Objective We aimed to study visfatin level in obesity and its relation with metabolic syndrome (MS).Patients and methods This case-control study included 42 obese children and adolescents and 39 age-matched and sex-matched nonobese children who served as controls. Full medical examination and anthropometric measurements were carried out. Fasting serum total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, blood sugar, insulin, and visfatin were measured. Homeostasis model assessment for insulin resistance (HOMA-IR) was calculated.Results Fasting serum visfatin level was significantly higher in obese children and adolescents compared with controls (8.7 ± 2.8 vs. 3.3 ± 2.3 ng/ml, P = 0.001). Visfatin showed significant positive correlations with waist circumference (P < 0.001), systolic blood pressure (P = 0.001), diastolic blood pressure (P = 0.01), and fasting blood glucose (P = 0.001). Visfatin was significantly higher in obese patients with MS than in patients without MS (10.03 ± 3.2 vs. 7.8 ± 2.2 ng/ml, P = 0.02).Conclusion Visfatin elevated in obese children. Visfatin might be used as a predictor test for the existence of MS in obese children.