## 1 Introduction  
Weight excess has been one of the largest public health problems of modern society for decades and, in the obesogenic context of the COVID-19 pandemic, obesity has been affecting children at rates faster than we have ever encountered before [1]. In many countries, not only are the lockdown conditions, which increased sedentary behavior, to blame, but also the worsening of financial status, which has led to reduced access to qualitative foods and more stress within families [2]. The importance of a comprehensive evaluation of obesity in children is of paramount importance for early detection of cardiovascular and metabolic complications. Atherosclerosis and high blood pressure, frequent complications of obesity, are slow but steady ongoing processes in obese children, manifesting in adolescence and early adulthood, depending on the severity of the weight excess [3]. Increased carotid intima-media thickness (CIMT) is one of the first observable signs of subclinical atherosclerosis, making this ultrasonographic technique probably the most accurate non-invasive method of detecting early stages of atherosclerosis. For a long time, in children, these early stages have been ordinarily estimated by monitoring the lipid and glucose metabolism alterations (lipid profile, fasting glucose levels, oral glucose tolerance tests, serum insulin, blood pressure values, etc.). Lately, cardiovascular risk has been proven to be well and reliably assessed through imaging technologies in pediatric patients as well [4]. [PERSON] et al. showed that blood parameters that are classically assessed in obese children are significantly correlated to CIMT [5]. Therefore, studies estimate that the use of CIMT, a non-invasive, non-painful, non-radiating, cost-effective, and easily reproducible method, can become one of the pillars of risk evaluation for pediatric patients at risk. Nevertheless, the value of CIMT in children as a predictor of risk is still a subject of research. Although cut-off points for CIMT are still a subject of discussion, there is significant evidence that its values reach higher points in children with obesity. According to [PERSON] et al., both in metabolically healthy and unhealthy obese children, CIMT reaches higher values. The same study showed that early detection of high CIMT in children with metabolic syndrome is a predictor of cardiovascular disease in young adults [6]. Hence, one of the goals of the present study, other than assessing CIMT in relation to obesity, is to evaluate some of the other risks associated with higher CIMT in children, and their effect on the vascular thickness when associated with obesity. Most of the risk factors we have analyzed are already set in stone as aggravating factors of cardiometabolic disease in adults and many are on the way to being settled for the pediatric population as well. Advancing age, masculine sex, and high BMI are three factors known to have a direct impact on CIMT values in both children and adults [7; 8; 9]. However, risks associated with pregnancy, mother's health, perinatal aspects regarding weight or nutrition, family history of cardiometabolic disease, exposure to smoking, high values for blood pressure, and a lack of physical activity on daily basis may also be risks that can impact vascular integrity or worsen the atherosclerotic progression. Previous studies place postnatal nutrition in a stronghold regarding breastfeeding's universal protective characteristics, on the condition that it not be too prolonged [10; 11]. There is evidence that artificial milk is associated with obesity, higher CIMT values, arterial hypertension, and insulin resistance [12; 13; 14; 15]. Data on birth weight as a risk factor for increased CIMT show that low birth for gestational age is the most prominent risk, and the more severe the weight deficit is, the more powerful the risk [16]. On the other side of the spectrum, higher than normal birth weight is also a risk factor for high CIMT in young adult life [17].