To determine whether the association of the ratio of waist to hip girth with cardiovascular risk factors exists in prepubertal children and pubertal youths, the ratio was related to blood pressure, serum cholesterol and serum uric acid levels in children and youths aged 6-17 yr in the Health Examination Survey. In these samples drawn from the United States population, the ratio declined with increasing age. Boys had consistently higher ratios than girls. Black-white differences were inconsistent. The ratio was lower in girls whose menstrual periods had started at each age after 10. The ratio was significantly associated with systolic blood pressure in youths and with diastolic blood pressure in children independent of confounders. It was also significantly associated with serum uric acid but not serum cholesterol independent of confounders among youths. Longitudinal studies are needed of greater abdominal relative to lower body fat deposits in children and youths and risk of cardiovascular disease in adulthood.