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Introduction: Metabolic syndrome (MS) in children has been associated to subclinical atherosclerosis as estimated by carotid intima-media thickness (CIMT). Objectives: We aim to ascertain the influence of MS, insulin resistance (IR) and nutritional status on CIMT. Percentiles with an increased risk of CIMT were also explored. Methods: A cross-sectional study of 447 children attending public schools in Santiago, Chile, was performed during years 2009-2011. This sample was selected considering the presence of one or more MS component and IR. Anthropometry and BP were assessed. A blood sample for determination of glycemia, insulinemia and lipids was taken. CIMT was assessed using high resolution ultrasonography with automated software. Pearson correlation, Student's t-test, Chisquared test, and stepwise logistic regression were computed. Results: Mean age was 11.5 ± 1.0 years old (range 10- 14); 59% girls; 93% pubertal; 72% excess weight; 24% MS; and 15% IR. Mean values of MS components in children with CIMT ⩾ percentile 75 versus < percentile75 had differences for systolic BP or diastolic BP ⩾ percentile 90 (BP ⩾ percentile 90) and high density lipoproteins cholesterol ⩽ 40 mg/dL (CHDL ⩽ 40 mg/dL). The logistic regression for CIMT ⩾ percentile 75 only selected BP ⩾ percentile 90 and CHDL ⩽ 40 mg/dL. The logistic regression for CIMT ⩾ percentile 90 did not select independent variables. Conclusions: In this group of children BP ⩾ percentile 90 and CHDL ⩽ 40 mg/dL values were associated to CIMT ⩾ percentile 75. Influences of IR and nutritional status on CIMT were not found. [ABSTRACT FROM AUTHOR]