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Summary Aims Sonographic measurement of mesenteric fat thickness (MFT) is a novel, accurate and simple tool to evaluate regional distribution of obesity. We used MFT to determine the optimal waist circumference (WC) values and associated risk factors for cardiovascular disease (CVD). Methods 282 healthy Chinese (age 41.8 ± 7.4 years, BMI 23.8 ± 3.3 kg/m2 ) was assessed. High MFT was defined as mean + 1 SD of the cohort. We compared the CVD risks including fatty liver amongst subjects with normal waist, central pre-obesity and central obesity. Results WC of 84.6 cm in men and 75.7 cm in women were the optimal cutoff values to predict high MFT with ROC analysis. Using WC cutoff values ≥85–90 cm and ≥90 cm to define central pre-obesity and obesity in men (≥75–80 cm and ≥80 cm in women), both central obesity and pre-obesity had higher MFT and CVD risk than those with normal waist. The frequencies of fatty liver in these 3 categories were 15.9%, 56.7% and 96.7% in men and 6.9%. 17.9% and 63.2% in women ( p < 0.001 for trend). Conclusion In addition to central obesity, “central pre-obesity” identifies subjects who harbor high CVD risks, fatty liver and excess visceral fat.