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We aimed to study visfatin level in obesity and its relation with metabolic syndrome (MS).This case–control study included 42 obese children and adolescents and 39 age-matched and sex-matched nonobese children who served as controls. Full medical examination and anthropometric measurements were carried out. Fasting serum total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, blood sugar, insulin, and visfatin were measured. Homeostasis model assessment for insulin resistance (HOMA-IR) was calculated.Fasting serum visfatin level was significantly higher in obese children and adolescents compared with controls (8.7±2.8 vs. 3.3±2.3 ng/ml, P=0.001). Visfatin showed significant positive correlations with waist circumference (P<0.001), systolic blood pressure (P=0.001), diastolic blood pressure (P=0.01), and fasting blood glucose (P=0.001). Visfatin was significantly higher in obese patients with MS than in patients without MS (10.03±3.2 vs. 7.8±2.2 ng/ml, P=0.02).Visfatin elevated in obese children. Visfatin might be used as a predictor test for the existence of MS in obese children.