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Context: We have previously found that visceral fat is a stronger predictor for cardiovascular risk factors than body mass index (BMI). Objective: To investigate the prevalence of diabetes in elderly men and women in relation to objectively assessed visceral fat volume. Design and settings: The cohort consisted of a population-based sample of 705 men and 688 women, all aged 70 years at the time of examination. Main outcome measures: Associations between body fat estimates, plasma glucose level and diabetes prevalence were investigated using multivariable-adjusted statistical models.Results:Theprevalence of type2 diabetes was 14.6% in men and 9.1% inwomen (p0.001). Mean BMI was slightly higher in men than in women (27. 3 vs. 26.6 kg/m2, p 0.01), with a greater difference in mean visceral fat mass (1987 vs. 1087 g, p 0.001). After adjustment for physical activity and smoking, men had about twice the odds of having type 2 diabetes compared with women (OR, 1.95; 95% CI, 1.38–2.76). The inclusion of BMI in this model did not change the risk associated with male sex (OR, 1.93; 95% CI, 1.34–2.77). However, when visceral fat was included as a covariate, male sex was not associated with increased risk of type 2 diabetes (OR, 0.77; 95% CI, 0.51–1.18).Conclusions: The higher prevalence of type 2 diabetes in older men than in older women was associated with larger amount of visceral fat in men. In contrast, differences in BMI was not associated with this difference.