Objective <p>This study aims to investigate the association between the retinal artery to vein ratio (AVR) and body fat distribution, and to further evaluate the potential beneficial effects of optimized fat distribution on systemic vascular health.</p> Methods <p>A total of 2,698 participants aged 18 to 80 from Lanxi cohort were enrolled. After applying inclusion and exclusion criteria, 2,045 participants were retained for the final analysis. Retinal vessel images were obtained through fundoscopy, and retinal AVR was automatically calculated using a clinically validated AI algorithm. Body fat was assessed by dual-energy x-ray absorptiometry (DXA). Adjusted multivariate linear regression models were used to identify the associations of retinal AVR with fat distribution.</p> Results <p>Retinal AVR was negatively associated with waist-hip ratio (WHR), android fat mass percentage, android to gynoid fat ratio, and trunk fat mass percentage. Similar trends were observed when fat distribution indicators were categorized into quartiles (P for trend &lt; 0.05). When stratified by age, a similar significant association was observed in the 45–60 age group.</p> Conclusions <p>Retinal AVR was associated with fat distribution, with particularly correlations observed in middle-aged populations and those with metabolic abnormalities. And these associations differ based on the location of fat depots, indicating that exercise-induced fat redistribution is associated with vascular health.</p>