BackgroundWaist circumference (WC) is an indicator of adiposity; particularly visceral fat, cardiometabolic risk factors and related morbidity. The aim of this study was to determine the attribution of WC to increased carotid intima-media thickness (cIMT) and circulating levels of inflammation and endothelial dysfunction in schoolchildren. MethodsA total of 122 children (61 boys and 61 girls) aged 10–15 years were distributed into three groups: (i) the lower smoothed sex- and age-specific WC (LWC) group (ii) the middle smoothed sex- and age-specific WC (MWC) group, and (iii) the higher smoothed sex- and age-specific WC (HWC) group. Measurements of cIMT using high-resolution B-mode ultrasound, lipemic profile, blood pressure, serum proinflammatory cytokines and soluble adhesion molecules were performed. ResultsMean measured values in the HWC and/or MWC groups showed significantly higher values (p ≤ 0.05) of cIMT (mm), total cholesterol, triglycerides, low-density lipoprotein (LDL), blood pressure, interlukien-6 (IL-6), and interlukien-1 beta (IL-1β), vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1(ICAM-1) and E-selectin, and significantly lower values of high-density lipoprotein (HDL) as compared to the LWC group. Using multiple linear regression analysis of WC-SDS adjusted for BMI-SDS with the studied subclinical atherosclerosis risk, WC-SDS was significantly (p ≤ 0.05) associated with the variation in HDL (R2 = −0.12), LDL (R2 = 0.36), IL-6 (R2 = 0.26), and VCAM-1 (R2 = 0.26). ConclusionsHigher WC is positively associated with atherosclerosis risk factors including increased cIMT, a state of dyslipidemia, higher blood pressure and circulating levels of inflammation and adhesion molecules among schoolchildren. Waist circumference seems to be useful for the prediction of subclinical atherosclerosis in schoolchildren.