PurposeTo assess the relationship between changes in abdominal adipose tissue and metabolic syndrome (MetS) in men with obesity after a weight reduction program (WRP).Patients and MethodsAdult men with obesity and MetS were recruited for this prospective single-arm intervention study. Participants consumed an energy-restricted diet of 1200 kcal/day and performed 50-mins aerobic exercise daily for 12 weeks. Changes in the components of MetS were recorded. Changes in subcutaneous abdominal fat area (SAFA) and intra-abdominal fat area (IAFA) at the umbilicus level were determined using magnetic resonance imaging.ResultsA total of 30 men (mean age, 42.3 ± 10.0 years; body mass index, 33.7 ± 4.1 kg/m2) were included in this study. A moderate (8.0%) weight reduction occurred. Reversion of MetS was observed in 15 (50%) participants after the WRP. There was significant reduction in SAFA (68.3 ± 20.2 vs. 51.5 ± 18.6 cm2; P < 0.001) and IAFA (96.3 ± 15.6 vs. 86.0 ± 16.5 cm2; P < 0.001); the magnitude of reduction was greater for SAFA than for IAFA (−16.8 ± 7.7 vs. −10.3 ± 8.3 cm2; P < 0.001). Multivariate logistic regression analysis showed a reduction in IAFA to be an independent factor to decrease the risk of persistent MetS after WRP by adjustment for age, baseline IAFA, and change in SAFA (odds ratio = 0.25, 95% confidence interval: 0.07–0.95, P = 0.041). Reduction in SAFA was not significantly associated with the reversion of MetS (P = 0.411).ConclusionReduction in IAFA via a 12-week WRP may help reverse MetS in men with obesity and MetS.