Individuals with abdominal obesity have a higher cardiovascular risk, regardless of the degree of global overweight.

To estimate the accuracy of the Waist/height ratio (WtHR) as a risk marker for metabolic syndrome (MS) in children or adolescents.

Published cohort or cross‐sectional studies (Pubmed, Embase‐SCOPUS and CINAHL) were searched, with no limits of time. Studies providing Waist/height ratio and clustered criteria of metabolic syndrome were included.

Thirty‐one studies (66,912 subjects) were selected. Overall, a high WtHR (≥0.5) was associated with a four‐fold increased risk of clustered criteria of MS (odds ratio [OR] 4.15, 95% confidence interval [95% CI]: 2.69 to 6.42) and two‐fold increased risk when adjusted by general obesity (adjusted OR 2.26, 95% CI: 1.29 to 3.98). The WtHR, as a quantitative measure, showed a pooled area under the curve of 0.76 (95% CI: 0.71 to 0.80) and, as a dichotomous measure, with a cut‐off point close to 0.5, a sensitivity of 60% (95% CI: 50% to 68.8%) and a specificity of 79% (95% CI: 71.6% to 83.9%).

Measuring WtHR may be considered in regular health checks of children and adolescents, as it can measure cardiovascular risk regardless of the degree of general obesity.