Background Body fat distribution (BFD) especially visceral fat accumulation is closely related to cardiovascular disease than the amount of total body fat itself. Many studies demonstrated the thickness of epicardial adipose tissue (EAT) increased in patients with metabolic syndrome and coronary artery disease. We studied the relationship of EAT thickness to the body fat distribution. Methods We measured EAT thickness using transthoracic echocardiography (TTE) and total body fat and regional body fat distribution using dual-energy X-ray absorptiometry (DEXA) in 390 patients (250 males and 140 females; 57 짹 10 and 62 짹 9 years). The EAT thickness was measured on the free wall of the right ventricle at the end of the diastole on parasternal long axis view of TTE. Total body fat and regional body fat distribution were measured from DEXA results. Results The median and mean EAT thickness of 390 patients were 4.0 mm and 4.2 짹 1.2 mm, respectively. The mean EAT thickness revealed positive correlation with percentage truncal fat mass to total body fat mass ratio, %FMtrunk/FMtotal (r=0.291, p=0.024). Subgroup analysis categorized by sex demonstrated the female group has stronger correlation of EAT thickness with fat distribution than the male group (r=0.369, p=0.003 and r=0.275, p=0.242, respectively) Conclusion EAT thickness is closely related to BFD, especially %FMtrunk/FMtotal representing central fat distribution. Women showed more significant correlation of EAT thickness to central fat accumulation than men. EAT thickness on TTE might be considered as a parameter of central obesity especially in women.