Background/Aims: Obesity is linked to metabolic complications, even in children, but the role of the distribution of adiposity is unclear. We aimed to assess which compartment of fat mass – total (TFM), visceral (VFM) or subcutaneous (SCFM) – is related to metabolic complications in overweight and obese children and adolescents. Design: Analyses were conducted in 159 overweight or obese children and adolescents (median body mass index 4.0 SD). TFM was measured by dual-energy x-ray absorptiometry. Distribution of abdominal fat was assessed by MRI. Insulin resistance (IR) was determined using a homeostatic model assessment. The definition of metabolic syndrome (MS) was derived from National Cholesterol Education Program ATP III. Results: A parental history of obesity was positively and significantly associated with fat content of the three compartments (TFM: β = 2.22; VFM: β = 0.17; SCFM: β = 0.12, respectively). VFM was also associated with gender (β = –0.29) and ethnicity (β = –0.54). TFM was a significant and independent determinant of IR (β = 0.02) whereas IR and VFM only were significantly related to MS (OR = 3.55 and 3.66 respectively). Conclusion: Our data indicate that even in overweight children VFM was influenced by several factors such as sex and ethnicity and that a relationship was evidenced between the amount of VFM and MS.