Abstract: Context Adults with cerebral palsy (CP) display a higher prevalence of cardiometabolic disease compared to the general population. Studies examining cardiometabolic disease risk in children with CP are limited. Purpose The purpose of this study was to determine if children with CP exhibit higher cardiometabolic risk than typically developing children, and to examine its relationship with visceral adiposity and physical activity. Methods Thirty ambulatory children with CP and 30 age-, sex-, and race-matched typically developing control children were tested for blood lipids, glucose, and the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Visceral fat was assessed using dual-energy X-ray absorptiometry. Physical activity was assessed using accelerometer-based monitors. Results Children with CP had higher total, low-density lipoprotein, and non-high-density lipoprotein (non-HDL-C) cholesterol, glucose, prevalence of dyslipidemia, prevalence of prediabetes, and visceral fat mass index (VFMI), and lower physical activity than controls (all p < 0.05). In the groups combined, non-HDL-C and glucose were positively related to VFMI (r = 0.337 and 0.313, respectively, p < 0.05), and non-HDL-C and HOMA-IR were negatively related to physical activity (r = -0.411 and -0.368, respectively, p < 0.05). HOMA-IR was positively related to VFMI in children with CP (r = 0.698, p < 0.05), but not in controls. Glucose was not related to physical activity in children with CP, but was negatively related in controls (r = -0.454, p < 0.05). Conclusions Children with CP demonstrate early signs of cardiometabolic disease, which are more closely related to increased visceral adiposity than decreased physical activity.