**1. Introduction**

The increasing prevalence of overweight and obesity, key components of the metabolic syndrome (MetS), in the pediatric and adult population poses a high risk of health complications and is associated with social and economic consequences.

According to the World Health Organization (WHO), the worldwide overall prevalence of obesity has nearly tripled since 1975. In 2016, 39% of adults aged 18 years and over were overweight and 13% were obese. However, among children and adolescents aged 5 to 19, the prevalence of overweight and obesity has risen even more dramatically: overweight increased from just 4% in 1975 to over 18% in 2016, while obesity increased from under 1% in 1975, to 6% in girls and 8% in boys. This is equivalent to more than 340 million overweight and 124 million obese children and adolescents worldwide in 2016 [1].

Obesity is associated with a high incidence of well-known cardiovascular (CV) risk factors such as dyslipidemia, hypertension (HTN) and diabetes. Numerous studies have shown the existence of a CV continuum, in which pathological processes begin as a result of various risk factors and lead to permanent changes and CV complications through endothelial damage, vascular and myocardial remodeling, and atherosclerotic processes. These changes may begin in early childhood and over time significantly increase the CV risk in young adults. This is of even greater concern in patients with already otherwise increased CV risk, e.g., in patients with chronic kidney disease (CKD), in whom the influence of classical and uremic risk factors is cumulative. The question arises, whether in the pediatric population early intervention in obesity will reduce the future CV risk in adulthood.

In this review we will discuss the importance of an early diagnosis and effective treatment of childhood obesity and the linked early and potentially reversible cardiovascular damage in children and adolescents to prevent CV complications, which remain the main cause of morbidity and mortality in the general population.
