Objective To investigate the association between Chinese visceral adiposity index CVAI and the risk of colorectal cancer CRC . Method In-service and retired employees who participated in the health checkup of Kailuan Group in 2006 were selected for this study and 98 311 participants were finally included. According to the tertile of CVAI the study subjects were divided into CVAI1 group ≤75. 36 CVAI2 group 75. 36~ 108. 30 and CVAI3 group >108. 30 . Participation in a physical examination was used as the starting point for follow-up and study participants were followed up with newly diagnosed CRC as the outcome event and the occurrence of the outcome event death or the end of the follow-up time as the follow-up endpoint. The cumulative incidence of CRC in each group was calculated using the Kaplan-Meier method and the incidence curves were plotted and the log-rank test was used for comparison between groups. The Cox proportional risk regression model was used to analyze the hazard ratio HR and 95% confidence interval CI of CRC incidence by different CVAI. The receiver operating characteristic curve ROC of the subjects was established and the predictive performnce of CVAI and traditional obesity indices for CRC was compared by calculating the area under the ROC curve AUC of CVAI visceral adiposity index VAI body mass index BMI and waist circumference WC . Result As the CVAI increased the cumulative incidence of CRC increased and the difference was statistically significant by log-rank test χ 2 = 72. 84 P< 0. 001 . The results of multivariable Cox proportional hazard regression model analysis showed that after correcting for relevant confounders the risk of CRC incidence was increased by 1. 27-fold 95%CI = 1. 02 ~ 1. 58 in the CVAI3 group compared with that in the CVAI1 group respectively. AUCCVAI = 0. 66 0. 64~ 0. 68 AUCWC = 0. 65 0. 63~ 0. 66 AUCBMI = 0. 65 0. 63 ~ 0. 66 AUCVAI = 0. 65 0. 63 ~ 0. 66 AUCCVAI > AUCWC AUCVAI AUCBMI . Conclusion Higher CVAI level is an independent risk factor for CRC and the risk of CRC increases with increasing CVAI CVAI has a higher predictive ability for CRC than VAI BMI and WC.