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Use of Continuous Metabolic Syndrome Score in Overweight and Obese Children. OBJECTIVE: To assess the utility of continuous metabolic syndrome score (cMetS) for predicting metabolic syndrome (MS) and determine the cut-off values in overweight and obese children. METHODS: This study was conducted among 104 children (7-14 y) attending obesity clinics of a tertiary care hospital in Mumbai, India. The cMetS was computed by standardizing the residuals of waist circumference (WC), mean arterial blood pressure (MAP), high density lipoprotein cholesterol (HDL-C), triglycerides (TG), and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) by regressing them according to age and sex and aggregating them. The optimal cut-off of cMetS for predicting MS was determined by the receiver operation characteristic (ROC) curve analysis. RESULTS: The cMetS increased significantly with increase in the number of MS risk factors. It was significantly high in children with MS than those without it (boys: 1.070 + 1.834 vs. -1.478 + 2.262; girls: 2.092 + 1.963 vs. -2.253 + 2.140; combined children group: 1.572 + 1.950 vs. -1.907+ 2.374; p < 0.001). The score predicted MS with high accuracy in girls; (AUC of 0.95, 95% CI: 0.90-1.00), moderate accuracy in boys (AUC of 0.79, 95% CI: 0.65-0.92) and in the combined group (AUC of 0.87, 95% CI 0.80-0.94) respectively. The cut-off of cMetS yielding maximal sensitivity and specificity for predicting the MS was -1.009 in boys (sensitivity 93% and specificity 62%); -0.652 in girls (sensitivity 96.4% and specificity 77%) and - 0.6881 in the combined group (sensitivity 91.2% and specificity 70.2%). CONCLUSIONS: cMetS predicted MS with moderate to high accuracy. It had high sensitivity and specificity in predicting MS in overweight and obese children.