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Introduction: Nonalcoholic fatty liver disease (NAFLD) has become a major contributor to chronic paediatric liver disease. The Chinese visceral adiposity index (CVAI) is an emerging indicator of visceral adiposity. However, there has been no research on the association between CVAI and the presence of NAFLD in obese children. The aim of the study was to investigate the association of CVAI with the occurrence of NAFLD in obese children with body mass index (BMI) > 30 and to compare the diagnostic execution of CVAI with other traditional markers of visceral adiposity. Material and methods: We enrolled 153 obese children (63 male, 90 female) with an age range of 9--18 years. NAFLD was diagnosed via ultrasonographic evidence of fatty liver. Results: Visceral adiposity indices were calculated. The complete lipid profile, liver enzyme alanine aminotransferase (ALT), fasting blood glucose (FBG), fasting insulin, HbA1c, and insulin resistance nonNAFLD were calculated using the homeostasis model (HOMAIR). The obese subjects were divided into 2 groups: the NAFLD group (53 [34.7%] obese children) and the nonNAFLD group (100 obese children). In the NAFLD group, 33 were boys and 20 were girls, with a mean age of 13.0 ±2.99 years. The frequency of metabolic syndrome was 26.71% of participants. CVAI was significantly higher (p = 0.001) in obese children with NAFLD. CVAI had a statistically significant positive correlation with HOMAIR, FBS, fasting insulin, and LDL (r = 0.227, p = 0.005), (r = 0.183, p = 0.024), (r = 0.267, p = 0.006), (r = 0.224, p = 0.006), respectively, and negatively correlated to HDL (r = --0.267, p = 0.001). Conclusions: The results suggest that CVAI was strongly associated with IR. The results of linear multiple regressions to predict NAFLD showed that CVAI, VAI, and visceral fat thickness were the most independent predictors. The receiver operating characteristic curve (ROC) showed that CVAI was the best predictor of NAFLD among obese children. [ABSTRACT FROM AUTHOR]