OBJECTIVE: This study aimed to examine the associations of longitudinal adiposity measures with two adipokines, leptin and adiponectin, and their ratio in children and adolescents. METHODS: A total of 953 children and adolescents participated in a 6-year longitudinal study. Body mass index (BMI), percentage body fat (%BF), and fat mass index (FMI) were used to assess adiposity status. RESULTS: After adjusting for possible confounders, our regression models revealed that BMI, %BF, and FMI, in both the baseline and follow-up surveys were independently associated with a higher level of leptin and the leptin/adiponectin ratio at the follow-up survey, whereas the significant association with adiponectin only partly existed in adiposity measures at the follow-up visit. Moreover, the longitudinal change in adiposity measures was found to be a significant predictor for follow-up plasma adipokine levels. Compared with the low-->low group, the medium-->medium group, up-trend group, and high-->high group all showed a significantly increased level of leptin and leptin/adiponectin ratio. The up-trend group and high-->high group also had significantly decreased adiponectin levels. CONCLUSIONS: These findings highlight the importance of adiposity surveillance and the utility of adipokines as biomarkers for adverse metabolic consequences of childhood adiposity.