Purpose:
The study aim was to verify if there were associations between performance-related physical fitness levels and the clustered cardiometabolic risk score among children and adolescents.

Methods:
The cross-sectional study involved 1200 (655 females) children and adolescents aged 7–17 years. Performancerelated physical fitness levels (upper limb strength [ULS], lower limb strength [LLS], agility, speed, and cardiorespiratory fitness [CRF]) were evaluated and categorized as healthy or unhealthy levels. Waist circumference, systolic blood pressure, glucose, and blood lipoprotein (triglycerides, total cholesterol, and high-density lipoprotein cholesterol) were measured. The clustered cardiometabolic risk score constituted the sum of internationally-derived standardized values (z-scores) for each risk factor divided by 5. Associations between performance-related physical fitness levels and the clustered cardiometabolic risk score were determined with linear regression models.

Results:
Participants with healthy ULS levels exhibited a less favourable clustered cardiometabolic risk score, whereas healthy levels of LLS, agility (only in girls), and CRF (only in boys) were related with a more favourable clustered cardiometabolic risk score. ULS (β: –0.091 [95% CI: –0.120; –0.062]), LLS (β: –0.272 [95% CI: –0.368; –0.177]), and CRF (β: –0.218 [95% CI: –0.324; –0.112]) were inversely associated with the clustered cardiometabolic risk score, while agility (β: 0.112 [95% CI: 0.082; 0.142]) and speed (β: 0.079 [95% CI: 0.039; 0.119]) demonstrated a positive association with the clustered cardiometabolic risk score.

Conclusions:
Our results emphasize the importance of following moderate-to-vigorous physical activity guidelines to better develop physical fitness levels for the maintenance of cardiometabolic health during childhood and adolescence.