Paediatric obesity has significant physic, social and psychological implications. Childhood obesity is usually associated in adulthood with increased risk of type 2 diabetes, metabolic syndrome and cardiovascular diseases. Aggregation of cardiometabolic risk factors is already observed at young ages, with a nonlinear association with enhancement of adiposity. Adiponectin is an adipokine that inhibits inflammation, oxidative stress and metabolic syndrome components, namely dyslipidaemia, high blood pressure and insulin resistance. Obesity has been associated with hypoadiponectinaemia in both adult and paediatric patients, which may contribute to co-morbidities observed in these patients. Interventional studies that aim to tackle obesity reported controversial results. Although the general positive effect on weight loss, inflammatory and cardiometabolic markers has been studied, the impact of these interventional studies on adiponectin remains unclear. Some studies reported that the improvement in adiponectin might only occur in paediatric obese patients with great weight loss or intensive physical exercise; the magnitude of the changes in body composition appears to be of particular importance. A revision about the knowledge on the relation between adiponectin, inflammation and cardiometabolic risk factors in paediatric patients is performed; the impact of interventional studies on adiponectin levels and markers of cardiometabolic risk is also addressed.