Background <p>Abdominal adiposity plays a key role in metabolic syndrome and is closely linked to cardiometabolic risk. Visceral and subcutaneous fat depots may have different metabolic effects, but their relative contributions remain unclear.</p> Objective <p>This study aimed to investigate the association between visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) with metabolic syndrome.</p> Methods <p>This cross-sectional study analyzed data from 4,292 adults (≥ 20&#xa0;years) in the NHANES 2011–2018. VAT and SAT were measured using dual-energy X-ray absorptiometry (DEXA). The association between VAT, SAT, and metabolic syndrome was evaluated through binary logistic regression, adjusting for potential confounders in three models: Model 1: Adjusted for BMI and age. Model 2: Further adjusted for sociodemographic, lifestyle factors, and smoking. Model 3: Additionally adjusted for VAT or SAT.</p> Results <p>Participants were 50.6% male, with a mean age of 39.5 ± 11.5&#xa0;years and BMI of 28.9 ± 6.9. VAT and SAT levels were higher in individuals with metabolic syndrome (<i>p</i> &lt; 0.001 for both). VAT consistently increased metabolic syndrome risk in both sexes. In males, the odds ratio (OR) for VAT was 1.013 (95% CI: 1.009–1.017) in Model 1, 1.013 (95% CI: 1.010–1.017) in Model 2, and 1.014 (95% CI: 1.010–1.017) in Model 3 (all <i>p</i> &lt; 0.001). In females, VAT also showed a strong positive association, with ORs of 1.015 (95% CI: 1.013–1.017) in Model 1 and 1.016 (95% CI: 1.013–1.019) in both Models 2 and 3 (all <i>p</i> &lt; 0.001). Subcutaneous adipose tissue was not significantly associated with metabolic syndrome in males (all <i>p</i> &gt; 0.05) and showed a weak inverse association in females only in Model 3 (OR: 0.998, 95% CI: 0.996–1.000, <i>p</i> = 0.035).</p> Conclusion <p>VAT, but not SAT, was a strong independent determinant of metabolic syndrome, underscoring the metabolic significance of visceral adiposity.</p>