BACKGROUND: Acanthosis nigricans (AN) is a common finding often associated with hyperinsulinemia and childhood obesity. There has been a lack of studies evaluating the association of AN with underlying cardio-metabolic risk factors in children and adolescents. Our objective was to study the association between AN and cardio-metabolic risk factors in children with overweight/obesity. METHODS: This cross-sectional study included school-going children (6-16 years of age) with overweight/obesity. Physical examination, anthropometry, and blood pressure (BP) data were collected. Fasting blood samples were collected to measure insulin, glucose, homeostasis model assessment index (HOMAIR), and lipid profile. RESULTS: Of 1930 children screened, 545 had overweight/obesity, and were included. Boys to girls ratio was 1.27. AN was present in 46.4% of children. Children with AN had higher body mass index [BMI] ( CONCLUSIONS: Children with overweight/obesity who have AN have significant elevations of BP, insulin level, and HOMA-IR. AN is a clinical marker that seems to be associated with cardio-metabolic risk factors in children with overweight/obesity in the given study population.