CONTEXT: Central adiposity is associated with cardiovascular risk independently of total adiposity. Microvascular dysfunction is thought to contribute to obesity-associated insulin resistance and hypertension and may thus link central adiposity with cardiovascular risk. OBJECTIVE: Our objective was to investigate how body fat distribution relates to microvascular function and the role of adipocytokines in these relationships. DESIGN, SETTING, AND PARTICIPANTS: We cross-sectionally studied 51 healthy adults and 29 of their prepubertal children born at the VU University Medical Center in Amsterdam. MAIN OUTCOME MEASURES: We measured visceral and abdominal sc adiposity with magnetic resonance imaging and truncal and peripheral sc adiposity with skinfold thickness. Postocclusive skin capillary recruitment was assessed with videomicroscopy. Concentrations of C-reactive protein, IL-6, and TNF-alpha were combined in an inflammation score. RESULTS: In adults, visceral adipose tissue and trunk/extremity skinfold ratio were inversely associated with capillary recruitment (partial correlation coefficients, -0.32, P = 0.03, and -0.37, P < 0.01, respectively). The inflammation score was inversely associated with capillary recruitment (r = -0.50; P < 0.01) and statistically explained 41% of the association between visceral adipose tissue and capillary recruitment. In children, trunk/extremity skinfold ratio was inversely associated with capillary recruitment (r = -0.49; P = 0.01), but other measures of adiposity were not. CONCLUSION: Our data in adults suggest a role for visceral adiposity and its associated proinflammatory state in capillary dysfunction and its possible sequelae such as hypertension and insulin resistance. Also, our findings in children and adults suggest that truncal sc adiposity is detrimental for capillary perfusion and that this process may start before puberty.