULTS: For subjects with (n = 345) and without (n = 841) adenomatous polyps, the mean ($\pm$ SD) volume percentages were 31.2% $\pm$ 10.8% and 28.2% $\pm$ 11.3%, respectively (p < 0.0001). For subjects with (n = 244) and without (n = 942) hyperplastic polyps, the volume percentages were 31.8% $\pm$ 10.7% and 28.3% $\pm$ 11.2%, respectively (p < 0.0001). Comparing the lowest and highest quintiles of volume percentage, the odds ratios for having at least one adenomatous polyp or hyperplastic polyp versus no polyp were 2.06 (95% CI, 1.36-3.13) and 1.71 (95% CI, 1.08-2.71), and the prevalence of having adenomatous polyps or hyperplastic polyps increased by 14% and 8%, respectively. CONCLUSION: Subjects with higher visceral adiposity measurements on CTC have a greater risk for the presence of colonic polyps.