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The association between cardiorespiratory fitness and cardiometabolic risk in children is mediated by abdominal adiposity: the HAPPY studyBackground: It is unclear whether cardiorespiratory fitness (CRF) is independently linked to cardiometabolic risk in children. This study investigated a) the association between CRF level and presence of cardiometabolic risk disorders using health-related cut points, and b) whether these associations were mediated by abdominal adiposity in children. Methods: This was a cross-sectional design study. Anthropometry, biochemical parameters and CRF were assessed in 147 schoolchildren (75 girls) aged 10-14 years. CRF was determined using a maximal cycle ergometer test. Children were classified as ‘fit’ or ‘unfit’ according to published thresholds. Logistic regression was used to investigate the odds of having individual and clustered cardiometabolic risk factors according to CRF level and whether abdominal adiposity mediated these associations. Results: Children classified as unfit had increased odds of presenting individual and clustered cardiometabolic risk factors (p < 0.05), but these associations no longer remained after adjusting for abdominal adiposity (p > 0.05). Conclusions: This study suggests that the association between CRF and cardiometabolic risk is mediated by abdominal adiposity in 10-14 year-old children and that abdominal adiposity may be a more important determinant of adverse cardiometabolic health in this age group.