Background & Aims Small studies have shown inconsistent results regarding the association between abdominal visceral adipose tissue and colorectal adenomas. We evaluated the effects of visceral adipose tissue volume on the development and growth of colorectal adenomas. Methods A total of 3922 participants underwent colonoscopy and computed tomography from February to November 2008. The associations between waist circumference, visceral adipose tissue volume, and colorectal adenomas were estimated with adjusted odds ratios and 95% confidence intervals (CIs). In addition, the association between characteristics of colorectal adenomas and visceral adipose tissue volume was evaluated. Results Compared with participants who had visceral adipose tissue volume of less than 500 cm 3, the odds ratio for colorectal adenoma was 1.09 (95% CI, 0.87–1.36) for a volume of 500 to 999 cm 3, 1.33 (95% CI, 1.04–1.69) for a volume of 1000 to 1499 cm 3, and 1.43 (95% CI, 1.06–1.94) for a volume of 1500 cm 3 or greater. The risk of colorectal adenomas increased with increasing visceral adipose tissue volume in both sexes ( P trend = .004 in men and .009 in women). Waist circumference was associated with colorectal adenomas in men ( P trend = .02), but not in women. High volume of visceral adipose tissue (≥1000 cm 3) had a positive association with larger adenomas (≥10 mm) and multiple adenomas. Conclusions Abdominal visceral adipose tissue volume can contribute to the development and growth of colorectal adenomas, and it was a better predictor for risk of colorectal adenomas than body mass index or waist circumference in both sexes.